Can a doctor force me to use a specific machine?

Memo from the Director, Office of Civil Rights regarding right to access health records: http://www.hhs.gov/ocr/privacy/hipaa/un ... ssmemo.pdf

MitzyG wrote:I know that they said they'd write one for someone else, but only for 1 year. I don't want to see this guy again!

Though a prescription for CPAP does not automatically expire, many are finding DME and/or insurance companies are requiring annual updates or reissue. If you do change doctors, your new doctor will write a new RX, if needed.

If you missed the views, and I suppose you might have read this already.

http://maskarrayed.wordpress.com/what-y ... me-part-i/

In the past many of us have depended on our docs writing a script for a specific machine, with the added, dispense as written to help us get the machine we wanted.

I am guessing you know all I am referring to, as others have referred to seeing what the script actually says as to which machine that might have been required.

There is in theory a reason why the doc might have chosen a PR machine over a Resmed, if the machine is to be used in the auto mode. That is the auto mode for the two different manufacturers is different. Not sure exactly how. I know that one of my sleep docs recommended that I not use a machine in the auto mode, now I know that is because of the way I breathe causes the machine to keep ratcheting up the pressure when it is not needed.

Usually sleep docs like the PR machines because the reports generated by the PR software is much better than what the Resmed machine produces. And if Resmed is listening, it is perplexing why they have not improved their software.

I have used an older PR machine, and I like the sturdiness and overall quality of the machine. All that said, my latest sleep doc acknowledged the superiority of the PR software, but happily wrote a script for a Resmed machine, saying, "a lot of his patients were happy with the Resmed machines." Just as I was interjecting that, "I did not think which manufacturer machine I got mattered so much in that I was not using the AUTO feature. I did not know if how the AUTO feature between the two really worked either."

I do like the feature of the Climate line hose on the Resmed, and it does make a diff in how well I sleep (which surprised me). Or should I say, something is better with my new Resmed VPAP Auto in that I sleep better. I suspect the heated hose of the PR machine is excellent as well.

I am pretty sure that to some DME's, PR machines of a similar type to the Resmed, cost considerably less, and PR gives a deep discount to DME for their machines. As one can see from the prices of our sponsor, cpap.com the PR machines versus a similar Resmed cost less.

I do know that like some of us, when the doc walks into the room, my IQ drops fifty percent, but my docs have always tried to be patient and answer all my questions. That is I suspect that my doc's can realize my mind is not always there, and just get on with what they have to do.

I am astonished that the docs office is not better able to just answer your questions over the phone. Usually the Sleep Doc's office has a nurse or RT who will speak on the phone to an individual, and work out issues of exactly what the script says, and get the doc to change it if the patient requests it, unless their is another true medical reason.

Thanks to those folks who referred me to the HIPAA info that I need to speak to the doctor's office. Certainly they HAVE to provide the records and billing info. They REFUSED to show me the billing and now I need it to get my ResMed rebate. Then, I truly want to get my titration results so that I can see someone else without having to do the test again. I really feel foolish...I thought that I was going to a sleep center to get a test that any doctor could read. I didn't know that the place was owned by the doctor and that he'd be watching his wallet more than my health. Yeah...I've been naive.

Guest - Ask the doctor why he recommended that machine. It could be because he really thinks that one is better for you because of a feature. Or it could be that he's getting a kickback or other financial incentive. I wouldn't assume the worst without talking to him. Everyone told me that...and when I asked the doctor, he became a HUGE butt and it was obvious that he was looking at lost money vs my comfort. His final words "This machine is doing the job...I'd hate for you to pay more money when this works" (he did take a breath and tried to be quite polite...I'll give him that much credit, he also did test the machine to verify that it was blowing the right pressure). I said that "It may 'work' but I can't sleep with it and it's very uncomfortable". He sulked, walked off and refused to speak to me again. To me, a 'helpful' doctor would have offered what he had promised earlier...there are many options and he will loan you the machines to try to find the right one before committing to a purchase.

