Sleep doc follow up and possible APAP

Well I had my 1st follow up with my sleep Dr since my initial diagnosis and prescription for CPAP. He asked how I was doing and I was honest I told him I felt like crap most days. I spent about 40 minutes going over why I am so tired, explaining that I am being treated for all conditions relating in any way to OSA such as hypothyroidism, depression and excessive daytime sleepiness and that I didn't think lowering my pressure has helped me any. He was very impressed with all the data I had compiled over the last 3 months and how much I new about my treatment. I have to thank you all for that because I new next to nothing before finding this forum!

We went over my sleep studies from August 05 (pressure set at 18 cm/w) and January 06 (pressure set at 10 cm/w) and how he felt they were correctly done. I explained that the 2nd study done in January had me sleep for 4 hours with only my dental appliance which made me extremely restless with unsatisfying sleep and not until 2 1/2 hours before getting up did they put me on CPAP. The tech started me at 10 cm/w and I had only one apnea. I told the Dr I looked at my software and I hardly ever have any apneas until the last two thirds of the night. I suggested since I had such a light sleep starting the study that maybe I didn’t run into the part of my sleep where I normally hit most of my apneas. Also pointed out some of my more prominent apneas are in certain positions. I mentioned in the last study I mostly slept in one position and that maybe that affected the titrated pressure.

I asked him about possibly needing more or less pressure depending on each night sleep needs such as how tired I was that night and what positions I was in as I slept. I had found out that sometimes he does have the DMEs lone out an APAP for a short time to check pressure needs. He suggested that I could get an APAP from my DME to try for a couple of weeks. If it was found to be more beneficial than my CPAP for meeting my sleep needs he would consider letting me have an APAP if it showed a change in my prescribed pressure over the two weeks.

I explained to him that “if” a change was made regarding my machine that I was most likely at the end of my insurance reimbursement for the unit I have now and I essentially will own it in a month. I told him if a change was made I would like a hard copy of the prescription so that I could have options as to where I might obtain any new equipment. I said if the insurance company would not pay for an APAP unit at my DME because they had just met the price of a CPAP then I would go to CPAP.com and order it there and pay out of pocket for it if I needed to do that.

I am sorry this is so long but other than my wife no one wants to take time to listen to anything regarding my treatment other than a short comment from me like “I’m feeling fine” or “boy did I have a rough nights sleep”. Most people I come across assume that apnea problems are just ordinary sleep problems and nothing to complain about so they are very uninterested. I do offer explanations about the effects of OSA if people seem willing to listen but most times they just want to move on and talk about something else.

Thanks for listening

Dale

Dale,
I'm curious. How much, would you estimate, that you have paid for the Pro 2?

If you have the heated humidifier for the Pro 2, it may work with the current model RemStar auto. But I don't think it will work with the new 'M' series units.

If your curious about the value of your Pro 2, check out Yahoo Auctions, they have several Pro and Pro2 units up for auction....

I wish cpap.com did trade-ins...

oldgearhead,
I would have to did up my SOBs from my insurance company over the last 9 months but I think out of pocket probably only 100 bucks or so for the CPAP unit itself.

I had considered asking if the heated humidifier would work with say a RemStar Auto if I end up getting a new machine which would help cut the cost down to a more manageable level. I did not even consider the M series because I don't think they have a humidifier available yet and I definitely need a humidifier.

As for Ebay auctions, I have never participated in anything on Ebay so I am unfamiliar with how to go about doing that but I am sure I could figure it out. I thought though that I had read a few posts in different threads that Ebay did not allow selling health equipment such as CPAP machines ---- I may be mistaken about this.

Dale

Dale,

FYI......your heated humidifier on your Pro 2 WILL work with the REMstar Auto (non-"M" models).

Den

Thanks wulfman,
You must have logged out to mark the spam post because I couldn't check your equipment to see if you use the remstar auto which I assume you do.

Now I have to wait for the doc to contact the DME and then the DME to get back to me to start the APAP test to see what happens. Could be awhile because they do not move very fast as a lot of folks here know.

