CPAPtalk.com

Slinky wrote:It is ILLEGAL for them to charge a $20 "processing" fee. HIPAA (federal law) allows only for a "reasonable" fee. And I believe but don't remember for absolute sure that they can only charge a "reasonable" fee PER PAGE. I'll have to get you the link to that. Or you can find it yourself at apneasupport.com under a sticky titled "accessing your medical records" or something similar.

Thanks for the link! The state I live in can charge up to $20 for labor and up to $1 per page the first ten pages. I think I can get my doc to cave vs. paying the $ to the hospital.

midwestosa wrote:I'm starting to learn that in the cpap community there is a perception that dme's are the equivalent of used car dealers, be very skeptical of them and take everything they tell you with a big grain of salt.

That is an insult. Expect to hear from the Used Car Dealers Association any day now.

Breathe Jimbo wrote:Get your Rx in hand. Ask your doctor to write "fully data-capable" on the Rx.

If you get a cooperative doctor, ask him to prescribe a range of pressures, for instance, if he wants 12, specify "12-16" and specify an auto adjust CPAP machine.

Also, you absolutely must have a humidifier. Like an Auto function, you can always simply not use the humidifier if you don't need it.

archangle wrote:you absolutely must have a humidifier.

Maybe yes, maybe no, but not "absolutely" yes.

I was tired of tending to mine and found I could do without it just fine. Still, it is good to get one in case you need it.

Once your doctor has the copies of the sleep study and issues you the Rx for your machine/mask, ask for copies via his/her office. I fully expected to pay about $1 per page at my sleep doc's office, but they gave me all my copies without charging me....I was amazed.

Usually, the doctor who analyzes your sleep study in conjunction with the sleep lab is unknown to the patient. They do that for a living and rarely do they interact with the patient/subjects. Their job is to issue the full report to the patient's referring doctor, and the patient works with that PCP or sleep doctor from that point on.

If your PCP isn't up on sleep medicine, I would suggest you find a good sleep doctor with whom you can discuss your therapy more effectively.

I recently got diagnosed and received a machine. For the most part, I just learned what I could on this message board and ignored the things my DME told me. My DME didn't really realize what my S9 Autoset was capable of, so he didn't provide much (mis)information about the product. If you get a datacapable machine, you should be able to download the data yourself. I know you can do this with the S9 Autoset.

If you decide to go with the S9 Autoset, I'd suggest you tell them you want "the S9 Autoset, not the S9 Escape Auto".

midwestosa wrote:I'm starting to learn that in the cpap community there is a perception that dme's are the equivalent of used car dealers, be very skeptical of them and take everything they tell you with a big grain of salt.

Not all. Just the ones you hear the most about. My DME has been great. Yes, they gave me a "compliance-only" machine at first, but a call to my doc got a revised 'script faxed to them and they swapped it out, no questions asked. Even upgraded to Auto. To my knowledge, they have never lied to me. But then, I tend to "over-discuss" things so there is no misunderstanding or "gray areas". Sentences which start "So you are saying..." will go a long way towards a good relationship with a reputable DME, I've found.

Emilia wrote:Usually, the doctor who analyzes your sleep study in conjunction with the sleep lab is unknown to the patient. They do that for a living and rarely do they interact with the patient/subjects. Their job is to issue the full report to the patient's referring doctor, and the patient works with that PCP or sleep doctor from that point on.

Emilia, this is a question that came up before on the forum: how do you know the qualification of the person who "scored" your raw data and created your PSG report? By the time you get the information, how do you know whether it was just computer-generated, or whether a board-certified and experienced Polysomnographic Technologist (no doctor, like in the case of radiological exams) has been in the loop? Depending on sleep lab conditions and protocol, equipment used, and post-sleep interpretation, there could be a large variability in the conclusions.
Could you be talking about a sleep center where the only role of the Sleep Doctor is to generate reports, without wanting to follow up with the patient's home CPAP treatment?

SleepyHound wrote:I've never met the sleep doctor that has analyzed my sleep studies, so I will likely go thru my primary care doc to get any ... reports that were put into my chart.

SleepyHound, whether the process you describe is advisable may depend on the severity of your SA.

Regarding DME qualifications: you could ask how much sleep disorder and CPAP training he / she has; whether their training and testing made it to a Registered Respiratory Therapist... not just another CPAP user who learned how to deliver and fit a mask. Note that your bill is for the hardware, not for the associated service. The person should have recent experience with the newer models, be able to demonstrate having serviced a number of customers, be able to bring you up the learning curve for its use ... be there for you if you have an urgent need, like breathing difficulties.

A recent experience in point: after my first 8 days on CPAP, with cumulating nasal congestion, I woke up in the middle of the night with very uncomfortable breathing. The DME had a 24/7 number, but wasn't knowledgeable enough. Since the sleep doctor had technicians performing PSG that night, I called there: the sleep tech wouldn't take any responsibility, said either wait til consultation hours, or go to the hospital ER. In the end it turned out to be a well known mask-induced effect, which both above people should have recognized.

To a technician (who may have less training and certification than an RN) it may have been an issue of medical liability (possibly the patient having a heart attack or a circulatory disorder), and of the sleep doctor's protocol... who may insist that the patient bring all problems to a billable consultation.

SleepyHound wrote: DME said no access to my data.

When I saw this subject line, I immediately knew the regulars here would howl.

