JulesDread wrote:

I really appreciate the suggestions.  I have been looking at the C-pap auction site and my local Craig's list.  If I did purchase one of these, would I be able to set the pressure myself?

BTW, I just found the post from PWPyle in this thread: http://www.apneasupport.org/post-458.html.   I have the same doctor.  PWPyle was lucky to have smartened up faster than I did.  It's so frustrating, because normally I obsessively research everything.  This time I was just too busy.

Hi Jules, first you need to find out if you are on the correct pressure.  With the symptoms you have described I kind of doubt it.  Were you going to try to go to the new provider you located.  I would sign a release at the new place to have your records from the old place sent to them.  Make a first appointment and see what the new certified sleep doctor has to say about it.  Check with your insurance, but I do believe they should pay for a second opinion.  I don't know the particulars of your insurance.  You may have to pay a percentage of the charge.  

I have a feeling the new doctor would want to make changes based on your continued problems.  Especially with the exhalation on your machine.  Your doctor may be able to help you with your settings if you can find a machine that he/she recommends.  Getting the right set up is key to your success.  I don't know if the one you have now can be adjusted to fit your needs.  Talk to your new doctor about that.  If not, and you need a different one, you might be able to get some money back from the machine you  have now by selling it on e-bay or craigs list or a site of this type.

You are on the right track, don't give up !


_________________
REMstarplus, M Series with C-flex and heated humidification
C- Pap setting of 10
ResMed Mirage Quatro full face Mask
Sleep study showed 36 events per hour
Location, Nebraska

Okay, I called the new place.  They need a referral.  I can't go back to the cardiologist that gave me the initial sleep study referral because she is married to the current sleep doctor (and I like the care from the cardiologist).  But my GP can probably do the referral after she gets my records from the current sleep doctor.  If what they send to my GP isn't sufficient, I'll need to get the rest of the records sent directly over. In the meantime, I'll call my insurance co...

Thanks for the encouragement.  I have had several moments of "forget it, I probably don't even have this anyway, he probably just diagnosed me to make money off of me."  However, I will keep trying. The encouragement of this board, plus helping keep my wife compliant by doing this myself are the only reasons I haven't just stuck that stupid Escape S8 in the closet.

JulesDread wrote:

Okay, I called the new place.  They need a referral.  I can't go back to the cardiologist that gave me the initial sleep study referral because she is married to the current sleep doctor (and I like the care from the cardiologist).  But my GP can probably do the referral after she gets my records from the current sleep doctor.  If what they send to my GP isn't sufficient, I'll need to get the rest of the records sent directly over. In the meantime, I'll call my insurance co...

Thanks for the encouragement.  I have had several moments of "forget it, I probably don't even have this anyway, he probably just diagnosed me to make money off of me."  However, I will keep trying. The encouragement of this board, plus helping keep my wife compliant by doing this myself are the only reasons I haven't just stuck that stupid Escape S8 in the closet.

I go to a pulmonary doctor who specializes and is board certified in sleep disorders.  Go to your GP and sign all the papers to have your records sent to the GP.  You can do that before you even set up the appt with the GP to discuss why you want to be referred to the other doctor.  It will save you some time.  They might even be able to mail you the paper work you have to sign.  Or fax them.  

Don't give up, this is important and will help you the rest of your life.  It is a hassle when you have to fight for good care, but in the long run it will be worth it.  Yes, there are lots of good people here on the forum who are very knowledgable and may have more suggestions.


_________________
REMstarplus, M Series with C-flex and heated humidification
C- Pap setting of 10
ResMed Mirage Quatro full face Mask
Sleep study showed 36 events per hour
Location, Nebraska

Update:

It turns out my machine is a 10 month rental (I thought it was full purchase with installment payments).  Insurance co. says I can take it back since its a rental and get something else.  I could go through a website like DHM and a better machine would be out-of-network but still cheaper than the barebones Escape in-network at the doctor's tripled price.

I still have some hurdles.  Doctor STILL hasn't sent sleep study and letter of necessity to ins. co. and they won't pay for jack until that happens.   Doctor STILL hasn't sent my records to my GP.  My GP's willing to do a referral anyway, but I'd still need the records for the new doctor.  And doctor charged me for my whole co-pay for the 10 months, which included $250 for next year's deductible and I would probably have to fight to get that $$ back.

