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Took the titration test.
#51
A lot of us on this forum have been let down by our sleep doctors in the sense that the doctors got us in compliance for insurance and quit there instead of actually treating our sleep apnea. This got us a machine the insurance would pay for, but the apnea is not treated so the patient is forgotten. Having a problem and take it to your doctor? Too often they tell the patient "too bad, you're in compliance, there is nothing else we can do for you". The people here are giving you the advise they are giving you because they are trying to keep from happening to you what they have seen all too often with other new members. We push data capable machine, hopefully an auto, so that if your doctor does fail you we can help you.

I will add my two cents for what it is worth. I didn't push for an auto, data capable machine even though I had lurked on the forum and knew I should. I got lucky in the sense that I did get a data capable cpap machine. It is not, however, an auto. I'm looking at buying an auto machine out of pocket or waiting 4 more years to get one through insurance.

You do need to get an auto cpap machine that is fully data cpapble if at all possible. If you feel you must take a fixed pressure machine, again, make sure it is fully data capable. Sleeprider and the other members have told you the proceedure on how to do that as well as what machines are in that category. If the doctor tries to stand in your way, just remember one thing. You hired him. If he is not willing to fulfill your wishes fire him and get somone who will. It probably won't get that far if you stick to your guns.
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#52
Just wanted to note since I read somewhere in the thread about sleep studies costing that KY at least, all the Medicaid MCOs pay in full for sleep studies as long as pre-authorization was given. Like in my case (I use Humana CareSource Medicaid) both my initial and titration studies were paid for in full by my MCO. As was the machine and tertiary equipment like mask and humidifier, hose. I did have to pay $25 for the modem though.

Of course, especially for someone who has a full time job, sleep studies are still very inconvenient, time consuming, and often uncomfortable. So of course if you can avoid getting another one that is ideal.

I was completely in the dark about APAP, data capable, etc before getting my machine unfortunately so I ended up with a fixed pressure machine. But at least it was data capable so I could've done worse. In my case though the sleep doctor and sleep study were in the same facility, the DME provider was entirely separate - and a staff member at the sleep study office gave me a list of DME providers to choose from before the titration study.

If your county has any 'St. Elizabeth' hospitals with a sleep disorder center I recommend switching to that. Most Medicaid MCOs give you the right to get a second opinion, and you can invoke that right to see another sleep specialist if your current one won't cooperate.

Of course, given what I've learned here if I am switched to another type of machine or when my 5 years are up and I can get a brand new machine I'll definitely ask for an APAP prescription in writing and then call DMEs to get a ResMed Autoset.

At least in my case with Humana CS, I was told I could swap anything out including mask within 30 days. But after that I was locked in at least in terms of the CPAP machine. The way Humana CS does it, and I assume other Medicaid MCOs in KY are similar, is the machine is rent-to-own. Insurance paid for mine monthly over a 6 month period after which I owned it.

Just some tips since the OP is on Medicaid in KY also: Regardless of which machine you get make sure to ask your DME provider for replacement supplies if you need them later on. Medicaid pays for those also. New entire mask kit every 6 months, I think water reservoir every 3 months, mask cushion every month (At least for me), fine filter (if applicable) every month, pollen filter every 3 months, new hose every 6 months, and new xPAP machine every 5 years. DME providers apparently aren't allowed to solicit you (even as a reminder) and offer replacement supplies, so you have to call them. I didn't know this at first so I figured I'd let you know.

I would assume that if you get a brick you can exchange it within 30 days for something else; but just in case you may want to refuse it and go with the suggestions posted here to get the written prescription and 'shop' around for local DME providers your MCO will pay for. That is what I should have done and regret not doing so. By the time I learned about the advantages of APAP I was beyond the 30 day point. But I at least did end up with a DreamStation Pro and not the worst one -- DreamStation (non-Pro) and the Pro does have a pseudo-APAP mode called A-Trial, but it might have a device lifetime limit of 5 months before irrevocably reverting to fixed pressure mode.

If your MCO (I think you mentioned WellCare is yours) has policies about only paying for bricks (I doubt they do, I think they have to abide by Medicare rules, even though Medicaid is a different entitlement) then you can switch to another MCO including Humana CareSource which I read is available in all KY counties. Humana CS will pay for any brand and model I believe. At least in my county there are 4-5 different MCOs and one MCO may be awesome in one county but lackluster in another so there isn't really one "best" MCO. It takes research to figure out which is a best fit for you.

