Perscriptions for CPAP Machines?

Slinky has a sad but true point about the insurance. Maybe one of the basic problems in medicine. Can't see the forest for the trees.

I worked most of my life at probably the best hospital in the world. Had my hands into both clinical and business. I remember once (early on) saying at a meeting of the suits that they could save a million dollars a year in patient care by hiring a $30k technician. The concensus was that the hospital would (1) lose its 3 percent profit on the million (from insurance), and (2) lose the 30k for the tech -- net loss 60k.

Not their worry -- they thanked the academic for his input and moved on. Of course this would have saved the insurance companies the million and maybe even improve patient care. The insurance companies just raise their premiums to cover the charges. The patients have no options but to pay.

I wonder what the cost/benefit would be for more open OSA screening. How many lives would be saved or improved versus how many people would get hurt or actually die from the air machine? In initial screening how many people could get hurt from an auto machine set to 2-4 cm just picking up baseline AI ane HI data? I wonder.

How much would asprins cost if they required a prescription?

AMEN, RestedGal!!! Right on as usual! Sleeptech010110, I hope you continue to monitor here with an open mind. You can learn a lot about "this side of the fence" 'cause sooner or later you are going to encounter more than one of "our type" of patient. And frankly, we really do appreciate those RPSGTs and RTs who do drop in occasionally and share their expertise and knowledge w/us. At least most of them we do.

Slinky wrote:Well, keep in mind that too high a pressure can cause central apneas and too high a leak can cause a high reported pressure.

And someone w/an undisclosed lung problem such as blebs could be harmed by CPAP pressure, especially the higher pressures.

And there are those few w/some form of inner ear problem that CPAP pressure can harm and even cause permanent hearing loss.

And then there are all those other sleep disorders that CPAP can't compensate for and APAPs can't detect or Dx ....

Medicare seems to be contemplating a decent compromise: at home sleep study, if indicated an APAP for 3 months, if still problems a full in-lab sleep evaluation or titration. That's simplified but gives you an idea of what they have up their sleeve.

Just keep in mind, once xPAPs aren't a script item, it won't be long and there won't be insurance coverage for them either - and if you think that is going to bring the price down .... even cpap.com's prices would be tough for many to come up with. And it can be dang expensive, even w/cpap.com's insurance, to go thru several masks to find the right one. Be careful what you wish for!!!

Great points, all. But...

I wouldn't necessarily advocate removing the prescription entirely, but can't your primary physician tell you something about the above complications? I mean, is a multi-thousand dollar sleep study the only way to know if you are going to be helped or harmed? But I also agree with the other comments that with the insurance MOST of us probably have these days, the out of pocket costs for a "covered" machine are more than an outright purchase, so it wouldn't necessarily hurt at all.

SleepFast you raised some good questions.

I have around a half of a dozen CPAP users on my father's side of the family and I think not being treated lead to his heart damage that killed him in the end.

I was falling asleep at the keyboard, in meetings and one on one conversations. Family and and company demands were crushing in a financial sense and I knew I was going down like a shooting star. My sister got one but her sleep study was a total failure as in no usable data because she fought it and never went to sleep. They just sent her home with a CPAP set at 9 per the SWAG method. Being a long term beleiver in the SWAG method I was fine to use it for setting my CPAP machine.

So in light of that and having a medical background I just purchased some Remstar units and did my own research. I started at 9 which was the setting the first owner of the CPAP and my sister's setting. To tweak the setting I used the kids who in the past would come into the bedroom and wake me. I told them to wake me if they heard me snoring. A setting of 11 worked for the most part but did not always control the snoring. 12 did and stopping the leaking was doable with a little practice. I did buy the meter to check that the CPAP setting was giving the displayed value as its output.

My $300 solution worked well for 4.5 years. I was 53 at the time and had not other health risks and would not advice others to treat themselves or not treat themselves. Because my sister had insurance they sent her home with a CPAP machine with NO sleep study data so I knew by that NOT having a sleep study first was NOT a technical requirement to getting a CPAP machine.

I know of one case where a person was near death and on oxygen so he needed all of the professional help he could get. He as not physically able to go do a sleep study so as I think about it they must to have SWAG'ed it with him too.

4.5 years later I am a better father and husband and the company is better managed than ever because when I started getting some rest it became clear things were in a mess so I hired some management with a degree and the lady I hired as our business manager 3 months after getting my CPAP machine is now the president of the company and I spend more time using the CPAP machine.

SleepFast wrote:How much would asprins cost if they required a prescription?