I'm only about 6 weeks ahead of you but had a similar experience with my DME. My doctor wrote an Rx for ResMed Brick and after 2 weeks I learned that it was the basic model with no data reporting feature. I called my DME and asked about "upgrading" to a better ResMed. I wanted the "Elite" model, not the Brick. DME said since I already had a machine, they could not accept a "trade" or upgrade as my insurance would not allow it. Not being one who takes "No" for an answer easily, and being retired at 50 years old with way too much time on my hands; I went after this the way Grant took Richmond.

After speaking with BC/BS they told me I absolutely could have whatever model I wanted but it must be via a physicians Rx. If my physician wants me to upgrade, according to BC/BS they DME could not prevent it. I came to this forum and got advice not to back down. I learned that DME's receive the same payment whether they dispense the cheapo model, or the more expensive model - so they prefer ALL patients to take the cheapest model. Knowing that, I went back to the DME and said, "You will be receiving a new Rx from my doctor and according to BC/BS you must swap out my machine." Unlike your case, my doctor was very supportive and she gladly issued a new Rx. I told her I needed data reporting to best follow my CPAP journey and she was thrilled I wanted to be informed and an active participant in my CPAP process.

Back to the DME who dug their heels in the sand and basically "refused" to upgrade. I then pulled the ultimate punch: "If you don't follow my doctor's Rx and dispense the machine she has requested, I guarantee you will never receive another patient from her office OR hospital". Moreover, BC/BS asked me to let them know if the DME refused to upgrade my machine, as they can invoke sanctions against DMEs who pull this type of stunt. Once I invoked the: "You will never get any more patients from...." and also, "BC/BS wants to hear from me as how this resolves..."the DME changed their tune FAST and I got my new machine within 2 hours.

The billing code E0601 is the same for all machines; as you read above, the DME makes more profit giving you the basic/bottom of the line machine. If you want a different machine and your MD isn't responsive, then you are correct, it is time to find a difference physician. If he isn't listening to you about this, then how will he listen to you about other matters/issues.

Sorry to sound sexist, but every physician I have is female, and far-and-away they are so much better practitioners. Much better listening skills, and as clinicians they are top notch. It wasn't easy finding a female surgeon and urologist, but I did, and I'd probably never go back to a male physician again. My cardio., pulmonologist, internist, surgeon, dentist, urologist and oncologist - all women. Where would the field of medicine be today without them? Surely I wouldn't be alive.

I reread the OP, and a few things struck me:

My doctor's office wouldn't answer my questions about my prescription, and insisted that I must direct my questions to their cpap supplier (who they insist is not affiliated with them). When I called the cpap supplier, they told me that my doctor had written the prescription for a specific machine only (Respironics REMstar Pro with C-Flex), and that I don't get a choice at all.

The fact that your doctor's office wouldn't answer questions about the prescription indicates to me that your doctor (and/or his staff) may not know much about the equipment. They are used to sending the prescription on to the DME and expect the DME to make the decisions about what equipment to use to fulfill the order. Some have suggested that your doctor "knows best" and you should "trust" your doctor, but we see thousands of examples here of doctors who don't know the CONSUMER side of equipment provision--I would say this is equivalent of a doctor prescribing a very expensive medication when a less expensive medication will do just as well--simply because they have no CLUE about how much it costs--and maybe a very good looking sales rep talked it up last week. Here, most doctors have no clue about the various brands and qualities of CPAP's out there. If your doctor did know this, he' should have NO problem with your choice, since it will do everything his supposed preferred model does.

I may be wrong but the proof will be in the prescription itself. Doctors almost NEVER write a script for a particular machine unless you ask them to. I'm betting a doughnut that the DME was lying to you about the fact that your doctor ordered a specific model. When you get the prescription in your hands, you'll be able to see for yourself.

Meanwhile, the DME you want to use who can get the machine you want can call the doctor's office and ASK for the Rx. They can explain that you have decided to work with that DME. The doctor cannot dictate whom you must purchase the machine from any more than he can insist you use a particular pharmacy to fill your medicine prescriptions. You can speed things along by faxing or going in to your doctor's office (writing is always better) to instruct them that they should send the rx to your preferred DME. Don't ASK them, TELL them. Be polite, but firm. You don't need their permission to use a different DME.

