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Just titrated - few questions
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Paptillian Offline

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Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #1
Question Just titrated - few questions
Greetings and salutations!

I just had my CPAP titration study last night and am waiting on the results. I'm expecting to be on a CPAP machine soon, so I wanted to pop in here, say hi, and get some ideas. It took me quite a while to get to this point as I've been fighting my insurance company for the authorization since January when I was diagnosed. Glad to be here finally.

The good news is I was able to tolerate the mask and I think I actually slept (can't verify because the tech. was not allowed to speak with me about the results). Bad news is I woke up tired, so I'm probably not going to get the next-day Energizer bunny effect that some lucky folks do.

I'd appreciate some advice on how to proceed from here. The sleep center had me fill out a form and choose from a list of local DMEs. I didn't appreciate that I wasn't given a choice other than those listed there, or even an online option. Anyway, I arbitrarily chose the one closest to my home. I presume the doctor will automatically forward my prescription to them and I'll be getting a call from the DME.

I tried calling the doctor's office today to discuss some concerns but, as usual, my calls go to voicemail. While I wait I was hoping others can chime in on the questions below?

1. How do I go about getting a copy of my prescription so that I can change DMEs later if I feel the need? Is the doctor obligated to provide it to me?

2. How do I ensure that the DME gives me the machine that I want? One of my questions to the doc. will be whether he can specify it on the script. I don't know if he'll do it. The local DME that I elected has a website but they do not list the machine that I want. They only have an older Resmed model (S8 Escape).

3. Can I request the doctor to not auto-forward my script to a DME, or is he legally obligated to do it? My insurance provider informed me that they will only cover it if the DME is in-network... so I need to shop around. I do not want to be stuck with another large bill at the moment.

4. Will the doctor or insurance company be tracking my usage? Back in January I had heard something about 'compliance.' How do they check? How long do they check for? What are the compliance rules and what happens if I fail?

5. When does the machine become mine to keep and do I need to do something now in order to set it up that way? My insurance company said they pay to rent the machine. I asked if it's a "rent to own" type thing and they gave only a vague 'yes' and the guy wasn't too confident. I'm not sure what to expect. I have a high deductible plan with 80/20 coinsurance, so I figure I'll be overpaying for the machine out of pocket anyway after the DME charges ridiculous rates for it. I would like to be at least making payments toward something I will own.

6. Is it customary to see the doctor for a consultation after a titration? They did not indicate that I would be seeing the doctor again. I think the next person I'll hear from is the DME.

Sorry for all the questions, but I really do appreciate any advice you can give. Thanks in advance!
06-14-2013 10:27 AM
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PaulaO2 Offline
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Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #2
RE: Just titrated - few questions
(06-14-2013 10:27 AM)Paptillian Wrote:  1. How do I go about getting a copy of my prescription so that I can change DMEs later if I feel the need? Is the doctor obligated to provide it to me?

It is part of your medical record and you are allowed a copy of it and any other record. I suggest you get a copy of the prescription and a copy of the sleep study report. They may try to tell you that the report is huge and you'll not understand any of it. Tell them you will manage just fine. Your doctor is not obligated to give you one, you have to ask.

Quote:2. How do I ensure that the DME gives me the machine that I want? One of my questions to the doc. will be whether he can specify it on the script. I don't know if he'll do it. The local DME that I elected has a website but they do not list the machine that I want. They only have an older Resmed model (S8 Escape).

The prescription can be as simple as the pressure amount. Or it can specifically say "AutoPAP with humidifier". If the doc does prescribe a specific machine or type of machine, make sure the "Dispense as written" part is checked.

The S8 is an older model. And Escape means it is a "brick" (collects only compliance data). Run from that one. You do not want a ResMed with "Escape" in the name nor a Phillips-Respironics with the word "Plus" in the name. Here's a good place to learn all that:
http://www.apneaboard.com/wiki/index.php...ne_Choices

Quote:3. Can I request the doctor to not auto-forward my script to a DME, or is he legally obligated to do it? My insurance provider informed me that they will only cover it if the DME is in-network... so I need to shop around. I do not want to be stuck with another large bill at the moment.

You can certainly request they give you the prescription then you can shop around. Ask the insurance company for their approved list.

Quote:4. Will the doctor or insurance company be tracking my usage? Back in January I had heard something about 'compliance.' How do they check? How long do they check for? What are the compliance rules and what happens if I fail?

