Curious about those with the better AUTO-SET machines with software and SD Card readings you give to your doctor...
Much has been said as to the scam of giving people the crappy machines t he hubby and i were both given the S9 ESCAPE
We have had many a discussion on the scam that goes with these, the high amounts they charge ones insurance firm yet pay little for it and that they are rather useless.
I understand all of that.
But in reading this forum, the posts of the ones with the auto-set machine, it seems to me that some of you engage with your doctors quite often.
Sending them your SD card information. Seeing the doctors and working out some treatment options/plans and so on and I imagine some other reasons you might have a visit with him/her.
Knowing that its fairly expensive in the US to see a doctor for the above reasons, and understanding here in Canada, not quite as much but they get around that by overbooking patients through out the day and then padding visits with unnecessary tests and whatnot, there is a great little side line business to be pocketed just in the seeing of the doctor through out the year.
These visits, alone should be making them far more money above and beyond what they would make handing out the machine I have so I don't understand if you are seeing them as often as it would appear OR putting them in a position whereby they can charge your insurance even if they don't see you but need to account for their time going over your data that it doesn't make sense to me for any doctor to throw those visits out the window which they do when handing you an Escape Model.
Since i havent a good SD card theres no reason for me to go TO the doctor unless I really do need something he must prescribe but that wouldn't work out to more than once a year at most I would think?
Knowing the padding that goes on up here in Canada with our OHIP system it especially doesn't make any sense.
They would be making more money from the visits and whatever else they manage to give to you and charge the insurance company will far more outweigh the the money they make from one simple machine.
UNLESS......most patients that get the AutoSet are NOT submitting any data to them, or showing up for regular appointments and so on.
Therefore, of those of you with the Auto Set can any of you guess on an average how many times a year you may see your Sleep Doctors?
Just curious.... :grin:
I got my machine and 1 month later went in for a followup. I took my Sleepyhead reports with me and explained to the staff what they were and how to use them, gave them the address of this site and encouraged them to take advantage of the opportunity we have here. Then we spent 14 seconds going over my actual results. Then they said to come back again in 6 months.
So, maybe twice a year?
When I started, I had my initial visit to try a machine, a follow up to get my own machine, a visit in 2 weeks to check on the progress, another 1 month later (same reason), then my regular visits have been about every 6 months (when I'm due for cushion / mask replacement).
To be honest, there are times when I know more about my therapy and what my numbers mean than the RT looking after me (like the 95% numbers...it's 95% of the time I'm less than that number, not 95% of the time I am at that number...I do NOT need my pressure increased!!). I think it is part and parcel...the DME's are there to make money...whether it is through maximizing profits on the machines they dispense or heavily booking appointments (i.e. short visits, just lots of them...the flurry of visits at the start is a good idea to get you up and running)...it all adds up.
There are 4 types of practitioners. Primary care doctor, Sleep Specialist, RT, Sleep Lab.
I have had 2 Sleep studies, the first in Oct 2010, the last in Oct 2013 when I was moved to an ASV machine.
I have had 3 visits to a sleep doctor the first in 2012, then one just before the sleep study and one about a month after I got my new machine.
The RT at Apria as often as neccessary to get a new machine, mask and supplies. For example it took many phone calls and a couple visits to get the proper filters for my series 60 ASV. They claimed they could not get them, but they arived at my door the day after my visit (when they claimed they could not get them).
My PCP seems to be monthly since he is a DO and can perform chiropractic type work as well as MD type work. He realy does help with things like bursitus and rotator cuff problems.
I haven't seen my sleep doc since January 2012, when he wrote me a script for a data capable machine of my choice, to replace my 6-year old "brick".
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(05-12-2014, 08:17 PM)ShelaghDB Wrote: Curious about those with the better AUTO-SET machines with software and SD Card readings you give to your doctor...
Therefore, of those of you with the Auto Set can any of you guess on an average how many times a year you may see your Sleep Doctors?
1) I don't have a sleep Dr.
2) My PCP says I know more about this than he does, and has no interest in graphs, reports, etc.
3) Just had a rather unsatisfactory visit w/ my PCP, and I may be looking for another soon.
My Health Ins is HealthSpan, formerly Kaiser, an HMO. I had a sleep study, run by a lady Sleep Tech. A while later, a Sleep study summary report was provided, which indicated I had Moderate sleep apnea (AHI 36). After a home titration (2 nights w/ a loaner S9 Autoset) a recommendation was made for CPAP at fixed pressure 14 (which turned out to be wrong). The sleep report was written by a Neurologist/Sleep Specialist I have never met or seen. In the summary report, she never mentioned position as a factor. After using my own S9 and reading my data for a month or so, it seemed that sleeping on my back was worse. I tracked down the Sleep Tech, and she had a copy of the report before editing. In that report I found that my AHI was 20 times higher when on my back. For whatever reason, the Sleep Specialist decided that I didn't need to know this, and excluded that data from the summary report.
Fortunately, I had read enough on this forum to know what machine I wanted. I stood firm and got it, and I have pretty good command of the OSA now, with my weekly average usually below 1.0.
Frequency of visits: I have to guess about 0, now I'm done with the initial phase of this. Unless I change insurance, or they change their ways, I don't expect to find any help there.
Hope this is the info you were looking for.
