New and Abused - Confusion with the process

[SuperSleeper]

Deadman.. I'm not arguing with you either and I hope that I didn't come across implying that you didn;t know what you are talking about.

The confrontation and frustration that you are in the middle of, goes straight to the soul of most folks here who contribute only with the intent of passing on some useful or helpful info to other sleep apnea folks. My heart goes out to you while you are trying to resolve some of your health issues, let alone your financial stalemate. The multitude of insurance companies, DME's, and physicians that wrongly apply the laws to their liking is what is dragging this country and other countries down. It called economics in business boardrooms; but is otherwise called "greed" to us lay persons. I wish you well.

[SuperSleeper]

Never took it that way, but I wanted to make sure that what I wrote was not offensive to you or just arguing for the sake of arguing. I tend to be somewhat clinical about making points sometimes and can come off as being strident when I do not intend to be. I makes me overly cautious and even that can send a wrong message as I thought I may have here. My basic premise as a journalist is somewhat unconventional in that I honestly believe that expanding the marketplace of ideas to include all ideas means that in the end rational people will find the best answer. For that reason I tend to argue points to the best of my ability, expect others to do the same, and then sit back and contemplate it all. I have NO problem with being wrong - especially when I learn something as I have on this forum - and hoped that your comments would be aimed at the same end: Helpful information. I guess being on a forum is still a lot like meeting new people in that it takes a while to get a feel for who you are talking with and get comfortable with them. Anyway, thanks for all comments and ideas. I have and will continue to appreciate them and the people who voice them and hope you take my posts in the same spirit. Thanks!

[SuperSleeper]

I don't understand the "zone" you mention.

[SuperSleeper]

Medicare approved DMEs are allotted by zones. Depending on where you live or rather where Medicare has your official residence designated, you are assigned a zone. You can only purchase your DME stuff from a vendor who is located in that specific zone and who has paid Medicare their annual $10,000 fee to be allowed to bill Medicare. If you want to see how it works, contact a DME in another part of the country and try to purchase DME from them. You will almost certainly be told they can't do it, unless the vendor is part of a chain - in which case they may have been allotted several zones and they will adjust their pricing according to the other DMEs in that zone to the fixed price for the zone. With the chains, you will be routed to the vendor in your zone if they have one and you will not likely even know this has happened. Where Medicare is technically coverage that extends all over the US, certain things are exempted or given special status according to the insured resident's zone assignment. I hope that explains it better. It can be complicated.

These are the basic DME zones:http://www.ezdme.com/aboutez/dmerc_regions.htm

There are other zones set up, including those for doctors and in one case there are 441 different zones set up that create variations in what Medicare pays for certain services. See the article but here's a quote:The report criticizes the current arrangement under which Medicare distributes tens of billions of dollars based on regional variations in wages, rents and other costs in 441 hospital labor markets and 89 payment zones for doctors. Of the physician payment zones, 34 cover entire states.

The New York Times article:http://www.nytimes.com/2011/06/02/us/02health.html

In both cases, what is there is a simplistic overview of some of the complications, and they do not really address the corruption involved but if you do the homework as I have done, it's not as hard to find as you'd think. Of course, having an ex-wife who worked processing Medicare/Medicaid claims and who still speaks to me doesn't hurt... But at least you can see the basic idea of the zones they set up in different variations.

[SuperSleeper]

Deadman, You have far more patients then I ever had. The sleep center was in clean violation of HIPPA. If you requested your records in writing, they have 10 days to give them to you, If they refuse and you put in a HIPPA complaint licenses can be revoked and huge fines enforced. My 80 something y/o mother was over dosed on coumadin at a rehab place after a knee replacement. The rehab place refused to admit something was wrong. I called am ambulance myself which they refused to do. At the hospital I was told she would not have lasted more than 8 hrs longer. Both the facility and the Dr. refused to give out the records under a HIPPA request. They both came within inches of losing their licenses.

I would consider the legal root as to the heart attack, that was malpractice and put your life in jeopardy. No excuse for that.

The price for the CPAP is absurd. I must admit I have used the same unit, (ResMed VPAP III) for 7 years and it is on it's last legs, but medicare won't pay for a new one until it is broken and if it is broken and I am not using it they want to know if I really need one. I think they have a ID-10-T error in there system. (IDIOT)

I finally purchased a new one on my own; a ResMed S9 VPAP S from one of the listed suppliers and with shipping it will cost under $1K. I figure there is a price we need to pay until the ID-10-T system gets worked out.

Really great work on your part. I would love to see a couple of sticky's on the forum about the information you have gotten it is worth it's wait in gold!

Sandy

[SuperSleeper]

Thanks for the encouragement. I stated with this just as a matter of trying to understand how it all works and why so many I've known have tried and immediately quit using the CPAPs. I guess it was the investigative journalist in me that was triggered by the strange responses from the DMEs and it was certainly made worse by the abysmal treatment at the sleep clinic.

