I haven't been providing all the info, but this whole situation just gets crazier.

My insurance denied again.  They provided a letter saying they only covered under 15 AHI with accompanying symptoms such as insomnia (like almost every other ins. co.).  It also provided appeal information and said they required written permission for someone other than the insured to provide representation during the appeal.  I wanted to represent myself because I knew I couldn't trust the sleep doctor's office.  So, I requested a copy of the original medical necessity letter.  I got it and it said absolutely nothing about my insomnia or other symptoms, so it's not surprising I was denied.  I asked for a new medical necessity letter mentioning the insomnia, and the sleep doctor refused, saying that the denial letter said they couldn't "help" me because of the letter's provision about me having to provide written permission for representation.

In the meantime, because the sleep doctor's office said they were going to charge me full purchase price of supplies and the rental cost for three months (the amount insurance didn't pay), etc. I had challenged the co-pay credit card charges I had made with my bank.  I wrote the sleep doctor's office a letter and told them this, and explained why. He demanded I return the machine immediately, and I did along with all supplies.
  
When the insurance appeal was pending, my bank said I needed to provide proof of returning the machine before I could challenge the charges.  I just decided to forget it and wait to see what happened with the appeal.  Then, I won the appeal.  My insurance said they would pay the full purchase price rather than a rental. I called the bank and asked if I could "take back" the charge challenge and they said no - that they had sent it through.  Before the sleep doctor was paid by the insurance co., however, my bank reversed the charges in my favor.  The sleep doctor's office called and said he would refuse me any further treatment and a machine unless I told my bank to reinstate the charges by Friday.  I said I couldn't do that - that I had already tried and it was impossible - so he said that was the end of the road, no more treatment for me.

I just thought of something else.  The bank reversed $212 of charges.  My co-pay was calculated on a monthly rental --  going into the next calendar year.  Therefore, it included my payment toward a $250 deductible next year.  But based on the approval letter, my insurance co. would have paid for the whole machine this year.  Therefore, I wouldn't owe him that money EVEN IF I had machine.  

So, hopefully, the dust will settle and I can get the machine elsewhere.  I just can't decide if I should get something cheap online or pay a higher co-pay in order to get support from a local RT, especially now that I'm doctor-less.



Last edited by JulesDread on Wed Sep 30, 2009 2:09 pm; edited 1 time in total

Just price comparasion.  If your insurance is not giong to cover it right now, then your DME costs will be sky high.  My DME charges 10X for a PAP if you don't have insurance.  You can get a state-of-the-art PAP online for around $500. Google CPAP supplies and not only compare costs, but return/repair policies as well.

Vicki


_________________
Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

I think they will pay in full for a purchase at this point.

And it gets even better with the sleep doctor.  I asked for a copy of my records and he said it would be a $29 fee.

________________________________________________

Update: Have a new doctor, a DME, an RT, and a Resmed Autoset II as of today.  Hopefully, it's the dawning of a new day with respect to my treatment.  The RT has to work in the CPAP/apnea community with old sleep doc, so wouldn't bash him - understandably.  But he did say I'm not the only person to have had a relationship end on terrible terms with this doctor.

Wow! You certainly need help!  It shouldn't be that bad.  There should be sticker on your present equipment.  You need to call the company that gave you your equipment.  They should come to your house to see what the problem is, or you should go to their office, either one.  It's up to them to fit you with the correct face mask, etc and do any adjusting.  They are the experts.  I use the Remstar Pro M Series, with nasal pillows for my nose.  I wear a stretchable head gear, that attaches to a soft ,  silicone nose "pillows" that go in your nose.  The "pillows" come in 3 sizes - you have to have the correct size, or you will have air leakage.  Someone needs to fit you with the correct size.  The same company who supplies your machine also needs to make any air flow adjustments necessary as well.  

Also, my machine has a hot water reservoir that I love.  I fill it with hot tap water the moment I am ready for bed.  Add 1 tsp. of Vicks-Vap-o-Steam to the water tank.  It helps any sinus or congestion problems you might have (since you said your head feels like it's exploding).  Every time you use your machine, you have to add new hot water and new Vicks-Vapo-Steam to it to work.

Cleaning:  You should clean all hoses and masks, etc every 3 or 4 days to prevent your getting sick.  More often if you actually have contaminated your equipment.  I use a deep plastic dish pan filled with hot water.  Add about 1/2 cup of liquid Pine Sol to the water, and soak all of your mask, hoses, etc for about 15 minutes to disinfect.  Then, rinse everything thouroughly.  Lay out a heavy, doubled bath towel , and lay out everything onto it.  Set up a small fan to dry your equipment.  Using a large, heavy container with a handle (such as a milk jug or laundry jug) to dry your hose.  Put each end of the hose thru the handle so that the air from the fan will be forced thru the hose.  This technique drys everything really quickly.  Hope some of this helps you.

Unfortunately, I had the same experience you did in the beginning.  They did the sleep test, I never saw a doctor, they gave me my equipment and sent me home.  For the most part, I simply had to figure out everything by myself.  Not very nice, but necessary.  Go slowly, keep trying, and you will get it all figured out eventually.  And, keep wearing your C-Pap - it really does help your brain function - you can't think clearly if you are not getting correct sleep, and if you truly do have sleep apnea, you can give yourself a heart attack from your breathing stopping and starting so much.  Good Luck!

Thanks, toedebusch

Yeah, I questioned whether I even needed CPAP, but I went and looked at my diagnostic study again.  I didn't have many full apneas, but lots of hypos and my oxygen was low - 86%.  From my research that seems to be a potential problem.

After 3 days, things are going much better with my data capable autopap.  Still trying to adjust, but it seems like I can get there. It's funny, there's lots of warnings on this site, esp. from the mods, about how the posters on this site aren't trained doctors, etc.  I understand where that's coming from, but I can tell you, you folks are much more knowledgable than my former doctor.  But fortunately, he's now both a former Dr. and CPAP supplier.