Went to see Sleep doc today.

My sleep doc is a trained Neurologist as well and uses sleep apnea equipment himself. He said he has tried a lot of the machines and masks out there. When I keep my mouth closed I learn a lot.

I told him I did not want to spend months without knowing the data from my sleep treatment and was thinking of borrowing enough money from relatives to get a Resmed S9 Auto Set, because I could more easily get reports.

Doc replied: I would not longer have to wait a year. Medicare patients must see sleep doc twice a year, or Medicare will drop paying for sleep treatment, DME and such. Medicare reimbursement to doctors is now like 37% of what it used to be. I can really believe it when the doc says he must see real paying patients to get enough money to see we Medicare patients. I thought it was probably not profitable before the cut, for the sleep doc to see me.

He said that the Respironics M series Auto with Aflex that I now have actually gave him more information than the S9 Auto Set would. he had used the S9 and thought it was a good machine, well made. Resmed was a good manufacturer, praise Resmed this, praise S9 that, praise. He also liked Respironics machines, and liked the greater amount of data provided to him by Respironics machines. However, Respironics uses a web based program to get data off machines, and they will make that program available to only DME's and Sleep Clinics, not me. I said, so if I was getting a machine he would recommend a Respironics machine, he said, probably. (I knew he meant a newer model Respironics.) He said he would work with whatever choice I made in terms of machine and would provide a script for whatever machine I wanted.

DeVilbiss has a new FFM mask out, Hans Rudolph V2, which I will try out when my DME gets one for me.

He said that it is now thought that adults do best when they get 7 1/2 to ____(I forgot) those who get less or more do not do as well and are more prone to heart attack, stroke, problems, and that one some days it appeared I slept a bit on the long side of the narrow window of optimum sleep, else all was going well.

Some of this I had to paraphrase, if some of you know a better way to state something, please do. Blame my flakey memory, I doubt the doc is ever wrong.

purple, you are lucky to have a sleep doc who has sleep apnea himself. It also sounds as though he is willing to work with you on the type of machine you get.

Yeah I have a whole group of great docs, including those who originally did my diagnosis and treatment. I suspect that everyone had had the same quality of care I have gotten, then the only thing we would use this forum for would be to socialize. A lot of folks here have had a difficult time. Just the difficulty of learning how to get the mask adjusted every night is hard enough.

Given the amount of difficulty of getting $1200 from my relatives, and the relatively good numbers, I probably will not get another machine.

I am unhappy that companies make it difficult to do something that I feel should be easy, that is, I should easily be able to see all my info whenever I want. This treatment is too important to only see it every few months. There is the other argument, I really do not understand what I am looking at. Plus, is it not obvious, I am thinking of altering the settings of my machines when I think it would benefit me. That is, the point of the manufacturers is I do not understand the consequences of altering the setting, or even how to dependably alter the settings, and therefore I should not.

I had hoped for someone who has experience with these things, would come along and write the S9 has all the Data the Respironics is reputed to have. My doc must be using an old Resmed program for some reason.

Purple, you do have a good doc, but I think he is misinformed on a few things:

He said that the Respironics M series Auto with Aflex that I now have actually gave him more information than the S9 Auto Set would.

Not true. The S9 autoset has MORE info than the Series M Auto, including wave form data with the software. PLUS, you can see a lot of your data right on the screen, instead of always having to download the card.

However, Respironics uses a web based program to get data off machines, and they will make that program available to only DME's and Sleep Clinics, not me

. Also not true. Respironics sells Encore Viewer software (you can buy it from our hosts at CPAP.com) specifically marketed for CPAP users and you can download detailed data reports with that. Plus, there's a member who has written a web-based program called Onkor--free to forum members.

Finally, you don't have to spend $1200 for a good machine. Check the prices online if you want to buy new, or you can look at cpapauction.com (run by our hosts), secondwind.com, Craigslist, etc. You must have a prescription except from Craigslist, so be sure to ask your doctor for one. You should be able to pick up a new or nearly new ResMed S9 auto or Philips Respironics System One auto with huidifier for around $600, maybe less.

Janknitz wrote:Purple, you do have a good doc, but I think he is misinformed on a few things:

purple wrote:He said that the Respironics M series Auto with Aflex that I now have actually gave him more information than the S9 Auto Set would.