Now, after the heart attack during the sleep test and the scare that put into me, I've redoubled my efforts. The cardiologist wants me on ASAP for all the same reasons as my GP presented and it appears the hardware will arrive next week. The supplier (one of those listed here that also does used units) has been absolutely wonderful. No hidden tricks, no evasive answers, and no hard-sale pressure. All this why the sleep therapist who owns it has been dealing with a father who is in the end stages of terminal cancer. So although he's been a little slow (out of town dealing with his father), he has the right priorities and I have NO complaint at all. I can manage a few more days but his father can't.

I will be getting a new 'Factory Sealed DeVilbiss intelliPAP Auto CPAP w/ SMARTFLEX with Heated Humidifier' that will allow ME to find out what is happening, how the machine is working, and how I am doing in an efficient and economical way. I have full access to programming and can adjust as I please. I will be getting a nasal pillow mask as it worked well during the test and a 12-foot hose so it accommodates my sleeping quarters and sleep behavior. The entire package, delivered to me and with warranty comes to $550. Far less than the Medicare co-pay and no nonsense.

I suppose a whole new adventure will begin when I start using it regularly and I will manage to figure all that out as well. Probably with help from some of you again - considering how well this has worked so far. Thanks again!

[SuperSleeper]

If what I've been reading is correct, the IntelliPAP does not store airflow waveform data, even with the smartlink module. In my opinion, this seriously reduces the usefulness of the data.

[SuperSleeper]

I spoke with the therapist about the different brands and he said that the older Devilbiss units were not quite up to par but he really likes the new stuff. Apparently the company really put a lot of work into the upgrades. Besides, it is one company that does not appear to be in the business of price fixing and restraint of trade, so from an ethical view I am much more comfortable doing business with them. I used many other non-related Devilbiss products over the years and it was known to be a reliable equipment manufacturer. Not a new company and one that has dealt with air delivery systems for MANY years. I guess I will find out if my research has paid off or if I will be sorry, but it's the best I can do now.

BTW: I ordered a 12-foot hose. One reason is that I have limited space to put it and limited places to plug in. (Did I mention I am playing Charles Kurault these days and living in a motorhome?) Another is to place the unit away from my head for noise reasons if that becomes an issue. I doubt it as I find pink noise like fans a good way to block outside noises. Finally, I tend to roll side to side a lot when I sleep and wanted a little extra hose so I would not be restricted. Any of that make any sense? I am just swinging blind and using my best guess at this based on what I can see as possible scenarios.



Archangle: I do not know about that. However, when I get the machine here I would be glad to look into it and see what it does or doesn't do that may be useful. Perhaps next week you might post some questions for me to answer? My main concern was to be able to determine what it takes to get rid of the apneas, how effective the machine is at doing that, what pressure is required, and what if any changes occur over time. I need time with it, but I understand that the codes produced are a fairly complex analogue-based analysis.

Being something of a techno-geek, I find the concept fascinating. My thinking is that I can use this not to completely replace a doctor or sleep therapist but to reduce unnecessary visits and be more in charge of the things I can be. I don't know about you, but I find that when I feel more like I have some control over my medical treatment it is not only easier to accept but often more effective. One theory I have at this point about the low tolerance ratio for CPAP use is that too often the patient's needs are not heard, dismissed, or considered to be out of the supplier's job description. If that is true, perhaps providing more information, and answering questions, and allowing the patient to be engaged in his own treatment will relieve that some. Am I the only one who has been profoundly dismayed by the almost total lack of consideration for and clinical distancing of the patient in this business? I doubt it.

[SuperSleeper]

If I understand correctly, the DeVilbiss will probably provide you excellent therapy, and a good bit of data, especially in terms of "scores" of how many apneas, what type, etc.

I don't think it includes flow waveform data. The current data capable ResMed and Respironics machines do.

On my PRS1 machine, if it records, for instance, an apnea at 2:14 AM, I can go look at the waveform, and see whether I stopped breathing completely, partially, how completely I stopped breathing, whether I breathed heavily before or afterwards, etc. Once you learn to read it, you can see "ragged" breathing, and hints of a restricted airway, etc.

Even if you don't learn to read it yourself, a good doctor can look at the waveforms and figure out more about why, for instance, you woke up gasping for breath with your heart pounding at 3 AM the night before.

The DeVilbiss will give you or the doctor some information that might help figure this out. A machine with flow waveforms will give you an EKG like graph that tells a lot more information.

The DeVilbiss isn't "wrong," it's just that having waveforms is a very powerful extra tool in the arsenal.

Here's the kind of info a flow waveform can give you. (The flow rate graph.)

[SuperSleeper]

Source Supplier #1- More people choose IntelliPAP Auto than PRS1 Auto, S9 AutoSet and F&P Icon Auto.

IntelliPAP Auto 37%, PRS1 Auto 21% , ResMed S9 AutoSet 24%, F&P Icon Auto 4% .

It is packed with features, humidifier and 3 years warranty. It got good reviews, i look forward reading your review after using the machine for a while.
Best of Luck.