CPAPtalk.com

My understanding is that APAP is contraindicated for patients with heart failure, patients with significant lung disease, patients that take medicine that may decrease respiratory drive, patients who have undergone upper airway surgeries, patients with neuromuscular disease, and patients with prominent desaturations from, for example, obesity hypoventilation syndrome. Said another way, all patients with comorbitities that can potentially interfere with adjustment accuracy are contraindicated.--Based on Sleep Medicine Essentials, 2009, by Teofilo L. Lee-Chiong, p. 107. Found by Googling "contraindications" and "autotitrating."

purple wrote:I further believe that no brick machines should be sold, the price differential today would not be so much higher, as the cost would be distributed across the entire market. I can guess that the current marketing climate that sells both a brick and a full data with auto capability is driven by that principle that a company should sell a crippled product to have a better product to sell for more money. That would be another time when our free market capitalism principles are causing harm rather than encouraging innovation.

I agree although I would not blame free market capitalism. It is simply that economy of scale changes when so-called extra features become standard.

It reminds me of when the auto industry started charging extra to delete features which now came standard but for which they previously charged extra to add on!


Nate

Just to clarify, I was referring to the automobile industry, not autos as in CPAP/APAP.

Autos that cannot differentiate open-airway apneas from closed-airway apneas (such as my S8 II) may react to central apneas the same way as to obstructive apneas, by raising pressure--at least until reaching 10 cm or so of pressure, as I understand it.

idamtnboy wrote:
4) But best of all, he IS dealing with it. I'm proud to say he is making it on his own, without me giving him regular handouts.

Kudos to your son.

I found my sons matured much later than my daughters and eventually went on to do very well career-wise.

It sounds like your son is working hard and keeping his nose clean.

The next step might be to look into a local trade or technical school and slowly begin upgrading his skills for a career change. As the economy improves he might find himself in a wonderful position.

You probably don't want to hear this, but if he is in Idaho he may need to relocate. I encouraged my kids to get way out of their comfort zone geographically. They are really happy they did.

We do get together two to four times each year and of course my wife is on the phone or Skype regularly with them.

All the best to your son.

Kiralynx wrote:
Had a job.

Company execs squirrelled around, making sure their golden parachutes were in place.

Company declared bankruptcy and is no more.

Can't get a job because of a moderate handicap -- and employers don't want to make allowances when they have a couple hundred perfectly healthy people applying for the same position.

Did save up and buy a second machine and everything to go with it before that, though.

I know that is a tough situation but it sounds like you are dealing with it well.

I was up in years and the company I had spent most of my career with decided to dissolve because the customers were moving to low-wage countries. I spent a little bit of time looking for the same type of work in the same type of industries. It was pretty clear that the large companies would not hire me.

I began networking with small companies in other industries and ended up with a great job in another industry. When they began to grow too large for an old guy to stomach, I used this experience as a springboard to start my own company.

I guess what I am saying is look to small companies and don't be afraid to look outside your field. The economy is slowly improving and you might be surprised to find more opportunities soon.

Best of luck,

purple wrote: I think the person who originally posted in behalf of her industry, the DME's, and such should be politely thanked for speaking the truth as she knows it, even though I disagree with her. I suspect she is correct in saying that there are a lot of patients are satisfied with a brick xpap machine and never worrying about the settings.

And there's also a 50% failure rate with CPAP. I wonder how many of those ex-CPAPers were given a brick, had serious problems with adjustment and/or felt worse with CPAP than without, but had no useful data available to point the way to what might be wrong with their therapy (settings? leaks?) and what might need to be adjusted to make them more comfortable and their therapy more effective; and so after several weeks or a month or two, they just gave up because "CPAP just didn't work" and returned the brick to the DME.

Surely it's got to cost a DME some money to process a returned machine. And what do they do with all the machines that get returned due to non-compliance or the CPAPer consciously deciding to give up before the rental is complete?

Isn't it possible that a DME might come out ahead profit-wise if they cut that non-compliance rate in half? Would they make more money (in the long run) selling us S9 Elites and System One Pros and then helping those who are struggling to make the therapy work understand their data and how to use that data to determine what kinds of things need to be worked on to improve their therapy?

robysue wrote:

purple wrote:
Isn't it possible that a DME might come out ahead profit-wise if they cut that non-compliance rate in half? Would they make more money (in the long run) selling us S9 Elites and System One Pros and then helping those who are struggling to make the therapy work understand their data and how to use that data to determine what kinds of things need to be worked on to improve their therapy?

