Happy in Houston (a bit long)

Hi,

I'm a new user and am new to all things CPAP, but wanted to share my story. Firstly I'd like to thank the members of this site - without the knowledge that I gleaned from these pages, I may not have been able to get the service that I wanted - so thanks!

I've been an insomniac for about 20 odd years, but had never really done anything about it - I just saw it as a fact of life, slept when I could, and read when I couldn't, no big deal. This changed in June when I suffered a cerebellar stroke. I am told that I was way too young to have a stroke of any kind (was 44 at the time), and was not even slightly overweight. I do however have coronary heart disease and so was on meds to keep my BP and Cholesterol levels down, which they were, all within normal limits, but have a stroke I did. Oh well.

It's been an interesting few months to say the least, didn't work for 3 months, but am very fortunate that my employer who would have been fine with me taking 6 months before I started work again. I returned to work after 3 months however (against doctors orders), because the temporary disability insurance stopped, and I would have had to spend the remaining 3 or so months on unpaid sabbatical. I am also fortunate that I work at home, so it wasn't too hard to start working again initially half days. I have now been working full-time again for about a month.

My rehab Dr. on hearing that I was an insomniac insisted that I undertake a sleep study - it seems that sleep-deprivation can raise the risk of a stroke, and since I had already had one, my risk was already increased.

To make a long story short, I was diagnosed with mild sleep-apnea, and titrated for therapy at 9 cm of water pressure. Then the fun started.

I learned here that it may be a good idea to push for an auto machine, since my insurance provider (BCBS) will only pay for one machine every 5 years. I first called CPAP.com and they were willing to help, although not "in-network" - I called BCBS and they said that they would not re-imburse the full whack if I went out of network.Turns out few if any online providers are "in-network". I asked BCBS for a list of providers in Houston that were in Network, they sent me a list.

I first called Lincare, and faxed them copies of my sleep study and everything that was needed, and they came back saying they would provide me with a CPAP machine (not an APAP) as that is what my prescription specified. I then called the sleep-study folks (Methodist), and they happily amended the prescription to please provide me with an APAP machine.

Lincare refused to do this because the sleep-study and script stated a single pressure of 9. I told them that yes, initially my therapy was going to be at a continuous pressure of 9, but would be changed to n Auto range sometime over the next 5 years. They still refused to provide me with an APAP despite what it now said on the script, because it did not specify a range. After a lot of back and forth, I told them to destroy my records and that I would take my business elsewhere.

I then called Aerocare - gave them my schpiel, and was told pretty much the same thing that Lincare told me - no range of pressures on the script, no APAP. I realise why they do it, as they receive the same money from the insurance co whether its a CPAP or an APAP, but I was not willing to settle for aCPAP given that I will have it for 5 years - or pay for a new machine out of my own pocket - I pay for insurance so that I don't have to do that.

I then decided to call Memorial Hermann, as they were also on the list, and I expected that they would have a more sensible attitude towards my case, they knew my sleep Doctor, and their attitude was much better than either of the DME's I had called. I told them exactly why I wanted an APAP, and they understood perfectly. The technician is coming out on Monday to fit me with the machine that I requested - A Philips PR System One REMstar Auto CPAP and humidifier.

I would recommend anyone use their services, certainly over the 2 DME's that I tried prior to choosing them.

Good for you!
You are off to a great start!
Welcome.

Welcome to the world of CPAP. I have had my machine for a month exactly today. Glad to hear you didn't give up until you got what you wanted. I assume you have the PPO with BCBS. I still need to call them to see exactly what they cover. Not sure if I will be sticking with my provider. I wasn't given a choice of where to get my machine\mask from. After many of the things I have read on here thing some things don't add up in my experience. I agree that this site is such a wealth of knowledge and appreciate the people for sharing it.

Good luck with your treatment.

Excellent self-advocacy there!

The PR S1 Auto is a great machine--I have that one myself. You will want to purchase the Encore Viewer 2.0 software so that you can see detailed reports of your data--our hosts at CPAP.com have it for $99.

Say "hi" to Houston for me! I went to Texas Woman's University for my undergraduate degree and attended classes and lived on campus right nextdoor to Methodist Hospital. It was an exciting place to be.

