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Prescription rights
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xdocgx Offline

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Posts: 15
Joined: Aug 2015

Machine: Phillips Respironics 960 BIPAP Auto SV Advanced
Mask Type: Nasal pillows
Mask Make & Model: Res Med AirFit P10
Humidifier: Phillips Respironics Heated Humidifier
CPAP Pressure: EPAP - 6; IPAP - 9 (approx)
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: So Cal

Post: #1
Prescription rights
What are the rights of patients when it comes to their prescription, especially for purchasing any XPAP machine in the future?

Can a patient request/demand a prescription that has no expiration date, or does this simply vary from doctor to doctor, by insurance plan, or even location.

Am I required to participate in another polysomnogram in another five years or so in order to establish my continuing eligibility, or is sleep apnea considered a chronic disorder?

BTW, I have Kaiser insurance, and live in So Cal. My previous prescription didn't have an expiration date. When I tried to purchase a Res Med P10 headset online, I was told that my prescription needed an expiration date.

Any assistance is appreciated.

Thanks ...
08-01-2016 07:23 PM
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DariaVader Offline
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Posts: 1,819
Joined: Nov 2014

Machine: Resmed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10 for Her
Humidifier: H5i humidifier with ClimateLine heated hose
CPAP Pressure: 8-15
CPAP Software: SleepyHead

Other Comments: diabetes II, Thyroidectomized, Primary Immune Deficiency, and the list goes on :P

Sex: Female
Location: Oregon

Post: #2
RE: Prescription rights
My prescription says explicitly that it is good for life

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
08-01-2016 07:39 PM
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PoolQ Offline

Advisory Members

Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #3
RE: Prescription rights
Some things to consider:
1. CPAP is not a cure, so you should not have a problem getting new masks. This should not require a new sleep study, ask your doctor to refresh the prescription.
2. After 5 years you should be able to get a new machine, there have been improvements. If you do this, your Doctor may want either another study or at least to look at your data to make sure you get the best machine for your current needs. If your Doctor wants to change your machine, they may need to do another study. If you are needing a different machine, you should get it.
3. Sleep Apnea is not "static" and you may have physically changed in 5 years.
4. A Doctor should be able to look at your existing data and decide if you need a new study and different machine.

Of course internal Kaiser rules may require a retest every 5 years, your Doctor or the front desk staff should know what the rules are and they should tell you because in your case the Doctors and insurance company are on the same side.
08-01-2016 08:23 PM
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OMyMyOHellYes Online

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Posts: 915
Joined: Mar 2013

Machine: Respironics 560 Auto
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage FX
Humidifier: Respironics System One (no heated hose)
CPAP Pressure: 08.0-15.0 cm/H2O
CPAP Software: EncoreBasic

Other Comments:

Sex: Male
Location: Texas

Post: #4
RE: Prescription rights
(08-01-2016 08:23 PM)PoolQ Wrote:  Of course internal Kaiser rules may require a retest every 5 years, your Doctor or the front desk staff should know what the rules are and they should tell you because in your case the Doctors and insurance company are on the same side.

We require you to have a $3,000 sleep study in order to pay $600 for a new CPAP machine." Bright folks, them insurance companies employ to make rules.

OMMOHY
08-01-2016 08:28 PM
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Mosquitobait Online

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Posts: 746
Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #5
RE: Prescription rights
You are entitled to a copy of your sleep study (get the RAW DATA, not just the summary). You are entitled to a copy of your prescription. Beyond that, you have to negotiate with your doctor.

The prescription I just received from the Sleep doctor says right on it that it is good only for one year and that a yearly prescription renewal is required. So, potentially, I'm SOL with an online retailer after a year unless they choose to ignore that section (which many do, apparently) OR if I instead choose to buy mask parts (which don't require a prescription).

You don't know where you will be in 5 years. But assuming you are with Kaiser, when you want a new machine in 5 years, download the data from your machine and have him/her review that. There should be a medical reason to do another study - you already diagnosed and can titrate from your auto machine. But if Kaiser is paying for it, they call the shots. You can refuse.

I have never had Kaiser, but sometimes it's beneficial to just tell the doc that you are buying out-of-pocket and what your needs are.
08-01-2016 11:53 PM
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icyura10 Offline

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Posts: 197
Joined: May 2016

Machine: RESMED AirCurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: Phillips Respironiscs DreamWear under the nose nasal ma
Humidifier: INCLUDED
CPAP Pressure: IPAP (20); EPAP (12); PS (8)
CPAP Software: ResScan SleepyHead

Other Comments: I just dropped in to see what condition my condition was in!

Sex: Male
Location: I'm just a Galactic Traveler Traversing the Universe on a Blue Rock!

Post: #6
RE: Prescription rights
Gezzzz...

I had a CPAP that was given to me from insurance co. "A". I had it for several years, it was really nice, auto start, no SD CARD in it, nothing.

Then I changed insurance companies and went with Kaiser. Kasiser didn't support my machine, wanted me to get a new study. I obtained my sleep data, titration presecriptions and other information and took it into Kasiser. They setup my new CPAP without a new study and sent me on my way. No big deal and it was easy as pie.

Now I'm with Blue Cross, and of all things, they "rent" the machine for 13 months. If for almost any reason, you fail to demonstrate compliance, they take the damn thing away from you.

About 2 weeks ago I saw my sleep dr. He was not thrilled with the progress on using the machine I had (I'd had it since April) so he prescribed me a bi-level machine. So, now I'm on a new 13 month rental, for the freakin' cpap and all the monies I put forward towards the initial machine gets flushed down the toilet and I get to start over.

I hate BLUE CROSS and if I had almost any other option I'd take it. BTW, w/BC I can get new tubing every 6 months, new head gear every 6 months and there seems to be a raging fight about how often the pillows can be replaced.

