Will I get into trouble for changing settings on my own?

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Sleeper Agent
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Will I get into trouble for changing settings on my own?

Post by Sleeper Agent » Tue Jul 15, 2014 2:11 pm

I got my CPAP a week ago through insurance and a local DME. I have been monitoring my data using sleepyhead and steadily optimizing my treatment: AHI went from diagnosed of ~13 to ~5.8 to ~1.5.

The only problem left is the painful aerophagia (air swallowing), which happened after I forced myself to sleep on my side, which lowered the AHI from ~5.8 to ~1.5 for 4 days in a row.

My doctor and I agreed that I should try a lower pressure setting (just one less), and monitor my AHI and aerophagia. If that didn't work, the doctor agreed that I should try an even lower setting (another one less) and see if that helps + maintain the AHI.

However, I am finding it hard to get through all the red tape. I have to call my DME, and the clerk would not be able to do anything and have to get someone else to call me back. It will take them FIVE hours just to call back and tell me I need to call my doctor. Then, I have to call my doctor and it will take forever to reach him. And the cycle continues for every change I want to make.

Question: will I get into trouble with the insurance if I make the changes myself?

I might have to bring the pressure back up if the AHI failed to remain stable, experiment with Gas X, experiment with the exhale relief etc etc. I don't want to have to go through back and forth calling and long hours of waiting every time I need to try something.

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Julie
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Re: Will I get into trouble for changing settings on my own?

Post by Julie » Tue Jul 15, 2014 2:21 pm

No, of course not. We all do it all the time and quite honestly I really don't think the insce. co's care about your tweaking anything... as long as they get paid, you could probably stand on your head in the street and play tiddly winks... there are no Cpap police around. Don't let the DME's (or MD's receptionists) give you a hard time.

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Re: Will I get into trouble for changing settings on my own?

Post by BleepingBeauty » Tue Jul 15, 2014 2:23 pm

Sleeper Agent wrote: Question: will I get into trouble with the insurance if I make the changes myself?
Yes, expect a knock on the door from the xPAP Police, so have money on-hand for bail.

No, you won't get into any trouble. Your doc is on-board with the careful changes you're making to your therapy to optimize your results, and the insurance only cares that you're using the machine (compliance) so they have a good reason to continue to pay for it. Best of luck.
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archangle
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Re: Will I get into trouble for changing settings on my own?

Post by archangle » Tue Jul 15, 2014 2:28 pm

If you screw it up, you may make your therapy ineffective and suffer the damage from apnea again. I did that myself and was miserable for a while.

Often times, the medical mafia (DME, doctors, and insurance) get ticked off if you intrude on their turf.

If your machine has a wireless modem, they can detect the change and readjust it remotely.

They probably won't notice if you change the pressure. Usually the insurance only checks or cares that you use it a certain number of hours per day for "compliance." The DME's usually only cares about compliance so they get paid by the insurance.

Question for the "self tweakers:"

Have any of you been "caught" adjusting your own pressure by the DME or doctor if you didn't tell them?

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Re: Will I get into trouble for changing settings on my own?

Post by Sleeper Agent » Tue Jul 15, 2014 2:31 pm

Julie wrote:No, of course not. We all do it all the time and quite honestly I really don't think the insce. co's care about your tweaking anything... as long as they get paid, you could probably stand on your head in the street and play tiddly winks... there are no Cpap police around.
Isn't there a 30 days 4 hours minimum a day compliance that the insurance companies require?

Does that also include "obeying" the doctor's prescription for those 30 days? Its so much effort to get them a new prescription every time I want a change, I feel like just trying things on my own until I find something that works, and then just get one prescription for it.

My doctor probably won't authorize me having free rein up front, since that would probably jeopardize his job. But I am pretty sure he would be totally on board if I eventually manage to get a setting that works.

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Re: Will I get into trouble for changing settings on my own?

Post by Sleeper Agent » Tue Jul 15, 2014 2:37 pm

archangle wrote:If you screw it up, you may make your therapy ineffective and suffer the damage from apnea again. I did that myself and was miserable for a while.
Well, I am miserable now from the painful aerophagia.

I read my data and keep an eye on my AHI everyday. It should be really hard to screw up, since I can always go back to the old settings that worked. Or am I mistaken?
archangle wrote: If your machine has a wireless modem, they can detect the change and readjust it remotely.

They probably won't notice if you change the pressure.
Yes, my machine has a wireless modem. I am betting that if I change it at 11 pm at night, they won't readjust it back until the next morning.

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Re: Will I get into trouble for changing settings on my own?

Post by archangle » Tue Jul 15, 2014 2:48 pm

BTW, what's your EPR setting? Sometimes that helps with aerophagia.

