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03-09-2017, 11:04 AM
Hey gang, well I thought I was going to get my machine today, but.... I went to the doctor and begged her for an apap. No avail. She said that I didn't need an apap and prescribed me a cpap set at 14. I took the prescription to the dme and explained to her that I needed an apap. She said she would try her best to get me an apap instead of a cpap. Anyways it's going to take 3 more weeks to get the insurance to approve it and to get my machine. This sucks. I thought I would get it today.
03-09-2017, 11:11 AM
Bummer. I feel your pain (been in those shoes).
Have you talked to your insurance? Because I think her line is BS. My insurance, at least, "approves" (pays for) an auto the same as a cpap, with no extra steps.
I forget your DME situation... are there other DMEs you can call?
03-09-2017, 11:16 AM
I'l l2nd the BS. Insurance approves by code. APAP is the same code as CPAP
Time to order I'll buy. They already have the approval.
03-09-2017, 11:25 AM
The dme woman said she would try her best to get me an apap. I know she won't though. I'll end up with a 14 setting cpap. My doctor insists it will help though, so I don't know.
03-09-2017, 11:29 AM
If you choose to be a victim, then fine, but why not get a LIST of DMEs to choose from? Your insurance can give you the list of DMEs in your area and you can SHOP for the one that gives you what you want. You're the most stubborn person I've ever met. You have 3 weeks to get this done, and you're going to sit on your hands and take what they give you.
Begging doctors is crazy. You politely tell them what your needs are.
When she said you dont "need" an Apap, did you ask why she feels that way?
Did you explain that you want an Apap that can better meet your needs now and in the future?
Did you tell her you want to be more proactive in your treatment?
Did you tell her that insurance pays the same whether it is a cpap or apap?
Did you tell her you are willing to set it to Cpap mode?
You can change it yourself, but she doesnt need to know that!
Have you considered a different doctor?
I realize that some DME's may not give you an Apap without the script stating that. Call around and check.
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03-09-2017, 12:49 PM
If your doctor wrote the script for a CPAP machine then that is what the dme is going to issue you. Sounds like you need to get your doctor to rewrite the script for the APAP machine. Good luck on getting the machine you want. But this really needs to handle quickly so it want be dragging on for months.
I'm in complete agreement with the others.
Read my experience with my crappy DME/sleep dr, and how I realized he was only in it for the $... so how I felt or what I wanted meant NOTHING if my machine was yielding the #s he needed so insurance would pay him. I was not even getting enough air, and he did NOT care one iota.
Found a new DME, and they hooked me up with what I wanted without me even having to ask for it.
The problem in this case is the clinic is integrated with the physician, sleep clinic and DME being under one roof. Full service is a nice concept, but they don't issue more expensive machines that might make the patient less dependent on services, or reduce margins.
03-09-2017, 01:04 PM
Glad to see you got it worked out.
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