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Do I need to switch doctors/providers to make progress?
#1
Angry 
I’m completely new to the whole of sleep apnea and am wondering if I need to switch doctors or providers. It just doesn’t seem like it should be this hard. I’ll try to be brief with the details:

I’ve had headaches for years. Saw a neurologic (mid-August) and he ordered a sleep study. He told me to go anywhere. I did some research and found a center. I had the first study in mid-October. Results came in and dr. called me (in the evening) to say I had sleep apnea and needed second study. When I contacted the sleep center, there was lots of confusion as to what I really needed (i.e., CPAP machine, second sleep study). Receptionist at the neurologist = clueless. Second sleep study in mid-December. The results weren’t ready when I had a follow-up visit with neurologist. A week later I received a prescription in the mail for a CPAP, but no direction where to go to get one. The receptionist said that they really don’t deal with that. Insurance company instructed me to search the Durable Medical Equipment listing online, I saw nothing that stated anyone carried CPAP machines so I just started calling around and found an insurance contracted provider. I called the provider and was told to fax my prescription and the results from the latest study. A week later I called to make sure that everything was proceeding, only to learn that they “never got the faxes”. I asked the dr’s office to re-fax . I called today to check on the status and learned they were waiting for the insurance. Called the insurance and learned they were waiting for the provider, but couldn’t tell me what they needed from the provider. I also learned that the claim’s determination deadline is next Friday and if the insurance doesn’t have everything, they will deny the claim and I would need to follow the appeal process.

Is it really supposed to be this painful? My primary dr. said that the doctor’s office was supposed to take care of everything. Do I switch neurologists? Do I get a sleep doctor? Is it normal to pay the full amount of my out of pocket costs before the DME provider will set up an appointment? This stress is not helping with my headaches!
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#2
Welcome to our group. Sorry you had to join us.

However, this delay may have been a blessing in disguise. Read the links in my signature line at the bottom of this post to get some clues on how to not get screwed by your DME. In particular, you can get some hints on how to get a fully data capable machine.

Unfortunately, you often have to manage your own therapy yourself with today's assembly line medicine.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#3
(01-09-2015, 06:04 PM)The Quilting Cruiser Wrote: Is it really supposed to be this painful? My primary dr. said that the doctor’s office was supposed to take care of everything. Do I switch neurologists? Do I get a sleep doctor? Is it normal to pay the full amount of my out of pocket costs before the DME provider will set up an appointment? This stress is not helping with my headaches!

Is it supposed to be this painful? Well, no.

My respirologist gave me a prescription for CPAP and a list of providers in my town and said "pick any one". I picked a dealer near me and things took off from there. Too bad it took about six months to get the appointment with the respirologist!

As to whether you should change doctors I can't say. Perhaps you need to be a wee bit assertive. It's your life you know.
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#4
(01-09-2015, 06:04 PM)The Quilting Cruiser Wrote: Is it normal to pay the full amount of my out of pocket costs before the DME provider will set up an appointment?

No, it is not normal. One piece of advice -- get your prescription in writing; plus a copy of the sleep report. And, if it was done in two sessions, get both reports.

The first session was likely a sleep test to determine if you have apnea.
The second would be a titration study to find CPAP therapy parameters.
The sleep lab maximizes profit by doing it in two sessions. They can do a split night session where the two sessions are combined.
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#5
The plain truth is, it's about your health and well being but it's business and money for the other players. You must push them when necessary.

If you have Medicare, it's somewhat easier since they protect you from being ripped off. All you have to do is make sure the supplier accepts Medicare assignment.

If you have private insurance, you have to watch out for yourself. You need to have your chosen supplier call for approval of the type of machine you plan to get. Then you must come to some understanding of how the supplier will be paid. Some will wait until the insurance pays them before billing you for your part. Others will want full payment up front and let you wait for the insurance company to reimburse you. It all depends on how they choose to serve their customers so shop around for the most accommodating one.

If you don't have any insurance you need to make the supplier aware of that and get their best cash price. Try for an open box or possibly a demo machine that is priced accordingly. You can also buy one online from several sources at a price usually lower than elsewhere.

