Finally! DME Appointment Tomorrow

Exactly. The DME's best interest is to sell you the cheapest machine money can buy so they maximize profit. I find it interesting you said that doctors WANT to manage OSA and so thats why they want fixed CPAP. In my experience, I find that most physicians DONT want to manage OSA thats why they prescribe a CPAP and no one ever gets follow up. So if anything if they wanted to "set it and forget it" (even though 4-20 isn't that effective in my opinion) they SHOULD prescribe AutoCPAP. I only prescribe AutoCPAP and have had no difficulty in maintaining follow up wiht my patients. The ones whose apnea is well controlled come back to see me yearly and the ones who have issues I see more often and having the data is so important to help make adjustments. I don't think there is really any legitimate reason for a physician not to prescribe AutoCPAP these days and if your's doesn't go find someone who will.

OKCSleepDoc wrote:I find it so interesting that so many people have trouble getting APAPs. I can understand if you don't know any better and your doctor doesn't know any better. However, have many of you run into situations where your doctor hasn't been willing to write for APAP and insisted on fixed CPAP? I would think that if the doctor didn't know any better and you did, that most should be willing to script it more specifically for an AutoPAP.

Of course I could be wrong. I see patients all the time coming in with fixed CPAP, no data machines who were told it was "the top of the line".

"My" experience has been that Sleep Doctors do NOT want you on an APAP.
They rely HEAVILY on ONLY the Sleep Study titration & will make changes to pressure ONLY if you complain of problems (i.e. still snoring a bit, etc.) Then, they up the pressure by 2.0 instead of by only small increments.

They also feel that an APAP is NOT accurate enough to be used.

The ONLY way they will agree to RXing an APAP is if you convince them of it.

My line was I have lost X lbs in only Y weeks & plan on continuing to do so.
It was actually true, but I would have had no problems still using that line even if it were not.

My Sleep Doctor is a NP in a group with 2 Sleep Doctors.
She has been there as the NP to my original Sleep Doctor who died several years ago. After using 1 of the 2 Sleep Doctors for a couple of visits, I decided to continue to see only her. But that entire group loves straight CPAP Respironics & will prescribe only them unless really pushed.

And as little as 2 years ago, they would have NEVER agreed to an APAP no matter what.
I believe that people like me who have been on CPAP for a long time are now demanding APAPs & the Sleep Doctors are VERY SLOWLY agreeing to them.

I mentioned my preference for ResMed & was able to convince her that the ResMed S9 AutoSet be specifically noted in my RX.

Then, you have to get the DME to buy into all of that also.

I visited my DME (who I have been using for the entire 15 years I have been on CPAP) & showed them my RX. I reinforced upon them more than once that the RX HAD to be filled EXACTLY as written & the APAP had to have 0 Run Hours on it otherwise I would NOT accept it.

With your doctor's RX for an Autoset, there is no way for the DME or the insurance to stonewall you for a lesser machine.
Once you have your prescription, you may still have to find another DME in network who will "play ball",
but your health depends on you getting effective, agreeable treatment--not in helping the DME pay for his lake house!

chunkyfrog wrote:With your doctor's RX for an Autoset, there is no way for the DME or the insurance to stonewall you for a lesser machine.

When I purchased my current ResMed S9 AutoSet, I was still covered only by my BC/BS PPO.

BC/BS states very clearly in its policy that even though your Doctor may prescribe something does not mean that it will be covered.
Same theory as when your Doctor prescribes BRAND X drug, but the insurance says that the cheaper GENERIC Y drug is just as effective & that is all they will pay for.

The DMEs use that to their advantage & tell you your insurance will not pay for it.

Now in reality, we all know that both the brick & the APAP are billed to the insurance under the same code & the DME can easily provide you with the APAP if they really want to.

So, anyone who does want an APAP should always stand firm & demand one.
When the DME sees you are serious & they may lose your sale, they WILL provide you with an APAP.

LOL, OKCSleepDoc. When I had a machine die on me, I urgently went to my GP at the time, and bless her heart, I had to tell her EVERYTHING to put on the scrip. I wish I had asked for more!! An online provider had the new machine to me in 3 days. Considering the most expensive overnight package always takes at least 2 days, I thought that was pretty good!!!

Since then, my local Lincare affiliated DME rep understands that this forum has made me a more knowledgeable consumer and she sneaks me the best she can under the guides of my insurance and her rules both.

I took a list of what I wanted to my sleep doc (listed all the manufacturer part #s), and he just stapled it to the Rx.When I got to the DME, they had marked my page "patient preference", but when I pointed out it was part of the Rx, they gave me what was on it.

I was clear that if they could not provide the machine, humidifier, hose and mask I had been prescribed, I would leave with nothing. I had to make for the door twice, but they gave me what I needed. They never even took the mask out of the plastic, though,so I've dealt with the mask issues myself. I never expect to see them again unless I have to pick up a different machine.

Better to take nothing than something not appropriate for your specific needs, and have to try and swap later. Until you take a machine they don't get paid. Getting paid is their only concern.

Take your prescription, a list of what you expect, insist on mask fitting, and get 3 months worth of supplies. Good luck!

Hi there,

I just was approved from my insurance company and will have to go through all this soon. It sounds like the hassle that we all have when we buy a car. Geez! Why do they fight the user/patient that will have to use this contraption every night? Is it everything for the almighty buck?

What did they tell you to cause you to start walking out toward the door?

Also, how did you get them to include 3 months of supplies?

Anything else you can think of to ARM ME(is this a war too?) to say or not to say to get what I actually need and want?

Thanks!

Rick

In my case, first they didn't have the mask I had ordered, and said I'd have to take one they had in stock. I had called ahead to be sure they had everything my sleep doc prescribed, so I said I'd come back when they got my order completely ready. Funny thing, my mask suddenly arrived!

Then, they wanted to give me a used machine, saying that was all my insurance would approve. I knew this to be untrue, since I'd called my insurance co ahead. I asked for a supervisor, who never showed up but eventually they gave me a new machine.

They had actually told me ahead of time that insurance would pay for supplies 3 months at a time, so that was on my list. Ask for their replacement schedule - they have to give it to you, then a way to reorder other than by phone (which takes forever and leaves you with no record of the transaction).

Seems like a lot of work, but you'll get better service if you are prepared. They only care about giving you the barest bones setup they can, so you have to advocate for yourself. Good Luck!!