@AMUW ..... my sleep study report indicates a Scoring Technologist who, I assume, is the tech that monitored my study and generated the file for interpretation. My tech was a registered polysomographic tech.... I know this because I engaged her in a discussion about her training and schooling. (that is the educator in me.... I am a retired teacher) The report was then interpreted by my sleep doctor who is on the board at the hospital's sleep center, but whose private practice office is in my town. So, in my case, my sleep doctor, a plumonologist, did the interpretation. It doesn't work that way in a lot of cases if you are using a PCP or other doctor, the report will probably be interpreted by a physician affiliated by the sleep center. His or her name and title should be on the report.

We have a number of PSG techs and RT's on this forum as well as a few doctors. Perhaps you can start a new thread with a title that might draw them to your question so they can chime in on this.....

midwestosa wrote:I'm starting to learn that in the cpap community there is a perception that dme's are the equivalent of used car dealers, be very skeptical of them.

....ahhh, yah think????

archangle wrote:That is an insult.
Expect to hear from the Used Car Dealers Association any day now.

Since my Rite of Passage into the cpap world and
being lied to by the Big A,
fighting to get a data capable machine,
I kind'of feel left out.

I learned to take matters into my own hands and
I became my own best therapist and DME.
I don't have any interaction w/the sleep lab, alleged sleep doc or DME.....
so I have no stories to share anymore.

I just get excellent therapy and sleep everynight,
and my therapist and DME are on call, 24/7.....
and they are good.

You and all noobs would be well advised to do the same,
really does make life much easier.

Emilia wrote:@AMUW ..... my sleep study report indicates a Scoring Technologist who, I assume, is the tech that monitored my study and generated the file for interpretation. My tech was a registered polysomographic tech.... I know this because I engaged her in a discussion about her training and schooling. (that is the educator in me.... I am a retired teacher) The report was then interpreted by my sleep doctor who is on the board at the hospital's sleep center, but whose private practice office is in my town. So, in my case, my sleep doctor, a plumonologist, did the interpretation. It doesn't work that way in a lot of cases if you are using a PCP or other doctor, the report will probably be interpreted by a physician affiliated by the sleep center. His or her name and title should be on the report.

We have a number of PSG techs and RT's on this forum as well as a few doctors. Perhaps you can start a new thread with a title that might draw them to your question so they can chime in on this.....

"Scoring Technologist" could be like calling the guy in India who barely speaks English and reads from a script a "Customer Service Specialist" or calling the garbageman a "sanitation engineer."

"Registered polysomographic tech" may be better, but I don't know what it really means. Wikipedia says "In the United States, a Registered Polysomnographic Technologist (RPSGT) "is a fully trained sleep technologist who has met the rigorous requirements to become credentialed by the Board of Registered Polysomnographic Technologists". In order to take the registry examination, one must complete a minimum of 6 to 18 months paid clinical experience performing polysomnograms which includes a self-taught program or complete a program in polysomnography that is accredited by the Commission on Accreditation of Allied Health Education Programs. By 2012, only those who have successfully completed a CAAHEP-approved polysomnography program will be eligible to take the BRPT examination in the US."

Sounds good, but I don't know whether the test or training is any good or not. "6 to 18 months paid clinical experience," doesn't mean much if they just hook up the equipment, babysit the equipment, print the reports for the doctor, and make sure the patient doesn't die overnight.

MOST of the time, at least in the USA, the PSGs are actually scored by an RPSGT. And whilst the sleep doctors SUPPOSEDLY also score the PSG before initialing the scored data and dictating his report, IN REALITY the majority of them just glance over the scored report enough to dictate some results, and then initial it. If I had to blindly rely on any ome of my three sleep "professionals": RRT, MD/DO or RPSGT, you can bet your bippy it will be the RPSGT I will put my faith in!!!!

LinkC wrote:

midwestosa wrote:I'm starting to learn that in the cpap community there is a perception that dme's are the equivalent of used car dealers, be very skeptical of them and take everything they tell you with a big grain of salt.

Not all. Just the ones you hear the most about. My DME has been great. Yes, they gave me a "compliance-only" machine at first, but a call to my doc got a revised 'script faxed to them and they swapped it out, no questions asked. Even upgraded to Auto. To my knowledge, they have never lied to me. But then, I tend to "over-discuss" things so there is no misunderstanding or "gray areas". Sentences which start "So you are saying..." will go a long way towards a good relationship with a reputable DME, I've found.

I began this whole process without the benefit of all the great information available on this forum and I walked out of my DME with a brick, a Respironics REMstar Plus. I'm not saying it was an easy or quick process to get my Rx and communicate with an out of town main office, but in the end Global Sleep swapped out my Plus for a PR System One Auto with A-Flex at no cost to me. To my surprise, a new humidifier and a chinstrap were included as well. So, while it was a bit nerve-wracking and a bit patience-trying, I too was able to get the machine I needed.

To the OP: Please pay attention to all this advice. This would have been MUCH simpler and easier for me if I'd done it right the first time! Good luck!

Sleepy, good for you for asking about the truthfulness of your DME's statement. Of course, it's false. Can you imagine if they treated your diabetes this way?

Here's the simplified version:
First, do you really want to do business with this DME? You can already see what louses they are (but that doesn't mean other DME's will be any better). The only reason to stick with them is that they carry the ResMed S9 line, so you CAN get the best machine. You may have to argue this all over again with another DME.

Ask your PCP to write you a script for the ResMed S9 Auto (NOT Escape Auto!) and mask of your choice. It's the best machine out there. It's hard to get software, I think, for the F&P Icons. Don't let your DME charge you a penny extra over and above your standard deductible and co-pay for that machine!

Don't even bother with asking your doctor or the DME to give you data access. We can help you with that once you have the machine. It's your health, not theirs. Your insurance doesn't care.