Yes because they are being very short sighted. They will make most of their profit not from the machines but from the accessories. When I was taking some business seminars it was hammered in that we should find a product that had a short life span and to do anything we could to keep that customer for repeat sales. Because that was the road to success, a customer "in the store" was worth many flying around lose. For each cpap client that doesn't make it they lose thousands of dollars of accessory sales that they really don't need to work for. I have never heard from my original DME, nothing, not a word, not a phone call, nothing. If I want to buy anything from them they make me jump through hoops to get an appointment. It is the most stupid business plan ever!

Here's one for the OP

My continuing saga of L***are - I can not stomach typing their name any more.

My wife fired them in November for the following reasons:
1. Lack of service, she was trying to schedule a mask refit and they would not return calls
2. Balance billing after our out of pock max was met for the year
3. Continuing to send bills even after our insurance company had called them to explain things to them
4. Sending us to collections
5. Even after we fired them via phone, and written communication and had them pick up all equipment. They continue to send us supplies and bill us when the insurance company refuses to pay. I have a phone log of every communication including all the times we ask for return UPS labels as I am not spending a cent to send it back to them.
6. The last time I requested a return label for the most recent box they said they personally talked to my wife. Don't lie to me.
7. We have placed several calls to the business office and all we get is voicemail, which they NEVER return.
8. Our insurance company has tried to mediate this as well, they get the same treatment with no return calls.
9. Every time we have had dealings with them they treat you like you were found under a rock.

All this information has been submitted to the insurance company and complaints have been filed with the Ohio Board of Respiratory Care and The States AG office. They decided to mess with the wrong guy on this as I personally know people in both these offices.

And they wonder why there is a lack of compliance when you have to deal with this sh*t.

Our new DME is courteous, timely, and professional. I needed a new cushion and chinstrap, called and had it in two days. Billing is a snap, they provide what they will charge, what they expect to be reimbursed for and what your out of pocket will be before they deliver anything. I appreciate honesty and integrity.

Dave,

I just sent you a private message with what you need to file a Balance Billing Complaint with the State of Ohio.

The law in Ohio, like many other states, is very strict about protecting Medicare patients from balance billing, especially after you have assigned to them the right to obtain direct payment from Medicare.

If you haven't already done this, be sure to do it now!

Regards, Nate

I think the OP has left the premises.

SleepingUgly wrote:I think the OP has left the premises.

Darn - I wanted to poke him with a stick some more - LOL

Maybe we should do a poll about whether the OP is a man or woman. I keep thinking a woman, but I have no idea why I think that.

"I'm an RCP that got her degree in 1984". This was in her first post! Now I have to think of a nice prize for you!

DoriC wrote:"I'm an RCP that got her degree in 1984". This was in her first post! Now I have to think of a nice prize for you!

Oh, for a second I thought maybe I was a mind-reader! Not it turns out I was just a reader before I became a skimmer!

purple wrote:when our free market capitalism principles

Principles?

FMC has no principles. That's just not part of the formula.

It's like the way water moves. Water flows where it does because of the laws of flow dynamics.

It has nothing to do with principles.

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IMHO, too many people here posting about what their insurance company could do, or should do.

Likewise, too many post about what DMEs could, if only DME would . . .

Coulda, woulda, shoulda.

I guess venting is good for the soul.

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Anybody here want to create a living, dynamic list of top DMEs, organized by state?

That would actually be doing something tangible.

Good DMEs do exist. I have one.

Let's stop bitching and publicly, loudly, drive business to them.

Or, if you have the choice, publicly, loudly, drive business our sponsor, CPAP.com.

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Now here's an idea:

Why don't some of us take responsibility for negotiating a discount, a gift, something, with each of the "good DMEs" (As we'll come to define them, a rating that we can decide to remove if they change their stripes) if the member belongs to CPAPtalk (and can prove it), and moves their busines to that DME.

Part of the negotiation will be that they must keep track of the number of people referred to them, and the gross dollar amount those people have delivered.

I volunteer to attempt this with my DME.

Is anyone else interested?

Guess I'll have to make a separate post and see.

I'm curious, perhaps you are too: are the members of this board, acting in concert, an economic force of any magnitude?

No harm if we're not, I'm just curious.


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SleepingUgly wrote:I think the OP has left the premises.