Nearly every insurance will do compliance checks. Usually this is for 3 months and you must use the machine for an average of at least 4 hrs per night. If you do not comply, they take back the machine. They can check several ways but one is to have you take the memory card to the DME who downloads the data and sends the hrs to the insurance. They can also attach a cellular modem to your machine and it sends it to the DME that way.

Contact the ins. company and ask about their compliance rules.

And, each time you call about any of this, note the time, date, and who you spoke to. Ask for a letter to confirm the information.

Quote:5. When does the machine become mine to keep and do I need to do something now in order to set it up that way? My insurance company said they pay to rent the machine. I asked if it's a "rent to own" type thing and they gave only a vague 'yes' and the guy wasn't too confident. I'm not sure what to expect. I have a high deductible plan with 80/20 coinsurance, so I figure I'll be overpaying for the machine out of pocket anyway after the DME charges ridiculous rates for it. I would like to be at least making payments toward something I will own.

Yeah, it's a rent to own thing. In the time they finish paying the rental, they could have bought you several outright. Medicare pays for rental for 13 mos and at that point, it is yours. Most ins. companies follow this.

Before you sign, find out what your co-pay is. Then go to Supplier #2 in the Supplier's List (link at the top of ever page) and check out their machines. More than likely, it will be cheaper for you to get one on your own vs through a local DME. You will probably have to pay for your own machine supplies (filters and probably hose) but the DME should still do the masks. You want to do this locally until you find one that works.

There's a wide variety of masks, even within the same type. Don't let them give you a full face mask right off the bat. If you sleep with your mouth open, try a chin strap before you go that route. They're great masks but not for everyone. Many DMEs have a mask trial policy where you get to try a mask for a few weeks then try another one if it doesn't work. Some you will know immediately, others you'll need a few nights or more to decide.

Quote:6. Is it customary to see the doctor for a consultation after a titration? They did not indicate that I would be seeing the doctor again. I think the next person I'll hear from is the DME.

Customary? Eh, depends on the doctor. You should speak to him, to get your questions answered. But it is likely you'll just go straight to the DME.

Quote:Sorry for all the questions, but I really do appreciate any advice you can give. Thanks in advance!

Never apologize for asking questions! This is YOUR health. Grab the situation by the...hand and take control.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
06-14-2013 10:54 AM
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trish6hundred Offline

Advisory Members

Posts: 6,430
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #3
RE: Just titrated - few questions
Hi Paptillian,
WELCOME! to the forum.!
What Paula said.
It's GREAT that you are interested enough in your health to ask as many questions as you need to have a good understanding of things.
Best of luck to you on your CPAP journey.

trish6hundred
06-14-2013 01:51 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #4
RE: Just titrated - few questions
Thanks, Trish! Glad to be here Smile

Paula, I appreciate the info.

I hadn't realized that I could source my own machine and use the local DME for masks. Is there an advantage (besides cost) to try and submit my own claim vs. just paying out of pocket and never telling my insurance about it? Can they deny future DME claims for this condition, maybe on the basis that I never followed through with treatment by their records?

I'm presuming that I would not be subject to compliance checks if I bought my own DME.

Quote:Grab the situation by the...hand and take control.

Big Grin
06-14-2013 03:45 PM
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archangle Offline
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Advisory Members

Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #5
RE: Just titrated - few questions
Welcome to the board, and good luck in the bureaucratic process and your treatment.

If you used your insurance for the sleep test, you're probably screwed in terms of keeping the insurance company in the dark. Probably also true if your doctor is sending bills to insurance.

It might be hard to keep them in the dark anyway. Big Brother knows all these days.

It's probably not worth the effort to try to keep them in the dark.

Find out which DMEs are "in network" for your insurance. Your odds of getting the right machine are much better if you can play one supplier against another. "Hey supplier 2, I'm not happy with supplier 1, will you dispense the S9 AutoSet I want?"

Check my links below for my recommendation on what machines to accept.

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.
06-14-2013 04:31 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #6
RE: Just titrated - few questions
Thanks, Archangle. I'm not trying to keep them in the dark. In fact, I fought for 6 months to get the titration approved because that was just too expensive. Between the two nights, the hospital billed enough to buy a small car. The S9 Autoset can figure out everything that it needs all on its own! It can detect apeas and distinguish obstructive from central apneas. It can auto-titrate. It can detect leaks and report status. Really, wouldn't it be cheaper to skip the 2nd night and just prescribe an S9 Autoset?