Not true. The S9 autoset has MORE info than the Series M Auto, including wave form data with the software. PLUS, you can see a lot of your data right on the screen, instead of always having to download the card.

Right. And...the data you can see on the screen is much more informative (imho) with a ResMed machine than with any Respironics machine, including the newest Philips Respironics System One machines. With the ResMed S8 or S9 you can see easily see "last night's" results -- Respironics and PR1 don't offer just "last night" in their results. Furthermore, in the results shown in the little window, ResMed shows not only the AHI, but also breaks the AHI down into AI and other indices. Respironics and PR1 give the AHI but don't break it down to let you see what just the AI is.

purple wrote: However, Respironics uses a web based program to get data off machines, and they will make that program available to only DME's and Sleep Clinics, not me

. They do have a web based program called Encore Anywhere. But that's not the only way to get full detailed data from your machine, purple. As Jan correctly points out:

Janknitz wrote: Respironics sells Encore Viewer software (you can buy it from our hosts at CPAP.com) specifically marketed for CPAP users and you can download detailed data reports with that.

Exactly.

Janknitz wrote: Finally, you don't have to spend $1200 for a good machine. Check the prices online if you want to buy new, or you can look at cpapauction.com (run by our hosts), secondwind.com, Craigslist, etc. You must have a prescription except from Craigslist, so be sure to ask your doctor for one. You should be able to pick up a new or nearly new ResMed S9 auto or Philips Respironics System One auto with huidifier for around $600, maybe less.

Right, again.

Well, I am not sure, but, If I buy a new machine, then while Medicare did not pay for it, Medicare might replace it if it is broken, after the five years on my current type M Remstar Auto is up. It is now at three years.

If I was only going to use the same machine I have now, I could buy a used one of CPAP Auction, or Secondwind for like 300 or 350. However, I wanted more data.

I am also concerned with two other points.

Medicare coverage may disappear by next year. Or my deductibles and co-pays reach the point where even with the aid of Medicare, I might not be able to afford a new machine unless I get swap it for my car. I have a Toyota, and everyone in my family are thinking they need a second economy car now.

As the US dollar weakens, and these machines, (I think) are manufactured outside the US, then a price of a similar machine maybe over two grand next year and higher the year after when my five years are up. Of course more used ones will be available then, as people give up their machines because of financial desperation.

I would not suggest options when I try to get money from relatives, as they will simply say, we will handle it if it comes up. Or tell me to buy something not as useful to me that is used. IE, the cheapest option possible. My family issues may seem off my start, but in the end. I may need a better argument than my feeling that I need that data more often. They will say, "Oh just do what the doc says."

So I need to be precise in exactly what I will gain from a new machine.

I only know what I was told today. ????

Do you get masks paid for by Medicare? Because that would seem to be the issue.

Might be because I changed zone of country and to a different sleep doc that I have only seen once.

While my machine is three years old, Medicare lists it as being only since I got into this zone of Medicare coverage (by the fact Texas is like 900 miles from Utah). Might be Medicare in Texas also lists me as a newbie to treatment.

Which brings up the point, if one gets a new machine with insurance, might be better to keep the papers on the delivery of the new machine, as (I suspect) insurance companies look for any reason not to pay for replacement later.

Yes, I understand that Medicare is Federal. Medicare billing is, as I understand it, done differently by different regions/sometimes states. Like Assignment rates in Utah are different than Texas.

I am guessing this is what happened. When I came to Texas, the region classified me, wrongly, as a new sleep patient. It dated my machine from the time I got to Texas. Thereby it told the Doc's office that I needed a follow up visit because of its need to verify compliance with a new patient.

Although, in truth, I have been on the hose for two years before I got to Texas.

Might be that some of the issue is that Medicare did not pay for my initial study and titration. That is, while I never paid for it, the sleep center might have done my case as a charity case.

A year before I had my test I was told by another Medicare recipient, that Medicare would not pay for the test, but would pay for treatment after I had a positive test.

Just like, used to be, a new Medicare patient was not qualified to get a general physical from their doc to look for issues. If the person comes to the doc with a specific problem, then Medicare would pay for that. Now Medicare will pay for a physical, not much of one.

Sorry about the confusion. I do not know what is happening, I just know I can expect to see sleep doc again in six months, which is OK by me because I want more info on how I am doing.