I won't go into all the other nonsense going on...

But as it pertains to masks and prescriptions, it seems to be dependent on the state you live in as well as the individual Dr. It seems most states have limits about how long a prescription can be in effect and valid (usually 1 year). In states where there's no limits on the length of time, Dr,s seem to be reluctant to create a prescription with an extended period of time as it's not consistent with most of the existing states laws.

And then there's a mixmaster of confusion if you are covered by an insurance company and you are in / on medicare or SSDI.

This is messed up!

So much for reduced medical costs that were supposed to accompany the "Affffffffffffffordable Health Care".... and the legislation that had to be passed so we could find out what was in it! Oh-jeezHuhHuhsignCrazyDodgyOopsOhwellThumbs-down-1Crying-into-tissueeeewcrygreen

It's nonsense like this that really makes people wonder about gun control and what causes it to be necessary! Not that I'm to that point.. just say'n

Warning: Eating chocolate may cause your clothes to shrink!
[Image: ry6XtE9.gif] <---- That's ME!
08-02-2016 12:48 AM
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FrankNichols Offline

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Posts: 714
Joined: Mar 2016

Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
Humidifier: Builtin
CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #7
RE: Prescription rights
(08-02-2016 12:48 AM)icyura10 Wrote:  Gezzzz...

It's nonsense like this that really makes people wonder about gun control and what causes it to be necessary! Not that I'm to that point.. just say'n

Sadly, the root cause of the problem is the "for profit" healthcare system and health insurance companies. But, they are not limited to for profit healthcare. Consider that in the past couple decades a lot of people (millions?) have been diagnosed with OSD of some form and given CPAP machines by insurance companies creating a multi-billion dollar industry. The good news is a lot of people are getting good treatment, the bad news is a lot of those machines are sitting in closets because the people that got them do't like the treatment and find it inconvenient. Many of those machines cost upwards of $5,000 to $6,000 each - sitting in a closet because of non-compliance.

Non-compliance is a major contributor to medical costs, and not just in the OSD field, I read somewhere that as much as 50% of prescription medication is not taken as prescribed. Not only is that a waste of money, in the case of antibiotics it is a seriously dangerous non-compliance since it can result in the creation of "super bug" strains of bacteria when people do not finish the prescribed treatment. The industry has been trying to find a way to minimize the waste. It is not a simple problem, in fact it is a extremely complex problem with medical, moral, and economic considerations.

You may intend to comply with your therapy and receive the benefits, but you may not (generic you, not you personally) and how does the insurance company know? How can they reduce the loss from paying for a sleep study and CPAP machine and office visits and all the other associated costs around people that spend the money then don't use the machine?

And don't kid yourself, those economic losses from non-compliance end up coming out of your and my wallets in the form of higher taxes and higher insurance premiums and deductibles.

I feel for your issues, and understand how and why you feel what you do...

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
08-02-2016 04:03 AM
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icyura10 Offline

Preferred Members

Posts: 197
Joined: May 2016

Machine: RESMED AirCurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: Phillips Respironiscs DreamWear under the nose nasal ma
Humidifier: INCLUDED
CPAP Pressure: IPAP (20); EPAP (12); PS (8)
CPAP Software: ResScan SleepyHead

Other Comments: I just dropped in to see what condition my condition was in!

Sex: Male
Location: I'm just a Galactic Traveler Traversing the Universe on a Blue Rock!

Post: #8
RE: Prescription rights
(08-02-2016 04:03 AM)FrankNichols Wrote:  You may intend to comply with your therapy and receive the benefits, but you may not (generic you, not you personally) and how does the insurance company know? How can they reduce the loss from paying for a sleep study and CPAP machine and office visits and all the other associated costs around people that spend the money then don't use the machine?

And the correct spelling of the above highlighted section is: ewe

Bahh... Bahhh...Bahhh... Don't get sheepish on us now and for goodness sake, don't let em' pull the wool over ewer eyes or ewe may be in need of a good shearing! Dielaughing

I just couldn't help it.. honest!

Warning: Eating chocolate may cause your clothes to shrink!
[Image: ry6XtE9.gif] <---- That's ME!
08-02-2016 11:44 AM
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KSMatthew Online

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Posts: 179
Joined: Jul 2016

Machine: PR DreamStation Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: none
CPAP Pressure: 7
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Kansas, United States

Post: #9
RE: Prescription rights
I *think* my insurance covers CPAP - but with a high deductible, I don't even bother since I'd have to pay out of pocket anyway. I buy my own and leave the ins. co. out of it. From what I've seen/heard/read about the experience others have had with insurance companies, I think I'm happier this way. My doc and I get together on an annual basis, if he thinks I need or could use another sleep study then I'll work something out, but until then, I think I'll stay away from insurance.
08-02-2016 12:45 PM
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0rangebear Offline

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Posts: 341
Joined: Jan 2016

Machine: ResMed AirSence 10
Mask Type: Other
Mask Make & Model: Amara View
Humidifier: HumidAire (Built-in)
CPAP Pressure: APAP 12.8-15 EPR 3 (cmH2O)
CPAP Software: ResScan SleepyHead

Other Comments: Ramp off

Sex: Male
Location: Brighton Colorado

Post: #10
RE: Prescription rights
My insurance company will not pay for any prescription older than 18 months. I have submitted a few that had long dates on them and they were rejected for payment.

I can still fill them if I want to pay out of pocket

2004-Bon Jovi
it'll take more than a doctor to prescribe a remedy

Observations and recommendations communicated here are the perceptions of the writer and should not be misconstrued as medical advice.
(This post was last modified: 08-02-2016 04:40 PM by 0rangebear.)
08-02-2016 04:40 PM
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