In my case I had a huge amount of contact with my sleep doc during the first year of PAPing because I was feeling absolutely horrible with the PAP. As in a hundred times worse than I'd felt before starting PAP.
I had a full efficacy data S9 AutoSet at the start of PAPing. The PA in the sleep doc's office and I knew that my problem was NOT caused by leaks or my pressure not being high enough to provide effective therapy: My leak lines were superb and my AHI was consistently below 2.0 and usually below 1.0. And yet, I was in the middle of a severe crash and burn in terms of daytime functioning and night time sleeping that started within three days of starting PAP.
Having the data kept us from randomly trying to fix things that were simply NOT the cause of my problems. For example, I was using a Swift FX nasal pillows mask at the time. Because the PA could see my leak line was excellent, I was NOT subjected to repeated suggestions that I needed try a full face mask in case I was mouth breathing. Rather, my multiple semi-emergency appointments with the PA focused on just what might be triggering my aerophagia and my intense and growing insomnia. And the data allowed my PA to make useful suggestions on changing the pressures. First from CPAP to APAP and then to a narrow APAP range. And when that still didn't work, the PA and the doc had plenty of data to justify switching me to a BiPAP even though I didn't meet the usual criteria of problems with high pressure settings.
During my second and third year of PAPing I was still seeing a sleep doc more often than most. I still had unresolved problems with insomnia and delayed sleep phase that set in after I started PAPing. And it took a lot of time to sort things out. I saw my current sleep doc in January, June, July, and August of 2013 because of some resurgent problems I was having last spring. Since August, I've been in email communication with the doc, to keep him up to date with the progress I've been making on addressing the issues we talked about last August with the strategies he wanted me to try.
But neither the doc nor I has felt that it is critical for me to have a follow up right now. (I will, however, probably ask for a routine follow up sometime in the late summer or early next fall).
05-15-2014, 10:19 AM
(This post was last modified: 05-15-2014, 10:20 AM by DocWils.)
OHIP is a weird and wonderful place when practising medicine, and one of Canada's more, shall we say, complex set-ups. The GP makes the same per visit from OHIP pretty much no matter what he does - extras are charged on and back to Ontario (and ultimately, the Feds) and reimbursed to the practice in a rather Byzantine manner, or directly to the patient, depending on the agreement, but there is little or no profit in that section - costs are covered, not much beyond that (although scams in that area are not uncommon - coding for 20 bandages and actually using one or such, but there are crack downs in that area and spot inspections). I have a few friends practising in Toronto (or is that Cherannah?) and in Ottawa, and one running a practice (and a farm) on the Ontario/Quebec border and dealing with both health authorities, and I hear stories, lots of stories (to start with, all are overworked and, for the amount of work, underpaid, and Ontario's desperate shortage of General Practitioners is starting to make other GPs quit and move elsewhere because of the massive load of patients they are forced to take).
But in terms of why you got the machine you got, well, that is a mystery - you should have gotten a top-line machine, no matter what, since agreements with the manufacturers and suppliers are handled in bulk directly by the health authority of each province, thus driving down the per unit price on most things (and adding a subsidy in the process), so I can only assume budgetary cuts are forcing OHIP to seek the cheapest possible solutions unless the Rx insists on the top-line solution. Blame your government, and get better ones elected. Considering what the folks voted for the mayor of Toronto (a dangerous clown), the Provincial government (incompetent and clueless), and above all, the near criminal government voted in to run the country (yep, I am incensed at the Herpes government), I am not surprised. Time for you to get out the vote and get the NDP or the Liberals back in power on all levels. Maybe then you will be given top of the line equipment again as a matter of course.
05-15-2014, 10:55 AM
(This post was last modified: 05-15-2014, 11:02 AM by ImaSurvivor.)
I have only seen the sleep doctor twice (actually it was the physicians assistant that saw me both times). First time to go over the results of the polysomnogram and let me know I would have another sleep study for titration. I received my machine and saw the sleep doctor's assistant 3 months later. She removed the card from my machine popped it in the computer for a few seconds, returned the card to the machine and said I was doing great and told me to come back a year later. I was told let them know if I was having any problem and I could make an appointment to come in sooner if needed. I am glad to be able to follow my progress on my AutoSet. I know I feel better but it is nice to have the confirmation of data to let me know my data is staying in the acceptable range.
ShelaghDB, in Ontario you have free sleep studies and as many free visits to your sleep doctor as the doctor wants. Even if you hate your doctor you can just go to another one for free. The culture in places like an urban area as Toronto, is to get a brick machine and let the doctor set the pressure by doing multiple sleep studies and titration studies to make up for this. You have the benefit of available sleep doctors and sleep labs, so the onus is to visit your doctor.
MANY people including in the states don't have such access to have a doctor patient relationship like that, so using auto cpap is better for them.
Also in Ontario the ADP program pays for 1080.00 for any Cpap machine you want. So if you can find a vendor to sell an autoset or remstar Auto then do so, but in your case it's not AS important as you can schedule a FREE appointment and sleep study with your doctor any time in Ontario Canada, and not have to worry.
If you want to skip the doctors appointments and all the vendor politics, just buy a Autoset online in the states and use that. Done.
Why you wouldn't want to see your sleep doctor as much as possible to solve any problems you have seems odd, if the doctor thinks you need the machine YOU think you need, then it will happen.