I love the medical mafia

[bwexler]

My primary doctor belongs to a medical group who acts as gate keeper for all specialists and DME, basically anything the doc does not do in his office.
I have been trying to get Apria to provide a new air filer for my Philips O2 concentrator that they did not provide. They don't stock the filter I need and refuse to order it. I complained to the medical group, so they had the doc do a test last week in his office. He checked my SPO2 then had me walk up and down his hall several times and checked SPO2 again. The results showed no desat so the determination was that I do not require supplemental O2.
The reports from my CMS50i with and without O2 are not relevant. Only the brief one time hall test provides conclusive evidence that I have have no need for supplemental O2.
I love the medical mafia.
I am just glad I own my own concentrator and simply need to buy my own supplies for it now.

[GrammaBear]

Sorry if my comments are not relevant, but how can walking up and down the hallway be compared to sleeping with supplemental oxygen? I don't have the extra oxygen, but it is much different for me when I lay flat in the bed as compared to walking or sitting upright. Medical Mafia is apparently alive and well.

[bwexler]

That is exactly what I said.
They told me my PAP machine should be supporting proper breathing. That should provide adequate O2. So no need for supplemental O2.
Then I asked, what about the reports from my recording oximeter showing desats when on PAP with AHI below 3?
Not relevant your doctor and DME need to fine tune the machine.

The person I was talking to, my case manager, claimed to have been a hose head for ten years. She informed me I should not be taking advice from sites like this, since the members are not MDs or RTs.

I need to warn the members who are, that they aren't supposed to be here.

[SuperSleeper]

The person I was talking to, my case manager, claimed to have been a hose head for ten years. She informed me I should not be taking advice from sites like this, since the members are not MDs or RTs.

So I guess when I was a kid and sick with a cold, I should have never listened to my mother who fed me chicken soup, plenty of other liquids and told me to get my rest.
How dare she give medical advice to me without a medical degree!!!?! I think I'll call her up and give her a piece of my mind.

[PsychoMike]

bwexler, sometimes people with real experience can be much better than those who "took a lecture on it once" or who settle for "this number means it's good enough."

Personally, it is my health and I will fight tooth and nail to be involved and to have the best treatment I can. If your primary ducktor is quacking about the hall test instead of actual numerical data, then I think he's out to lunch (and as one who deals with applied science, it strikes me as almost negligent to use two instantaneous data points outside of the conditions of concern vs. continuous data from the actual conditions of concern). Just because you don't desat whilst awake doesn't mean it isn't a problem when you're asleep.

Based on the comments by other US folks here, though, it sounds like Apria is a significant part of the problem.

[bwexler]

My primary doc is OK. He is ignorant about OSA but he is learning from me and pretty much writes whatever RX I request. The problem seems to be the medical group he belongs to. They act as a gate keeper for anything that costs money. Apparently they get bonuses by limiting or reducing costs. First everything must be in their network, not just the insurance network. Then anything they can disallow ads to their bonus.
I probably need to chill out and accept what they approve and pay for what they don't. Unfortunately that is not my nature.

[basstenor]

Can't you chose which doctor you go to?

I'm from Germany, so I don't fully understand your health insurance system. I'm in what you'd probably call socialistic-like federal health insurance. You have to pay about 15 % of your net income for it. Some docs are good, some are not, but it's me who can choose.

[justMongo]

Can't you chose which doctor you go to?

It depends...

I'm from Germany, so I don't fully understand your health insurance system. I'm in what you'd probably call socialistic-like federal health insurance. You have to pay about 15 % of your net income for it. Some docs are good, some are not, but it's me who can choose.

What the US calls Obamacare is not yet socialized medical care. It's a mandate that all citizens have insurance. The insurance companies backed the law because they thought the young, healthy, uninsured people would join and pay premiums.

The majority of people in the US get their medical insurance as a benefit from their employer.

Many people are in Health Maintenance Organizations (HMOs.) With an HMO, the patient must see doctors who are in the HMO's network. HMOs became popular in the early 1990s.

US Medicare is an extension of the US Social Security System. Social Security may be called a socialist program. It was created in 1935 by President Franklin Roosevelt. Medicare was created in 1965 to provide medical care to the elderly (over 65 years) and the disabled.

Those people on Medicare may join a HMO type program. Or, they may stay with traditional Medicare. Under Medicare, a person may see any doctor who accepts Medicare. A doctor is not required to attend to Medicare patients.

[GrammaBear]

That is exactly what I said.
They told me my PAP machine should be supporting proper breathing. That should provide adequate O2. So no need for supplemental O2.
Then I asked, what about the reports from my recording oximeter showing desats when on PAP with AHI below 3?
Not relevant your doctor and DME need to fine tune the machine.

The person I was talking to, my case manager, claimed to have been a hose head for ten years. She informed me I should not be taking advice from sites like this, since the members are not MDs or RTs.

I need to warn the members who are, that they aren't supposed to be here.

Not relevant your doctor and DME need to fine tune the machine???
....with me it would be Good Luck if I could get an appt with the doctor as he is way busier than he wants to be. And as far as the DME fine tuning my machine - - "Yeah, right - when he77 freezes over." The last time I brought my machine to the DME for 'fine-tuning', the lady told me straight up......"I've only worked here 4 months, but YOU have no business looking in the clinician's menu, that is for us professional people." I had all I could do to keep a civil tongue in my head. Normally I am quiet and say nothing, but this time I sure was P*ssed. Good thing my husband hurried me out of there or I might have said something I would later regret.

[PsychoMike]

The US for profit healthcare system is one of the reasons I didn't pursue a job in the US (though with my qualifications, I've had more than a few headhunters try to dangle the greenback carrot in front of me).

It comes down to a simple observation: In the US medical system, the goal is profit and the patient is the annoyance that must be put up with in order to make said profit.