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New CPAP - Not Happy
#1
Hello again, as I have talked about in the past my girlfriend has had her CPAP for about 18 months with varying levels of success. She has recently changed her insurance from Keiser to Blue Cross. This was in part because we have not been happy with the OSA treatment that she was receiving from Keiser.

Two weeks ago her new Dr sent her for a sleep study. The results of that confirmed moderate OSA with an AHI of 22. This past weekend she went back for her Titration. The result of this was a pressure of 9 (Keiser had her at 18) which makes more sense for moderate OSA. They also sent her home with a new CPAP as well. Previously she has been using a Resmed S9 Elite with humidifier which she still has and has been using up to today. The machine that they gave her is a Respironics REMstar System One 150. From what I can tell this is a very basic unit that does not have any data logging nor does it have exhale relief functions.

Obviously her original machine has far more capabilities than the new one. My inclination is to just reset her old machine to the new pressure and continue using it for daily use and just use the other for naps on the couch and travel. My concern is that she has to send in the card from the new one every 3 months which I suspect is for compliance for insurance. I am afraid that if she continues using the S9 that her insurance will make an issue about the other machine.

My thought is to try to get her another machine with the data and exhale capabilities from her Dr. I do have Rescan and occasionally look at the data from that, but I am more concerned that we won't even be able to get the AHI from the new machine. Without that we will have no idea if the treatment at the new pressure is effective or not.
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#2
Why in the world did the doctor prescribe a new CPAP is she already had one. They could have just reset her current machine since it wasn't "old". Did she tell the new doc that she already had a machine?

If it were me, I'd go back to the doctor and explain your/her position and see if he'd take back the RemStar machine.
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#3
(03-26-2012, 03:15 PM)bobg1946 Wrote: Why in the world did the doctor prescribe a new CPAP is she already had one. They could have just reset her current machine since it wasn't "old". Did she tell the new doc that she already had a machine?

If it were me, I'd go back to the doctor and explain your/her position and see if he'd take back the RemStar machine.

They do know that she already has a machine. I suspect that they gave her a new one since they use Respironics and not RESMed. I like the idea of having 2 so that she can have a backup/spare and for naps on the couch or travel. I would not even mind if the new one could be for that and keep the old one for daily use, but I don't like the idea at all of the primary machine not having data collecting, not to mention the lack of auto start/stop and EPR or C-Flex.

I am the one who monitors her treatment so it is more important to me than her. I asked her to call the Dr. and see what he says about either using the original as her primary or replacing the new one with a data capable unit.
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#4
simply call the insurance company and tell them that she has a perfectly good unit, does not need the new inferior one and will not pay her co-pay for it. they will surely agree not to pay and you return it to the dme. the doctor will have to go along at that point. let the cards then fall where they may with the dme and doc.
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#5
(03-26-2012, 03:34 PM)greatunclebill Wrote: simply call the insurance company and tell them that she has a perfectly good unit, does not need the new inferior one and will not pay her co-pay for it. they will surely agree not to pay and you return it to the dme. the doctor will have to go along at that point. let the cards then fall where they may with the dme and doc.

In her case the Dr. is the DME as well as sleep lab. I am hoping that they will agree to upgrade to a data collecting unit. If not then I will see about just using the S9 even if that means returning the new one.
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#6
(03-26-2012, 03:40 PM)Rritch Wrote:
(03-26-2012, 03:34 PM)greatunclebill Wrote: simply call the insurance company and tell them that she has a perfectly good unit, does not need the new inferior one and will not pay her co-pay for it. they will surely agree not to pay and you return it to the dme. the doctor will have to go along at that point. let the cards then fall where they may with the dme and doc.

In her case the Dr. is the DME as well as sleep lab. I am hoping that they will agree to upgrade to a data collecting unit. If not then I will see about just using the S9 even if that means returning the new one.

conflict of interest alert........ run, don't walk. i wouldn't take anything he says at face value. like i said, they don't have a choice if you drop it in their office and don't pay past the first month. this is one of the very few times i will say if you can't find another doc, you have the tools to do it without a doc.

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#7
(03-26-2012, 03:40 PM)Rritch Wrote: In her case the Dr. is the DME as well as sleep lab. I am hoping that they will agree to upgrade to a data collecting unit. If not then I will see about just using the S9 even if that means returning the new one.
There is conflict of interest here and the doctor ought to be prescribing data capable machines and looking after the welfare of the patients not counting dollars and imo he ought to be struck off.
I would take the machine back to this lousy doctor and demand PR System One Auto or even the newer 60 series with the heated hose.
Others mentioned that you don,t have to get the machine from this lousy doctor/DME, You can get it from any DME on the insurance approved DME list and whether CPAP is auto/data capable or not are paid by billing code E0601 exactly the same amount by insurance just the doctor/DME makes more dollars if he hand out the cheaper machines.


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#8
Yup. I don't like sleep docs who also sell machines. Same as I don't like eye docs that also sell glasses. Low priced stuff, sure, it is handy for the doc office to have. But high end stuff? Nope.

Take the new machine back. Tell them either to give/sell her one that is capable of data or not at all. Or just take it back and switch docs.
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#9
(03-26-2012, 03:55 PM)greatunclebill Wrote:
(03-26-2012, 03:40 PM)Rritch Wrote:
(03-26-2012, 03:34 PM)greatunclebill Wrote: simply call the insurance company and tell them that she has a perfectly good unit, does not need the new inferior one and will not pay her co-pay for it. they will surely agree not to pay and you return it to the dme. the doctor will have to go along at that point. let the cards then fall where they may with the dme and doc.

In her case the Dr. is the DME as well as sleep lab. I am hoping that they will agree to upgrade to a data collecting unit. If not then I will see about just using the S9 even if that means returning the new one.

conflict of interest alert........ run, don't walk. i wouldn't take anything he says at face value. like i said, they don't have a choice if you drop it in their office and don't pay past the first month. this is one of the very few times i will say if you can't find another doc, you have the tools to do it without a doc.
We talked to them this afternoon. They are going to replace the 150 with a 450. They just need the Dr. to sign the order in the morning.
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#10
(03-26-2012, 05:12 PM)Rritch Wrote:
(03-26-2012, 03:55 PM)greatunclebill Wrote:
(03-26-2012, 03:40 PM)Rritch Wrote:
(03-26-2012, 03:34 PM)greatunclebill Wrote: simply call the insurance company and tell them that she has a perfectly good unit, does not need the new inferior one and will not pay her co-pay for it. they will surely agree not to pay and you return it to the dme. the doctor will have to go along at that point. let the cards then fall where they may with the dme and doc.

In her case the Dr. is the DME as well as sleep lab. I am hoping that they will agree to upgrade to a data collecting unit. If not then I will see about just using the S9 even if that means returning the new one.

conflict of interest alert........ run, don't walk. i wouldn't take anything he says at face value. like i said, they don't have a choice if you drop it in their office and don't pay past the first month. this is one of the very few times i will say if you can't find another doc, you have the tools to do it without a doc.
We talked to them this afternoon. They are going to replace the 150 with a 450. They just need the Dr. to sign the order in the morning.

be sure what you are getting. mine is a pr system one remstar automatic with a-flex 550P and is fully data capable. just because that one has a data card does not make it fully data capable.

just looked it up and could be PR System One REMstar Pro CPAP Machine with C-Flex Plus (DS450). if it is DS450 it appears to be data capable but is not automatic.
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