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Re: Will I get into trouble for changing settings on my own?

Post by Sleeper Agent » Tue Jul 15, 2014 2:51 pm

archangle wrote:BTW, what's your EPR setting? Sometimes that helps with aerophagia.
EPR 2. Going to 3 or 1 or 0 is on my list of things to try.

Right now, I want to try lowering the pressure another notch first because my doctor said from my in-lab sleep study, I should be alright on that pressure setting when I sleep on my side. Then, maybe try Gas X.

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Re: Will I get into trouble for changing settings on my own?

Post by archangle » Tue Jul 15, 2014 3:22 pm

Sleeper Agent wrote:EPR 2. Going to 3 or 1 or 0 is on my list of things to try.

Right now, I want to try lowering the pressure another notch first because my doctor said from my in-lab sleep study, I should be alright on that pressure setting when I sleep on my side. Then, maybe try Gas X.
The standard suggestion would be to try 3, and check to be sure your AHI doesn't increase.

A bilevel machine is a bigger step to try and eliminate that problem.

Gas X may work, but you should understand how it works. Gas X just bursts the bubbles in foam and makes it easier to belch up the gas or prevents the foam from running up your esophagus. It doesn't actually eliminate or prevent gas on its own.

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Re: Will I get into trouble for changing settings on my own?

Post by Sleeper Agent » Tue Jul 15, 2014 3:27 pm

archangle wrote: The standard suggestion would be to try 3, and check to be sure your AHI doesn't increase.
Thanks! Will try EPR 3, after trying the lower pressure. Since my doctor recommended the lower pressure, its easier to explain if I get caught.
archangle wrote: Gas X may work, but you should understand how it works. Gas X just bursts the bubbles in foam and makes it easier to belch up the gas or prevents the foam from running up your esophagus. It doesn't actually eliminate or prevent gas on its own.
Yeah. I am hoping it will help me tolerate the gas.

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Re: Will I get into trouble for changing settings on my own?

Post by BlackSpinner » Tue Jul 15, 2014 3:33 pm

kids change their insulin levels based on their readings, do you think you should adjust the level of AIR? You can kill someone with insulin - the only way to kill someone with a cpap machine is to hit them with it.

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Re: Will I get into trouble for changing settings on my own?

Post by Tatooed Lady » Tue Jul 15, 2014 3:45 pm

archangle wrote:
If your machine has a wireless modem, they can detect the change and readjust it remotely.
The FIRST time I find out they've changed my settings remotely, I'm taking off the modem and telling them to let me know when they want compliance data, I will hook it back up at that point til it sends the info, then take it off again. I'm the idiot with the hose hooked to my face, trying to sleep. If I can't sleep, I'm out of compliance, I'm out of a job, and have no one to blame but MYSELF for not making this as comfortable for myself as possible.

That being said, I started using my machine 5/23. I first adjusted settings on 6/22 after a month of dealing with the "prescribed" wide open setting. I have since fiddled with settings to make therapy more comfortable for ME so I stay in compliance with room to spare for a "bad night" or two. They just checked my data, so I'll double check, but I doubt they CARE what I have it on, so long as I'm using it.

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Re: Will I get into trouble for changing settings on my own?

Post by palerider » Tue Jul 15, 2014 4:09 pm

BlackSpinner wrote:kids change their insulin levels based on their readings, do you think you should adjust the level of AIR? You can kill someone with insulin - the only way to kill someone with a cpap machine is to hit them with it.
*lols*

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Re: Will I get into trouble for changing settings on my own?

Post by Sleeper Agent » Wed Jul 16, 2014 6:51 am

I decided I wasn't going suffer another night of painful aerophagia while waiting for them to wade through all the red tape. So, I lowered the pressure myself (to a setting recommended by my doctor when I last spoke to him).

AHI was 2.31, a little higher (+0.5), maybe a fluke since 12/14 are central apneas. The aerophagia went down SIGNIFICANTLY. Definitely tolerable.

I am so glad I went against the system.

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Re: Will I get into trouble for changing settings on my own?

Post by HealthyandHopeful » Wed Jul 16, 2014 7:15 am

Sleeper Agent wrote:
Question: will I get into trouble with the insurance if I make the changes myself?
I'm glad you asked this -- I had been wondering the same thing. I have only adjusted the EPR and mask settings (well and the TIME on the clock). And have wondered about having just changed the small settings. I won't be changing pressure until after my 30 days, if I do at all. One night I forgot to put the SD card back in after having it my laptop, and I'm hoping they don't notice!! (I am a rule follower by nature!)

Another question -- after the 30 days compliance check, do most insurances make you come back for compliance checks again? If so, how often?

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