If your MCO ends up being the issue, you can learn how to switch to another MCO here but be aware that not all KY MCOs have the same networks. So if you really like your PCP / GP doctor or your dentist, etc then one or both may not be in network at the new MCO.
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#53
I just wanted to chime in and say that as a newbie who is only a month and a half ahead of you, I completely agree with what the others are saying.

The doctor writes a prescription saying you need a cpap. You can choose where you want to get that prescription filled, just like when a dr Rxs you a med and you can choose which pharmacy you want to get it from.

Click on my username, and click on my first few threads... and you'll see what happens when you accept a machine that's not optimal for you. Thankfully I was renting the machine (that's what my insurance requires), so I handed it back to my dr after 3 weeks and said I didn't want it anymore. I told him I'd like an auto, or I'm walking. He was LIVID. Why? Because he's only interested in improving my sleep enough to make insurance pay for the machine, rather than caring for how well he can improve (optimize) my sleep.

How would you like it if your dr Rxed a med for your thyroid, and it manipulated your blood results to be in the normal range despite you still feeling like utter crap, and your dr saying "you're a-okay; i've done my job"? Not cool.

I think the reason it's so important for *you* to get an auto is because it will titrate you in the comfort of your own home, while you are actually sleeping, and it will give you the optimal pressure that your body is needing at any given time, so you can feel your best.

If you'd slept a lot in your titrated sleep study, and they were able to experiment a lot and really figure out the pressure your body responded best to, then I don't think you'd be getting such a strong shove by these kind & caring folks here who know you're going to be best served by an auto.

I slept 4 hours in my sleep study, and they were only able to try 4 pressures (4, 5, 6, 7) on me. I supposedly responded well to 2 of the pressures (5 & 7), so my dr decided to Rx me a pressure of 5. Ummmm, ok. But I have been letting my auto titrate me, and it's been ending up on 8 as the pressure my body is wanting the most of. I wouldn't have known that without the auto... or at least it would have taken me a lot of experimentation, over many nights, with the fixed DreamStation Pro my dr gave me.

And the reason everyone is pushing you to get a data machine (ie: not the cpap brick) is because then you'll be able to show this group your data, and they'll be able to help you fogure out your ideal pressure... which we don't have all that much confidence that your dr will do (based on what you've told us).

Trust me: it is MUCH easier to refuse the machine your dr is trying to get you to take from her/him, than it is to take it and then be trying to either give it back to her/him or figuring out if you're just going to accept the mediocrity for 5 years until your insurance will pay for another one.

Click on my username, and read the threads I started. <3 We are trying to save you from a real hassle.
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#54
Ok, I will heed all of this advice. Thursday is the big day, I'm kind of excited.
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#55
(03-05-2017, 08:36 AM)UKwildcatfan Wrote: Ok, I will heed all of this advice. Thursday is the big day, I'm kind of excited.

That's great!  It really is life-changing when you stick with it.  Good luck, and let us know what you ended up getting.
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#56
(03-03-2017, 07:05 PM)Well-stated pupcamper  ******************************************************************************************  pupcamper Wrote: A lot of us on this forum have been let down by our sleep doctors in the sense that the doctors got us in compliance for insurance and quit there instead of actually treating our sleep apnea. This got us a machine the insurance would pay for, but the apnea is not treated so the patient is forgotten. Having a problem and take it to your doctor? Too often they tell the patient "too bad, you're in compliance, there is nothing else we can do for you". The people here are giving you the advise they are giving you because they are trying to keep from happening to you what they have seen all too often with other new members. We push data capable machine, hopefully an auto, so that if your doctor does fail you we can help you.

I will add my two cents for what it is worth. I didn't push for an auto, data capable machine even though I had lurked on the forum and knew I should. I got lucky in the sense that I did get a data capable cpap machine. It is not, however, an auto. I'm looking at buying an auto machine out of pocket or waiting 4 more years to get one through insurance.

You do need to get an auto cpap machine that is fully data cpapble if at all possible. If you feel you must take a fixed pressure machine, again, make sure it is fully data capable. Sleeprider and the other members have told you the proceedure on how to do that as well as what machines are in that category. If the doctor tries to stand in your way, just remember one thing. You hired him. If he is not willing to fulfill your wishes fire him and get somone who will. It probably won't get that far if you stick to your guns.
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.
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