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Permalink Reply by RockRpsgt on March 27, 2010 at 12:13am

No matter what CPAP you get it will be effective. Should be anyway. I would ask for a fully data capable machine. With some software downloads you will be able to monitor your own data. Both respironics and resmed each have 2 on the market. I am sure soome others will post on this. Good luck.

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Permalink Reply by Judy on March 27, 2010 at 5:54am

Since you posted this on the 26th, I'm assuming the appointment on the 20th was a typo and you meant this coming Monday, the 29th.

Ask for:
1] a copy of the sleep doctor's dictated results of the sleep evaluation and PAP titration study(s)
2] a copy of the full scored data summary report w/condensed graphs of the sleep evaluation and PAP titration study(s)
3] your equipment order (prescription) so that you can "shop" your local DME provoider options
4] that your equipment order (prescription) include "access to leak, pressure, AHI and AI data" and "full face, nasal cushion, nasal pillows or oro/nasal mask of patient's choice"
5] ask if there is a local A.W.A.K.E or other local apnea support group

The above are part of YOUR medical records and as such YOU have a LEGAL RIGHT to these copies under HIPAA.

Be sure that you keep the above for your own records and ONLY provide COPIES of them to the DME provider you opt to go with.

Call your insurance company and ask them which local DME PAP suppliers they are contracted with. Hopefully you will have the option of more than one.

Shop your local DME PAP provider options just as you would for a new car. Judge how comfortable you are w/the staff you will be working with, ask what brand and model PAP they prefer to provide you with, ask how lenient their mask exchange policy is.

Understand that most all insurances pay by insurance (HCPCS) code, NOT by brand and model. A bottom of the line, compliance data capable only CPAP and a fully data capable CPAP and a fully data capable APAP are "all" HCPCS code e0601. While the fully data capable APAP costs the provider more than the fully data capable CPAP which costs the provider more than the compliance data only CPAP, the insurances pay one set price for HCPCS e0601. So if the provider can get away w/foisting a compliance data only CPAP off on a client, that enhances their profit margin.

Understand also, that the three major mask manufacturers; Resmed, Respironics and Fisher & Paykel, all provide a FREE mask exchange to the local DME providers of most of their masks that patients have tried unsuccessfuly IF the provider fills out a form and returns mask and form to the manufacturer W/IN 30 DAYS.

Keep in mind that this is YOUR therapy, YOUR sleep, YOUR health and that YOU are paying for it, whether thru insurance or out of pocket is immaterial, YOU are still the one paying for it. Be diplomatic, but be FIRM. This applies to the doctor and sleep lab as well.

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Permalink Reply by Tom Frank on March 27, 2010 at 9:54am

Thanks Judy for your insights!! Yes, it was a date typo...I do go THIS Monday 3/29.

As an audiologist/hearing aid specialist I am all too familiar with insurance codes being fairly "generic"
and potentially covering a broad range of product lines and costs... the very reason I asked the question. So thanks for that info.

My father too uses CPAP.... so I have been asking questions of him, especially about local durable med providers since we are fortunate enough to live in the same area. I think my referred provider will do well, but I feel better now knowing what to ask.

As per the medical records, I'm a bit confused. Since I'm in an HMO, my PCP "ordered" the test. I have had no interaction with the Sleep Lab physician (other than his staff constantly calling to see if I have received my equipment). So should my request go to my PCP (will he really have the info I want) OR to the Sleep lab physician?? I'm assuming the latter, even though I've had no "contact" with him as such.

Thanks again, so much for your reply.. Will let you know how things go !

Tom Frank

Judy said:

Since you posted this on the 26th, I'm assuming the appointment on the 20th was a typo and you meant this coming Monday, the 29th.