Dale

Dale92,

You have a RIGHT to your prescription. They can't refuse to give it to you.
My sleep doc wouldn't prescribe an Auto without seeing me first AND when I made teh appointment it was 3 months away AND that was AFTER telling them that my current machine was dying and I needed to replace it NOW! I went to my regular doc and told her what was going on and she wrote the prescription exactly as I asked for it. All it said was "Auto CPAP"

Done deal. Sent it to cpap.com and bought my Remstar auto out of pocket.

I think in order for this to work AND be effective and as SAFE as possible, you have to be educated enough to be able to explain your reasoning for wanting whatever it is that you want. When my doctor asked why I wanted a machine that operated at a RANGE of pressures as opposed to the single pressure I was prescribed, I told her this...

"When my pressure was determined, it was based on one night's sleep in a lab with all kinds of wires hooked up to me. With the REMstar Auto I can still run it at a single pressure if that proves to be the most effective treatment for me, but I also have the OPTION of running the machine at a narrow RANGE of pressure to see if my pressure needs appear to have changed from that one night over 5 years ago. With the smart card and the software I can easily see the results of any changes and I can tweak the settings for optimum treatment. My sleep doc obviously doesn't have the time to devote to a single patient to get as detailed as I can be on my own. And any time you'd like, I can fax or email my current data."

She just smiled and said, "You honestly sound like you not only know what you're doing and have LEARNED how to care for your apnea, but you also sound like you know more about effective treament than many doctors who supposedly specialize in it."

That's pretty revealing, I would say. I love my regular doc.

Hey Yardbird
Yah I think my sleep doc is pretty decent and my regular doc also. But my regular doc would never give me a prescription for CPAP because being a family practitioner he would say it is outside of his field and would prefer I seek someone who knows more about OSA. With my sleep doc I explained my problems and the logical conclusions I reached sort of the way you did explaining that these were only two tests on two nights and the second one did not work out very well -- that on any given night I may have different needs. He was not sold on the idea my pressure may not be correct at first but listened to my reasoning and agreed that I was having more trouble than I should. He was very happy that I took such an interest in my treatment! I was careful not to sound like I was telling him what to do just explaining what I understood about my treatment as it was progressing or not progressing and presenting data from my software.

One point the doc made a statement where he said he wished the sleep clinics that I went to had the same software (Encore Pro) that I had so he could compare data from what the sleep clinic got and what my software would get on the same night. Next time I talk to him I will volunteer to have a sleep study if they have a Remstar using Encore Pro software as long as they don't charge me for it, just in the interest of science so he could compare apples to apples. He said it would really make his job easier if he had a way of comparing data from the same night from a sleep study and Encore Pro software because if more patients used the software then he would know how they are doing based on something he knew and had compared to his normal testing.

Dale

Why would you need a new prescription for an auto. Look under FAQ for Cpap.com and read that a cpap prescription is fine for APAP. Just get your prescription from whomever wrote it the first time "for your files". You don't need your doc to agree with where you buy it and what you buy. The prescription is good for another machine from the vender of your choice.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, CPAP, Prescription, auto, APAP

I forgot to second the post that YES the humidifier is the same for the Remstar Pro 2 and the Auto. Same part number. I have both (only a pro not pro2).

Only difference is if you think you might want an extra humidifier, with the Remstar Auto purchase it is only an additional $110 for the humidifier when you buy them together and if you get just a humidifier it is $160.

I tend to be a packrat and get the whole unit. Kind of like buying a new computer and the moniter and printer coming at almost for nothing with the package. But if $110 means a lot, you can just get the Auto and use the other humidifier that you already own.

Dale,

Very intuitive.....that I was the one that marked that SPAM post.....

Actually, I have the Pro 2 machine. However, I'm planning on getting another machine for a backup and it may be a REMstar Auto. I'm not sure if I REALLY need the Auto, but.....what the heck.....it's only money, and I've saved a lot of it by not having to buy a bunch of other masks....

Snoregirl is right. You can buy an "Auto" with a prescription for a CPAP.....it's the same billing code number for both. And, at CPAP.COM, your prescription is good "forever".

Best wishes,

Den

Hey Den and Snoregirl thanks for the replies!