So, with that in mind ...should I get (1) an S8 Elite II; (2) an autopap (like S8 Autoset II); or (3) neither and wait to see what new doctor suggests if I can ever get records to him?   Again, my main issues are suffocating after 2 hours and aerophagia.

JulesDread wrote:

Update:

It turns out my machine is a 10 month rental (I thought it was full purchase with installment payments).  Insurance co. says I can take it back since its a rental and get something else.  I could go through a website like DHM and a better machine would be out-of-network but still cheaper than the barebones Escape in-network at the doctor's tripled price.

I still have some hurdles.  Doctor STILL hasn't sent sleep study and letter of necessity to ins. co. and they won't pay for jack until that happens.   Doctor STILL hasn't sent my records to my GP.  My GP's willing to do a referral anyway, but I'd still need the records for the new doctor.  And doctor charged me for my whole co-pay for the 10 months, which included $250 for next year's deductible and I would probably have to fight to get that $$ back.

So, with that in mind ...should I get (1) an S8 Elite II; (2) an autopap (like S8 Autoset II); or (3) neither and wait to see what new doctor suggests if I can ever get records to him?   Again, my main issues are suffocating after 2 hours and aerophagia.

Well, actualy this is something a good board certified sleep doctor should determine based on your sleep study.  The set up for you is an individual plan, just as it is for all of us.  What works for one may not work for another.  I like my machine which is posted here, but that was determined by my doctor and dme provider.


_________________
REMstarplus, M Series with C-flex and heated humidification
C- Pap setting of 10
ResMed Mirage Quatro full face Mask
Sleep study showed 36 events per hour
Location, Nebraska

And the beat goes on...

I went back to sleep Dr. today. Gave him a list of machines that are fully data capable and have some sort of EPR and said I wanted to try one of the ones on my list.  He said he will not give me an auto-pap (they're terrible for all kinds of reasons, blah blah blah) and he doesn't carry Respironics, so he'd give me a Resmed Elite II.  I was happy about that, but then he came back with an Escape II.  If he knew the difference between them, he didn't admit it.  I said I wanted an Elite and he said he didn't carry them.   So, now I have an Escape II with EPR at least, but no data.  I've decided to give it a shot, but I'm preparing to ditch him and the machine completely.  All I need to do is get the records from him sent to my GP and then return the mask I'm borrowing from his clinic once I qualify for a new one.  I have an appt set-up for a different doctor next month, by that time, I should be able to get all this stuff accomplished and will know if EPR helped.

JulesDread wrote:

And the beat goes on...

I went back to sleep Dr. today. Gave him a list of machines that are fully data capable and have some sort of EPR and said I wanted to try one of the ones on my list.  He said he will not give me an auto-pap (they're terrible for all kinds of reasons, blah blah blah) and he doesn't carry Respironics, so he'd give me a Resmed Elite II.  I was happy about that, but then he came back with an Escape II.  If he knew the difference between them, he didn't admit it.  I said I wanted an Elite and he said he didn't carry them.   So, now I have an Escape II with EPR at least, but no data.  I've decided to give it a shot, but I'm preparing to ditch him and the machine completely.  All I need to do is get the records from him sent to my GP and then return the mask I'm borrowing from his clinic once I qualify for a new one.  I have an appt set-up for a different doctor next month, by that time, I should be able to get all this stuff accomplished and will know if EPR helped.

Is your insurance covering the tab for the Escape?  Are you planning on returning the machine before seeing another dr?  Would your insurance let you file a claim for a machine you purchase out of pocket?  And why can't your Dr. order the Elite?

Well, that's a really good question - all c-pap technological advances are completely dismissed by him.  According to him:  (1) EPR, C-Flex, A-Flex compromise treatment and the machines are too noisy; (2) the data in the data-capable machines is unreliable and is misused by insurance companies; (3) autopaps compromise therapy because they don't adjust in time to provide enough pressure. As a result, he only provides Resmed Compacts and Escapes initially to his patients (I was able to assert myself into getting an Escape II).  This way, he also makes a huge profit margin by selling bare-bones $200-300 machines for $1600.   Someone above suggested that maybe he's hiding something by not providing data machines...could be, I dunno.