Ask for:
1] a copy of the sleep doctor's dictated results of the sleep evaluation and PAP titration study(s)
2] a copy of the full scored data summary report w/condensed graphs of the sleep evaluation and PAP titration study(s)
3] your equipment order (prescription) so that you can "shop" your local DME provoider options
4] that your equipment order (prescription) include "access to leak, pressure, AHI and AI data" and "full face, nasal cushion, nasal pillows or oro/nasal mask of patient's choice"
5] ask if there is a local A.W.A.K.E or other local apnea support group

The above are part of YOUR medical records and as such YOU have a LEGAL RIGHT to these copies under HIPAA.

Be sure that you keep the above for your own records and ONLY provide COPIES of them to the DME provider you opt to go with.

Call your insurance company and ask them which local DME PAP suppliers they are contracted with. Hopefully you will have the option of more than one.

Shop your local DME PAP provider options just as you would for a new car. Judge how comfortable you are w/the staff you will be working with, ask what brand and model PAP they prefer to provide you with, ask how lenient their mask exchange policy is.

Understand that most all insurances pay by insurance (HCPCS) code, NOT by brand and model. A bottom of the line, compliance data capable only CPAP and a fully data capable CPAP and a fully data capable APAP are "all" HCPCS code e0601. While the fully data capable APAP costs the provider more than the fully data capable CPAP which costs the provider more than the compliance data only CPAP, the insurances pay one set price for HCPCS e0601. So if the provider can get away w/foisting a compliance data only CPAP off on a client, that enhances their profit margin.

Understand also, that the three major mask manufacturers; Resmed, Respironics and Fisher & Paykel, all provide a FREE mask exchange to the local DME providers of most of their masks that patients have tried unsuccessfuly IF the provider fills out a form and returns mask and form to the manufacturer W/IN 30 DAYS.

Keep in mind that this is YOUR therapy, YOUR sleep, YOUR health and that YOU are paying for it, whether thru insurance or out of pocket is immaterial, YOU are still the one paying for it. Be diplomatic, but be FIRM. This applies to the doctor and sleep lab as well.

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Permalink Reply by Judy on March 27, 2010 at 10:04am

Send your request to the sleep lab then. Or the sleep doctor's staff and never mind the sleep doctor. I really dislike these prima donna sleep doctors than can't be bothered consulting w/the patients. To my mind it really reduces their credibility. Plus it just plain irritates me and cause me to dislike them w/o ever having met them.

However, often in these circumstances it is the sleep lab's fault there are no consultations w/the sleep doctor. They're too cheap to have one or more on staff to do so. So it could well be your HMO's cutting corners as the reason you have no contact w/the sleep doctor. Either way the staff does seem concerned enough so likely they will be the best to work with. Don't be bashful about invoking HIPAA if necessary.

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Permalink Reply by Mary Z on March 27, 2010 at 12:08pm

Tom, I'm sure you know to write down your questions and take that list to the appointment. I think it's always helpful to describe yourself as highly motivated and as having the desire to be part of the "team", working with Doc and DME for the best treatment. Many people are not really interested and the DME (some) tend to invest their energy in proportion to your committment to treatment. As others have said, you do want a data capable machine. I have the ResMed VPAP Auto 25 which gives me access to leakage, Tidal Volumn, minute volumn, AHI and AI, and respiratory rate. These really are sufficient for my needs. A copy of your presciption is helpful, or ask to see their copy. If you can't get what you want, eg. the doc prescribes only a compliance data capable machine, try to correct that.
The machine I have is a ResMed Series 8, the newest version is the series 9 and is considered "sexier", more bells and whistles meaning some nice features. The other companies mentioned make excellent machines

I think one of the most important things is the fitting of the mask and trying the mask with a machine set at your pressure.

Distill all of these ideas to the ones most important to you- I would say the type machine (data or just compliance capable) and the mask, and the prescription. Copies of all the sleep study data can be gotten later, though if it's easily available at the time go for it.

You've gotten a lot of good advice so you should be well prepared.

Good Luck,
Mary Z.

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Permalink Reply by D. W. Conn on March 28, 2010 at 5:36pm

No matter what unit you get make sure you like the mask.. Please wear it everytime you sleep..even brief naps.

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