I am confused by one aspect of what you are saying about getting my prescription from the doc, isn't the prescription for one machine or is it something that is considered "lifetime" because of the nature of OSA. The reason I ask is if I get a prescription from a doc for say Provigil, that is given with X amount of pills for X amount of days and refillable say 3 times. I don't understand how I can get my original prescription form my sleep doc since it has already been "filled" so to speak.

As far as where to get the machine I know I can get it from where ever I choose, my DME or cpap.com it just depends on whether the insurance will cover any new machine I get. If they say yes I will most likely get it from my DME since they are "in network" and it will cost relatively little compared to cpap.com which is considered "out of network". But that out of network stuff is being appealed by me through my insurance company. I figure since I am buying my own equipment and saving them money they should consider me to be my own DME and give it to my at "in network" rates. But it think that will happen when you know what freezes over

I do realize that APAP and CPAP are the same codes for insurance so they wouldn't know the difference but I am unsure if they would honor me getting a second machine on the same prescription. Oh and I realize I have a right to have a hard copy of the prescription if I ask for it which I will when I see him the next time.

Any thoughts from you guys on if the prescription is usable indefinitely or does it end when you buy a CPAP and then if things change in the future you need to obtain a new prescription?

Dale

Dale,

I think you hit the nail on the head with the quote ".....'lifetime' because of the nature of OSA". It is usable indefinitely. The only limitations to that is how often your insurance will pay for one (or a replacement). Technically, you can buy as many as you want (or can afford).
Will your insurance provider deal with BILLMYINSURANCE.COM? That would be another possible option.

Den

Den I am pretty sure that my insurance would work with billmyinsurance but it would be the same if I purchased it and submitted it to them. Both instances they would be considered coming from cpap.com and that is "out of network". I tried to explain it to them in my appeal on other items I have bought from cpap.com that cpap.com would technically be like a distributor and I would be the DME through whom I purchased equipment. I am pretty sure they will come back and tell me only registered providers in my network are eligible for in network rates even if I am acting as my own provider. They think they save money this way because they cap what they will give out but if I were purchasing from cpap.com I would save them over half of what they are paying for my equipment now.

I have a long wait on the appeal I think - but that is worthwhile if it comes out in my favor.

Dale

The comment on thinking that saving them money is a good thing and "when you know what freezes over".

The you know what freezes over portion has been my experience. My insurance company is not interested in any kind of intelligence or money saving, not even our employer themselves who manages the contract that they buy from a healthcare provider (our company is self insured and just pays someone to manage the program, not like buying a specific policy from BC/BS or whomever). I would have thought that they might be more open to the idea of saving money. NOT!!

My company will not buy a backup machine. I seriously doubt any other would either. But, hey, you never know. The numbers I hear kicked around are 5 years for a replacement. I have no direct experience with this.

PS The prescription is good for more machines. Whether or not insurance might require a new prescription in a couple years or even next year I don't know, but for you to buy with your own money that prescription is fine and doesn't get "used up".

In fact no one ever takes it. It gets faxed it to the DME and the original generally stays in the Doc's office from what I know. When I talked to Cpap.com and also my dme, it is fine to copy and fax even though the copy makes a "Void" show up on the copy due to the special paper. I had to fax one to my DME since it had to be adjusted (no pressure range was written on the original) and I wanted it done quickly so I did it myself and of course filed the original at home (doc knew I was keeping it).

If you have almost paid for this machine, unless you can convince them why you need an auto (maybe you can, but I wouldn't bet on it at this point) I would bet that what you have is what the insurance will pay for. I would love to be wrong though!

From the sounds of it you are happy with what you have, although you question if it is the "best thing" for you.

From what I know and my experience, the insurance is not interested in what is best, just what is adaquate to solve the immediate problem.

So if you want to try auto you are most likely on your own. But should you decide to take the plungs, the old prescription is fine.

Good luck with whatever you decide, I would love to know the outcome our of curiosity.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, DME, Prescription, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, DME, Prescription, auto

Good luck with the appeal. I lost all three levels and was told the only coverage for me buying was out of network with major deductable. Maybe your insurance will be more intelligent!!