Someone suggested going in to ask to see the doctor for just two minutes--dream on, it's not going to happen. And the staff will be angry that you think that's even a possibility. To make a living in these reimbursement times, doctors have to be over-scheduled as it is. They are not going to have 2 minutes to give you, especially when it might turn into 4 or 20 minutes for all they know.

penuel wrote:IMO, there is a lot of misinformation above. If you want to keep the same physician then you better follow his/her advice. Otherwise, go seek another one. The Sleep Clinic is responsible only to the physician who ordered the test. As a matter of fact according to some State's laws the Clinic under certain conditions can refuse providing you the results.

So you need a cooperation by your Physician and your Insurance. Never mind the DME.

Example: if I wanted to change my S9 Elite, which I got from my DME on Medicare rental, and wanted to change it after a month, to an S9 Autoset, I needed to ask my Sleep Doc to give me a new Rx, and I had to convince him that an S9 Autoset is better for my treatment (also b/c Janknitz was using it at that time). So he agreed. But at this time I had to pay cash from my pockets for the new macine.

Who's giving misinformation here? Medical providers can refuse to provide you medical records only under very limited circumstances under the FEDERAL HIPAA law:

Physicians have some discretion to not disclose certain mental health or other records if they believe the disclosure may be harmful to the patient or another. Additionally, some test results may be subject to state-specific or other federal laws regarding disclosure (i.e., HIV tests or those rolated to substance abuse/treatment).

(see http://www.physicianspractice.com/blog/ ... al-records)
Since HIPAA is clear the right of patient access to their own medical records, state laws can't restrict it.
There is no reasonable basis in this case for the physician to refuse to supply the OP with a copy of her prescription and doing so is a clear violation of HIPAA regulations.


I have NO idea where you get the idea that I was ever using an S9 Autoset or why you think that's a reason why you should, too. I'm in the less common situation of having an HMO (Kaiser) that is essentially the only DME I can use. They contract with Crapria to SUPPLY the equipment, but my insurer, Kaiser, is also the DME and the health care provider that prescribes the equipment. They make the choices, I have none if I want them to pay. My particular region supplies ONLY PR's and THEY decide if you get an auto or fixed CPAP. If i wasn't happy with that decision, my only option would be to pay out of pocket for what I want.

S9 Autosets are the most popular here. They have all the great bells and whistles and people tend to like them very much, but I have no idea if they are better or not because the only machine I have ever tried is my PRS1 Auto (550). I like it well enough--it works, it has data. I don't have money to get another machine, this is what I've got, and I'm OK with that except on really cold nights when a heated hose would be appreciated (they weren't available when I got my PRS1).

Janknitz wrote:

penuel wrote:IMO, … according to some State's laws the Clinic under certain conditions can refuse providing you the results.…

Who's giving misinformation here? Medical providers can refuse to provide you medical records only under very limited circumstances under the FEDERAL HIPAA law:

Physicians have some discretion to not disclose certain mental health or other records if they believe the disclosure may be harmful to the patient or another. Additionally, some test results may be subject to state-specific or other federal laws regarding disclosure (i.e., HIV tests or those rolated to substance abuse/treatment).

(see http://www.physicianspractice.com/blog/ ... al-records)

Since HIPAA is clear the right of patient access to their own medical records, state laws can't restrict it.
There is no reasonable basis in this case for the physician to refuse to supply the OP with a copy of her prescription and doing so is a clear violation of HIPAA regulations. …

I agree with Janknitz here, penuel. Federal Law trumps State Law. Any laws on this subject previously passed by any state are null and void if they attempt to reduce the rights granted and responsibilities imposed under Federal Law, even if they failed to erase them from their state laws after HIPPA was passed. And HIPAA has so much enforcement teeth in it, that doctors and hospitals don't fool around after HIPAA is invoked by a patient. They jump. If they don't, their business manager and their liability ins. co. gets on their neck pretty fast. There are significant penalties for doctors and hospitals and clinic if they try to hem and haw or play around with HIPAA.

Regards, Nate

it is quite amazing. I could not get my prescription and report from my doctor either. I am A cpap newbie.

He sent the prescription to his favorite medical supplier, but his office would not send to me.