Janknitz wrote: You will want to purchase the Encore Viewer 2.0 software so that you can see detailed reports of your data--our hosts at CPAP.com have it for $99.

They are quick with the shipping too. I ordered mine Saturday or Sunday night, got free 2 day FedEx shipping and it's waiting on my porch right now.

Good for you!! Persistence is the key here
I have the same machine, get the software if you can. It will help you monitor your therapy, and there are a lot of people here who can help.

TL

Ubik, do you have a sleep doc you like? If so, who is it?

hi there..
good for you, got yourself a very nice auto indeed..

I think you are going to love the algarithm of that machine..

heres to many restfull nights sleep ahead for you..

elena

Thanks all! Appreciate the comments and feedback.

@ danimal71 - Yep, my insurance is BCBS PPO. It seems that they lease the equipment for the DME for a year and then consider it purchased. If I understand it correctly, they pay the DME $250 a month for 12 months. I've met my deductible for 2010, so won't start paying my 10% until January, and then only for 10 months, so my total out of pocket should be $250, which I can certainly live with. I'm supposed to be able to get supplies (I presume that means filters) renewed every 3 months.

@Jaknitz - Houston may have one or two faults, but I love living here - and being near the Med-center is great if you need to get your tires kicked every now and then by doctors!

@SleepingUgly I haven't met my sleep doctor yet, I have an appointment with her, but my work schedule is a bit messed up at the moment so it will probably be in a couple of weeks. I can say that the Methodist Sleep Centre has been excellent, my sleep-studies were well handled - and the responses from the Doctor through the assistants has been great. Will PM you the doctors name.

I will be purchasing the software too, so thanks all who mentioned it - I will wait until after Monday though when they deliver the gear. I've been assured that I'm getting what I requested, but I want to be 100% sure.

Good Job! You didn't mention what mask they're bringing you? Make sure it's fitted lying down with the pressure on and that it feels comfortable when turning from side to side. Masks are also considered supplies so find out how often you're entitled to a replacement. Keep us posted and good luck.

Ubik,

Sounds like you and I had similar situations. I got my equipment before I saw the Dr too. I think I paid the same amount ($250...they changed my wife's insurance deductible schedule so we just restarted when I got mine). I was told that the $250 was all I had to pay and that the machine was mine to keep. I was told replacement parts every 3 months and new mask every 6. I'm haven't been impressed with my DME or Dr so far. Good to hear you have had good luck with both.

DoriC wrote:Good Job! You didn't mention what mask they're bringing you? Make sure it's fitted lying down with the pressure on and that it feels comfortable when turning from side to side. Masks are also considered supplies so find out how often you're entitled to a replacement. Keep us posted and good luck.

Thanks!

I'm getting the mask that we arrived at during my sleep test. I tried a number of them, but found "nose only" masks to be very comfortable but they didn't work well. I broke my nose playing Rugby as a kid and my right nostril is very narrow, even a slight amount of congestion makes it pretty much impossible to breath through my nose. We tried several.

We then tried a full-face mask which I found to be very comfortable, and it did not seem to hamper my sleep at all - so I'll be getting a Resmed Mirage Quattro in medium, the same as the one I used during the test. I didn't know that masks were also considered supplies, so thanks for that! I can get supplies every 3 months on the insurance. There may well be better masks out there for me, but I found the one I tested with to be pretty good.

On issue I have noticed with any of the masks is reading. I read for 30 - 60 minutes prior to falling asleep - it's very hard to read wearing a mask!

danimal71 wrote:Ubik,

Sounds like you and I had similar situations. I got my equipment before I saw the Dr too. I think I paid the same amount ($250...they changed my wife's insurance deductible schedule so we just restarted when I got mine). I was told that the $250 was all I had to pay and that the machine was mine to keep. I was told replacement parts every 3 months and new mask every 6. I'm haven't been impressed with my DME or Dr so far. Good to hear you have had good luck with both.

DME's and Sleep doctors are very hit and miss it seems. I was glad that I could use a Hospital (Memorial Hermann) as my DME, as I had had no luck whatsoever with the couple of DME's that I first tried. I am very happy indeed with the Sleep Clinic so far (Methodist Neurological Institute).

Of course, I haven't received my equipment yet, so will withhold final judgement on Mem. Hrm. until then!