RE: Your Personal CPAP Success Story - Post Here
At my provider's request, I had a sleep study done in 1998 at a local hospital. The first four hours of the study, I had wires/electrodes connected to me which indicated apneas, and for the second four hours, I was titrated with a CPAP machine. The result was that I was prescribed a CPAP machine which I used for 10 years. At this point, I don't remember the brand/model number of the machine, but I know it did not have a provision for adding water. And it was loud.
In 2008 the CPAP machine went South. At this point I had quit working and gotten a job, and was covered by a nationally known HMO. I went to their sleep medicine department and was issued a new ResMed S8 elite with a humidifier, and this proved to be a better machine.
Jan 23, 2012, the S8 stopped working because the on/off switch broke. So, I took the machine back to the HMO and they gave me a loaner (an S8 machine without EPR). A week later I retired on Dec. 31, 2012 and was not able to get back to the HMO in the Christmas week, for a replacement machine.
Jan. 1, 2013 I enrolled in Medicare part B, and also signed-up for private supplemental coverage and prescription coverage. OK, I thought I was set. I arranged for an appointment with a new physician (I was no longer covered by the HMO) and at the first appointment was supposed to get a thorough physical. I brought lab records and other medical history from the HMO, and included it in my initial survey. The physician is a young woman who is not a native American, and I don't know where she trained; but she is a licensed physician. After five minutes she listened to my heart and lungs and determined that I was alive. She then put on gloves and asked me to "assume the position". At this point, I pointed out that my prostate had been removed 5 years ago, as shown on my records, so I didn't get the exam. (She does have small hands though) I asked for prescriptions for the meds I was already taking, and she wrote those for me without any questions.
I went to a DME supplier (the one where I had originally gotten my first CPAP machine) and said I wanted a new S9. Whoa, they said, you have to have a doctor's prescription! Back to the Doc's office where I was prescribed to have a new sleep study. Went to the sleep study place and after 8 hours, was never titrated for a CPAP (or other) machine despite my asking for this 3 times. I asked the SS lab for a copy of the results, and they said no, they would only send the results to my Doc. I did manage to get a copy of the study and saw that yes, I still had apneas without a CPAP machine. The study was never sent to my Doc. I made a copy and hand delivered it to her. The sleep lab charged more than $5000 to Medicare and a substantial amount to my supplemental insurance. I asked the sleep lab why they didn't titrate me and they said that wasn't part of the study, but that I could come back for a second study if I wanted to be titrated. LOL on that.
At this point for Medicare faded so I went on the internet and found new S9 machines selling new for $900 to $1100. This included the humidifier, climate line hose, nasal pillow mask, carrying case, and SD card. I was going to buy one, but couldn't because I didn't have a prescription! So I went to a web site on which sellers can list all kinds of equipment, and found a used S9 Autoset for $400. I checked it out and found it had only 4 hours of use. The owner said he couldn't tolerate the face mask and decided to give up and sell it. So I bought it. And it works perfectly.
I didn't give up on the chance of getting Medicare to provide me with a new machine, so I went back to the Doc, told her that I needed this particular machine, and she finally wrote a prescription and sent it to a second DME supplier here in town. Two days later the new supplier called me to have me come to their office for the machine and to have a fitting for the headgear. This quick transaction has me believing that the Doctor's group has a financial interest in this DME supplier, either some form of ownership arrangement, or some type of kickback (consulting fee!).
I went to the DME supplier and was shown how to use the machine by one of the technicians. When she was finished with her talk, I asked if she had set the machine EPR to level 3. Oh, she said, I forgot that. She did fill out the forms to get reimbursed from Medicare, and pointed out that I was eligible to come back periodically for new masks, and other supplies (for which the DME supplier would make money). I asked her if she had programmed these dates into the machine, and she said, Oh, I didn't know you could do that. I left the office with the equipment and decided to program everything myself when I got home.
I took machine data on a flash drive, back to the DME supplier's office after a month. I was told that they couldn't read it from the flash drive, that I would have to bring (take?) the SD card from the machine for them to get the data. At this point I had to go into their office to show them how to use the ResScan program to download data from the flash drive onto their computer. Oh, they said, I didn't know you could do that! I looked at the invoices that would be sent to Medicare and see that this S9 machine with humidifier, hose, case, etc. is going to cost Medicare more than $2600. Is there any wonder why Medicare is going broke?? Before I went to the DME supplier, I called Medicare (you have to have a speaker phone and a lot of time) and finally got through to a person. I explained that I had a prescription for the machine, that I wanted to buy it online, and asked if I could get reimbursed for this. I was told that this was not possible, that I had to get the equipment from a DME supplier who is registered with Medicare.
At this point my opinion of the DME supplier is a little bit lower than low. My experience with Medicare and reading about it in the news for several years, leads me to believe that it will have to change or die. I don't believe the Doc I'm seeing is knowledgeable about sleep studies, apneas, and equipment (what else?). I have to see her again soon and will provide her with a copy of ResScan, my data, online learning sites, etc. Hopefully she will come up to speed.
I believe that medicine has become just another commodity, that I must be an informed consumer, and be my own advocate. I have found online sites to obtain medicines without a prescription, medical equipment, and many learning sites (which I need). I am not a doctor and will still rely on expert opinions, but will check out all options. Using the S9, I have zero apneas, and get good sleep, so I'm happy with the equipment. I do see online that the difference in price between the S9 AutoSet and the S9 Elite is about $50. Seems like the same machine with different software, maybe minor difference in parts. Why get the Elite when the AutoSet functions better??