I had to threaten my doctor with the NY State Law requiring doctors to provide the medical file to a patient within ten days, and also threatened to report him to the referring physicians. It helps that I am a lawyer.

Within two hours of my e-mail, I had the prescription and preliminary report e-mailed to me. I then a few days later received a CD with the complete sleep studies.

This is from a "quality" office where the director is a professor of one of the ten best Medical Schools-Centers in the country.

Then I found that the CPAP machine sent to me was an el cheapo Respironics SE, no data at all except for compliance data. But, the prescription did not dictate a model, and was silent as to the data issue. I had expected a Resmed 90 SE.

The supplier uses four different names and was selected by the Physician.

And, I am having masks problems as well.

My brother is a general practice internist in another state - he says he also always prescribes an auto machine, and then sets it as a cpap, and monitors the patient. He keeps checking the data and adjusts the pressure. Too bad he lives 3000 miles from me.

Anyway, I will have to go back and fight again with my doctor's office and the suppliers, it seems.

From what I've read here, I am a lucky person. My Specialist had no qualms about making a copy of my sleep studies for me.

Keeping fighting for those records, you are entitled to them

1. There really is no reason that your doctor shouldn't give you a copy of the prescription. I find this in my opinion really unethical. You should drop this doctor.

2. Medical organizations often have a deals with CPAP suppliers. A medical organization that is rather large sent off for a Resperonics for me even though I didn't ask for one, just said I wanted to consult about a better machine. I had to tell the supplier and call back and tell them I had not ordered it, I was not going to pick it up.

A lot of medical suppliers, pharmaceutical companies pay for doctor trips to medical events. This is clearly a violation of ethical standards. As an engineer I will not accept any gifts from any vendors besides a pen with their name on it and lunch. However, other items I have refused. This is fairly well understood. Why doctors accept this despite being defined as a "profession" amazes me.

3. A certified letter I have always found works wonders. Stop talking on the phone and write a demand letter. A demand letter should be temperate.

Once they get the certified letter you will find that they change their attitudes. I always here people say that they called and called, but they were unwilling to write and send a certified letter. I have used certified letters to great success over the years for myself and helping a little old Japanese lady who people thought could be victimized.

They will likely call right away. When they do, make sure you write up a summary of the phone call and mail it to them. Unfortunately you are running out of time.

4. I would find your local medical review board and report your doctor. Once a dentist broke a bridge for the above mentioned Japanese lady, and the day before the hearing the dentist coughed up the money. Turned out that the dentist had a record and was close to losing his license.

sleepy1235 wrote:…3. A certified letter I have always found works wonders. Stop talking on the phone and write a demand letter. A demand letter should be temperate.

Once they get the certified letter you will find that they change their attitudes. I always here people say that they called and called, but they were unwilling to write and send a certified letter. I have used certified letters to great success over the years for myself and helping a little old Japanese lady who people thought could be victimized.

They will likely call right away. When they do, make sure you write up a summary of the phone call and mail it to them. Unfortunately you are running out of time.…

I agree with this advice 100%. With today's computers and printers in nearly every home (and certainly in the homes of cpaptalk members) I really don't understand the reluctance of people to prepare a certified letter, return receipt requested, and take it to the Post Office to be delivered. It is much more effective for the reason sleepy1235 explains above, and also for another reason:

Often, people post on cpaptalk that "The doctor won't do this…" and "The doctor won't do that…" but if you really pin them down on whether they talked to the doctor, it turns out that they are really describing a conversation with somebody in the doctor's office who claims that the doctor said this or claims that the doctor never does that. Folks, these are what I call "gatekeepers*" - office staff people who think it is their job to protect and shield the doctor from being bothered with patient requests. Many of these people are stretching the truth when they choose words which suggest that they are quoting the doctor when they may have never really passed your request on to the doctor, but are merely describing what they see as the usual office routine.

These people often won't bother the doctor with passing on your verbal request to him or her (although they should) but they sure as heck won't put their jobs on the line by hiding a certified letter from him/her which has been specifically addressed to him/her! So it often turns out that when the doctor sees and reads your letter, it is really the first time he or she really even knows about your request!