I digress...

All I want is the option to get a machine which will give me the most benefit, even if I have to pay more for it. I don't care that insurance may not cover the whole cost... I'm willing to pay the difference as long as it's fair. I just want the option. And I don't want to lose coverage in the future because I don't know where I'll be financially when the first one needs replacement. (Speaking of replacement-- how long do they last?)

Seems to me the biggest barrier is not insurance but rather the DME who is motivated to pawn off the cheapest hardware for the highest prices and do everything in their power to avoid losing that fat profit margin. Get rid of the leeches and maybe we could all get S9 Autosets. Dont-know

I will certainly try pitting the DMEs against each other. That's a good tip.

BTW, your "alternative to CPAP" link really hit home! I know of someone related to my wife who was not using his CPAP and paid the ultimate price. We need more awareness of OSA because growing up I always assumed snoring was harmless (albeit noisy). My father snored heavily for years before he quit smoking. Never once did the thought cross our minds that maybe he wasn't breathing. I'm sure I'm not alone.
(This post was last modified: 06-14-2013 06:34 PM by Paptillian.)
06-14-2013 06:32 PM
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iSnooze Offline
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Posts: 239
Joined: Feb 2012

Machine: Respironics PR System One C-Flex+
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage Micro
Humidifier: System One Heated Humidifier
CPAP Pressure: 11
CPAP Software: SleepyHead

Other Comments: also use a Comfort Gel Full Mask by Respironics

Sex: Female
Location: Indiana

Post: #7
RE: Just titrated - few questions
Hi Paptillian,
Paula and Archangel gave you excellent advice. I wanted to let you know that I received a prescription from my general physician after I received my machine and started cpap therapy. I never saw the sleep doctor. I only saw the technicians who did the sleep study and the triation study. After I received my machine from the DME I started shopping around for replacement masks and that's when I asked my regular doctor to write me a prescription. She did since I had started with her complaining about extreme fatigue.

After I had my machine and was paying my part of the copay on the rent to own program, I did some research to see how much cheaper it would have cost if I bought it out of pocket from one of the suppliers. It turned out that it was about $150 cheaper to use my insurance. I was shocked considering my copay is 20% like yours.

Good luck getting the machine you want.
06-14-2013 09:24 PM
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archangle Offline
Wiki Editor
Advisory Members

Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #8
RE: Just titrated - few questions
Supplier 1 will sell you a new PRS1 Auto CPAP machine with humidifier for around $600. It's an excellent machine. You'll have to get a mask, too.

There is a later model PRS1 60 series Auto CPAP machine, but the main advantage of that model is the heated hose option.

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.
06-15-2013 01:03 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #9
RE: Just titrated - few questions
Been doing a lot of reading and thinking about advantages of auto CPAP. Does such a machine relieve you of needing followup sleep studies to track progress since theoretically the pressure is always correct?

What's the reason that pressures are prescribed anymore? Seems like an overly expensive proposition that requires ongoing maintenance and followup. Are there cases where auto CPAP doesn't work?

Are the doctors and DMEs motivated to keep you coming back, or is there more to it?

Sorry for the newbie questions. I'm still learning and some things aren't making sense.
06-16-2013 12:37 AM
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iSnooze Offline
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Advisory Members

Posts: 239
Joined: Feb 2012

Machine: Respironics PR System One C-Flex+
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage Micro
Humidifier: System One Heated Humidifier
CPAP Pressure: 11
CPAP Software: SleepyHead

Other Comments: also use a Comfort Gel Full Mask by Respironics

Sex: Female
Location: Indiana

Post: #10
RE: Just titrated - few questions
Never feel bad for the newbie questions. I teach and I like it when students ask questions because it shows that they want to learn (or are trying to stall to get out of a test).

I don't have an auto CPAP machine. I was told that the results of my triation test was pretty straight forward and that a constant pressure would do the trick. Not only did the constant pressure reduce the hypneas but I tolerated the pressure well. I can't complain. My average AHI for the past year is incredibly low.

However, everyone is different. Some people need a higher pressure but can't tolerate the high pressure for long for the entire time they sleep. An auto cpap would be better for the sleeper in this case.

Most master members on this forum will tell you that a data capable auto machine is better and they are right. It is better to have the lowest amount of pressure you need to reduce your hypneas. I didn't know the different machine options when I got mine and fortunately mine works for me.
06-16-2013 12:33 PM
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