Lastly, and applicable to all instances, since it sounds like you'll be doing your own titration, check the way your prescription is written. If it doesn't specifically call for a data capable auto adjusting machine, then you should go back to your doctor and request that he include that info on the prescription. Otherwise you will have to haggle with the supplier and the insurance company and may not succeed in getting the best machine for your purpose.
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#6
Out of all the sleep studies that I have had, every time, the doctor that read my sleep study wrote a script and sent it to a DME. If I didn't like that DME, I would make sure I had a copy of my study and the script and go where I wanted to.

The process that you and others have faced is just something I haven't experienced. I am not even sure what to tell you other than call the sleep center if you don't have a copy of the study or the name and number of the doc that read it and then ask them and/or the doc's office to write a script for you for an auto machine and put dispense as written on it.

I am sure others will have thoughts on how you need to proceed.
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#7
Hi
The Quilting Cruiser,
WELCOME! to the forum.!
I'm sorry to hear that you've had such a painful experience. Unfortunately, this happens far too often.
Hang in there for more suggestions and much success to you with getting this straightened out.
trish6hundred
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#8
I use ZocDoc to find providers and research them. Use that and look for a neurologist or pulmonologist that also has sleep issue medical training. Most really don't; most ENTs don't. You want someone with a practice that sees lots of sleep patients, not someone that sees a lot of runny noses.

ZocDoc is easy...put in your insurance and location, and they do the rest. They let you see what the training is. They also give reviews like other sites do. Just don't use them to schedule, because they mess that part up regularly. Also, not all docs in your plan use ZocDoc, so they don't have an exhaustive list.

Your current provider may be just fine, but I would take the fact that his organization is not organized (how ironic) as a sign that maybe the effectiveness of his procedures with patients may also not be well-organized. If you are dealt a crappy hand in draw poker, what do you do? Draw new cards.

The silver lining here may be that since you had such a frustrating experience, that it has led you here.
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#9
Quote:The sleep lab maximizes profit by doing it in two sessions. They can do a split night session where the two sessions are combined.

First, realize that many sleep labs have a criteria that must be met before they can do titration the 2nd half of the night. If the criteria is not met, then they continue to record proceedings and the doctor determines whether you (a) have sleep apnea and/or (b) can benefit from cpap/bipap/vpap. While I do think some sleep centers probably drum up $$, if your sleep study showed that you had severe apnea and they didn't do the split study, then you have cause to report them to your insurance company (and Medicare if they have Medicare patients).

Now, on to the original poster - Having had severe headaches with 3 separate causes for years, I sympathize greatly. It's hard to think under those conditions.

First, with your insurance company - will they allow you to simply buy a machine and then get reimbursement? This would save you a lot of effort since you can get help with setting the machine yourself here. You would only then be dealing with your insurance company regarding compliance.

In my experience with a lot of medical things, but particularly durable medical equipment, you have to constantly get on the phone and ask "What can I do to get this to progress? Whose butt should I light a fire under?" I have to do this for my brother all the time and more often than not, the doctor ordering the equipment doesn't know that s/he needs to provide information to the insurance company/Medicare in a particular format. Not necessarily the doctor's fault, mind you, since rules change and that isn't their job. If a fax doesn't go through the second time, I call the office manager of where the fax should be received. HIPPA laws really help you in this regard - your medical information isn't supposed to be going off into the ether. I've gone so far as to simply go to the doctor's office and ask them to give me the copy of what they are faxing and hand carrying it to the office where the equipment is to be had. This is actually the BEST thing for you to do in your case, I think, due to all the delays. Call your doctor's office and tell them that you are coming in to get a copy of your script and documentation. Ask that the doctor signs it so they can't come up with an excuse about 'electronic' signatures or some such thing. You no longer want your medical information faxed because you don't know where it's going to but it clearly isn't getting to the necessary people.

Finally, if you do bring the hand signed script, don't let them take it!! They can simply make a copy of it and you keep the original.
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#10
Get a hard copy of your prescription and your sleep studies. This is no different than getting your glasses prescription!


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