So don't waste time with more than one phone call or two! If you don't get what you are entitled to - send a polite but firm certified letter addressed directly to the doctor!

Best wishes, Nate

*Remember the man in the green uniform at the front door of the Emerald Palace in the Wizard of Oz movie who yelled at Dorothy because she had ignored the sign that said "Bell Out of Order - Please Knock" and when she pressed the bell, it rang just fine!? There are many life lessons like that one to be gleaned from the characters and the scenes portrayed in that movie, which it is why it is one of my favorites.

Nate and Sleepy1235 - You know, before you guys mentioned it, I had not considered the certified letter option (I feel dense). Now that I better understand HIPAA and that I have a LEGAL right to view my records and claims, all I'm doing is exercising my government provided right! I'm not being nasty, I'm not begging, I'm just exercising my right. He agreed to follow the rules...he should follow or accept the consequences. HMPH!

I'm so tired of them treating me like I'm stupid and that they have power over me. Now that we're financially even, I'm ready. And I am looking forward to my ResMed rebate that requires the receipt!

Thank you again for the info...this week's project is to write the letter and get it sent certified...

My last visit to my sleep doctor was a disaster. He was sitting in his office next to the examining room and I could hear every word. He was arguing with another doctor about retirement and when he was leaving...anyway, he missed my appointment by 40 minutes. Afterwards he comes storming in looks at my data and says "ok, your good, see you next year". I looked him square in the eye and said "Hey, I know your behind, but that's your problem, this is MY TIME." I got a prescription for additional masks and supplies for the next year.

Doctors see people all day long, there is no more personal health physicians who really care, your just a number, and the faster they finish their numbers, the faster they get to go home.

I had a similar situation in which the sleep center and the doctor want me in Phillips products. I said I wanted the ResMed S9 autoset and made case for why including the fact it is quieter and can tell the difference between a central and obstructive apnea. They tried to convince me but I stuck to my guns and eventually I got exactly the machine and mask that I wanted. The DME had to order the Resmed machine for me from another store but in the end I had what I wanted and am now a happy camper.

Bobshouse wrote:My last visit to my sleep doctor was a disaster. He was sitting in his office next to the examining room and I could hear every word. He was arguing with another doctor about retirement and when he was leaving...anyway, he missed my appointment by 40 minutes. Afterwards he comes storming in looks at my data and says "ok, your good, see you next year". I looked him square in the eye and said "Hey, I know your behind, but that's your problem, this is MY TIME." I got a prescription for additional masks and supplies for the next year.

Doctors see people all day long, there is no more personal health physicians who really care, your just a number, and the faster they finish their numbers, the faster they get to go home.

Right, we have to be more assertive now with our doctors.

The last few years, I've typed out and brought with me to every doctor visit three (3) copies of a sheet of paper with the visit date and my name and birth date at the top, entitled "Things I wish to discuss with Dr. ____________ Today" followed by a 1,2,3,4,5 etc. itemized list - some items are self-explanatory and only need one word, while other items are a full sentence or question.

Below that, I have a list of "Current Medications I am taking" to save all the time the first nurse or office worker otherwise wastes asking me about medications one-by-one by dose and frequency.

And at the bottom is typed: "Please place a copy of this list in my medical file."

When the first office person or nurse or tech comes in to the examining room, I hand a copy of the list to her; when the doctor comes in, I have the 2nd copy ready to hand to him/her if he/she isn't holding the 1st copy in their hand when they walk into the room, and I let them see that I am retaining the 3rd copy to look at while I talk to them and cover each topic on the list.

It is clear that the doctor and the staff like this system - it seems more efficient, and they don't have to worry that the conversation is going to ramble or go on endlessly, because they can follow my numbered list of discussion items right down to the last one so they know when they will be done. Since we are both carrying on the discussion from copies of the same list, I don't have to worry that I will forget something, and they know when the conversation/consultation will be over. They clearly like and respect my system, as they are respectful and friendlier since I have been doing this.

Of course, I keep a copy of this paper on my computer, so that it is less work to just make modifications to it and re-print for each subsequent follow-up visit.

Just a suggestion I pass along for what it may be worth to others.

Best wishes, Nate