Sleepfast, I can answer that. I have gut issues and 90% of the fillers used in OTC meds are anathema to me. If I try to take ordinary OTC acetaminophen (500 mg), I'll spend about the next 6-8 hours on the toilet.

To get compounded acetaminophen -- just acetaminophen in gelatin caps -- costs a $30 set up fee and around $1.50 a capsule. Because they have to be hand measured and filled.

Other prescriptions can cost even more.

I diagnosed, and have treated my own sleep apnea since 2004. I am an RN/Paramedic, with lots of experience in my field. I quit dreaming, got 5x a night to pee, and started nodding while driving. Bought a used CPAP off ebay on a hunch, got a full FM and set the pressure to 10, and took a 4 hour nap. Bestf***in sleep I ever had in my life. Every muscle in my body was completely relaxed when i woke up. It took nearly a year or more to completely repay the sleep debt. Wife loves it, doesnt worry about me snoring anymore. I dont even take a nap without it, unless I am nodding in the recliner. I dont recommend everyone to go this route, My Doc laughed at me when I told him what I did, was uninsured at the time. Don't plan on having a formal sleep study done any time soon, I'm taking just fine care of it myself.

WTG, John!

My story:

viewtopic.php?p=5977#5977
http://www.apneasupport.org/viewtopic.php?p=2332
http://www.apneasupport.org/viewtopic.php?p=7956

Your best bet is to get a prescription and have your local DME set up the machine and instruct you on it.

Guest wrote:Your best bet is to get a prescription and have your local DME set up the machine and instruct you on it.

You still around?
I was beginning to worry about you. You OK?

Take care.

Den

Ahh, thedean, it has been rather quiet w/o your input.

Yup, the IDEAL is a full PSG and titration at a top quality accredited sleep facility thoroughly gone over by an excellent certified, accredited sleep specialist doctor, who AFTER a thorough consultation and discussion of your results writes a script for a fully data capable CPAP which is provided by a knowledgeable, caring, local DME who understands and supports the equipment they provide and the importance of a comfortable fitting, leak free mask AND the necessary education, support and advice they claim they need to be paid for by their considerably high prices for equipment.

HOWEVER, thedean, not everyone has the insurance, the money or the access to a decent sleep lab, decent sleep doctor and decent local DME supplier. Under those conditions other alternatives have to be considered and we do what we have to do as best we can.

Slinky wrote:HOWEVER, thedean, not everyone has the insurance, the money or the access to a decent sleep lab, decent sleep doctor and decent local DME supplier. Under those conditions other alternatives have to be considered and we do what we have to do as best we can.

AMEN, Slinky!!! Right on as usual!

Slinky, that was perfect.

O.

SleepFast wrote:I wonder what the cost/benefit would be for more open OSA screening. How many lives would be saved or improved versus how many people would get hurt or actually die from the air machine? In initial screening how many people could get hurt from an auto machine set to 2-4 cm just picking up baseline AI ane HI data? I wonder.

You nail it. The issue becomes if you have something besides OSA, because at that point APAP either doesn't pick it up - or can make it worse. Considering the insane amount of people who have undetected OSA (80-90%) and the massive medical expenditures down the road on them, you'd save an awful lot more lives than you would lose. That wouldn't work very well for those who lost their lives, but on a societal basis it's why there's got to be some way to improve screening since the benefits are immense - but I'll leave it for those far more educated to explain this part.

What about the reading glasses on can pick up at Wal-Mart off a display even in the bifocal style. What if they have diabetic changes taking place in the retina and because they did not go to see the OD and they go blind?

With 90% of CPAP machines setting in closets tonight what are the real chances of CPAP use abuse by the masses.

Heck they could sell them at WM next to the reading glasses and who could pack on home and use it?

As a person with a health care background I do understand the need to manage health care options but those of us who self treat are not totally in the dark.

The wall of hassle (maybe it is needed) will prevent 95% of those in need of treatment to be doomed to die early and run up huge medical bills on the tax payers backs in many cases just from stroke and heart attacks to say nothing about those who loose their jobs or create a car crash because they feel asleep.

As always there is two sides to every story.

Slinky wrote:AHOWEVER, thedean, not everyone has the insurance, the money or the access to a decent sleep lab, decent sleep doctor and decent local DME supplier. Under those conditions other alternatives have to be considered and we do what we have to do as best we can.

Amen to that!!

See my post over on the BCBCIL rip-off thread...

viewtopic/t38476/Insurance-company-take ... CBSIL.html