My machines start out as a rental and my insurance company so far has told me if I don't like the machines to take them back.  I'm trying out the EPR for now - unfortunatley, I was sick last night and couldn't take it on a maiden voyage.  I think I'll give it a try for awhile, probably until I get into the new doctor.

So, letter from insurance co. today.  Denied C-pap due to 6 AHI in initial sleep study.  I was 11 during titration.  I was assured by those jerks at the doctor's office that they had done whatever pre-approval was necessary, my insurance would pay X amount.  But it was BS and now I could stuck with these huge bills for that mask and the rental cost on the machine ($150/month).   I'll fight however I can, but I am mad.

deleted

JulesDread wrote:

So, letter from insurance co. today.  Denied C-pap due to 6 AHI in initial sleep study.  I was 11 during titration.  I was assured by those jerks at the doctor's office that they had done whatever pre-approval was necessary, my insurance would pay X amount.  But it was BS and now I could stuck with these huge bills for that mask and the rental cost on the machine ($150/month).   I'll fight however I can, but I am mad.

That's ridiculous.  6 AHI is 6 events per hour too many!  I assume you're very tired?  If so maybe you can let them know that if an accident should happen when you knowingly have sleep apnea which could not be treated due to their denial of coverage then they should be liable for the damage.

Good luck in your fight.


_________________
Brian
Severe OSA
19 cmH2O
Respironics M Series Plus
F&P Forma Full Face Mask

This is a mess.  The doctor's office has re-submitted saying my AHI is 9.7.  Not sure how they got that, but maybe they factored in the titration study results.  Also, I can't get the insurance co. to provide a copy of their policy stating the criterion for coverage.  They acted like they didn't know what I was talking about when I requested it.  Is it possible they don't have a written policy?

If anyone here has had experience with the National Association of Letter Carriers (NALC) insurance?  If so, please PM me.  Thanks!

And BTW, y'all were right.  The expiration relief feature really helped with suffocation.  You know more than my doctor! Thanks!

JulesDread wrote:

Also, I can't get the insurance co. to provide a copy of their policy stating the criterion for coverage.  They acted like they didn't know what I was talking about when I requested it.  Is it possible they don't have a written policy?

I'm new to this forum so I can't speak to apnea-related specifics.  But I do have a lot of experience dealing with insurance companies.  Including a neighbor whose job was to figure out ways to deny claims.

It's very unlikely they don't have a written policy ... also very unlikely they would share it with you.  

- Before trying any of the below, see if the claim goes through based on the new information from your doctor.

- Every insurance company has an appeal process.  Usually there's some type of time limitation, so find out what the process is now and start it asap if the claim is denied again.

- Talk to your union rep (if that applies) or your Human Resources person, they may be helpful.  They may give you the name of the local rep from the insurance company, I've found talking to that person can help sometimes - they can direct you to different people in the insurance company.  Let them know you've already filed an appeal.

 - If the appeal doesn't move along in a timely manner, doesn't go your way, or the folks above aren't helpful, contact your state insurance regulatory body and file an official complaint.  Send a copy to your insurance company.  This should only be done as a last resort, but it can and does work.

Thanks!  I hadn't really thought about the union rep/HR option.  I'll keep that in mind if I get to that point for sure.  Also, I knew about my state insurance department, but had no idea if that was ever effective or just a govt. black hole, so I'll definitely try it if it comes to that.

I guess I thought they would share the policy because both Aetna and Cigna provide their coverage policies and requirements online.  Cigna's is very clear - under 15 AHI requires accompanying symptoms/problems.  That I could prove.  Just don't know if that's the same with my insurance co. and I'm afraid I may never find out.



Last edited by JulesDread on Tue Aug 18, 2009 12:51 pm; edited 1 time in total

JulesDread wrote:

I guess I thought they would share the policy because both Aetna and Cigna provide their coverage policies and requirements online.  Cigna's is very clear - under 15 AHI requires accompanying symptoms/problems.

Wow, thanks for that tidbit, I'm covered under Cigna (well, I will be again when COBRA coverage kicks in), and my PSG is this coming Sunday.

I was pleasantly surprised to be able to get this online.