Second sleep study after 14 years. Now what?

[Night Train]

Hello again everyone.  It has been a while.  I've been on CPaP therapy for fourteen years, same machine, every night and nap.  Best thing I ever did for myself.  I thought it would be good to get a new one now that I am on Medicare, so I had my PCP schedule me one.  That study was last Tuesday and I guess I will have a follow-up consultation with the clinician or doctor in a week or so.  The purpose of this post is to make sure that I make best use of the limited time that they will appropriate to my consult.  With that in mind, please educate me of what I need to be on top of before I get in there.

The place I went to for the sleep study is also the DME equipment supplier/dealer.  My first impression is that they are more about placement of equipment for profit than concern for optimal patient care.  I was swept away on a "conveyor belt" of a process that seemed slanted to ultimately sending me out the other end with equipment whether I needed it or not.  In this case I do, but I got the impression that I was only a component in the process of product placement rather than the reason for product placement.  I was their means to an end result that is their prime directive, that being revenue maximization.  

Because after the initial consult we found out my wife has cancer I had to reschedule the sleep study on two occasions around her appointment schedule and in doing so it gave me time between phone calls to consider things.  I came up with a few questions.  When I asked questions the response seemed to be, "Why do you need to know that?"  Even asking how the machine would be paid for by Medicare seemed to raise suspicion on their end.  It was like they had not often been asked these reasonable and customary questions and that I was prying whey I would not accept a brush-off answer.  I was wasting their time.  It was as if they wanted to be in total control and did not want me to participate in managing the quality of my healthcare.  (Imagine that.)

So now they have the sleep study results and I await my appointment.  Am I out of line to request a copy of the results to read and digest BEFORE my appointment?  I'd like to DISCUSS the results with the doctor or clinician from an informed position rather than have the results read to me.  I think the time spent in the appointment would be best used if I could participate from an informed position rather than just sit there and listen.  

1.  Am I justified in requesting the results prior to the visit?

2.  What else should I consider and be cautious of?

3. Am I likely to end up with a unit that is from their lowest bidder rather than one that is optimal for me because of Medicare rental rate?


THANKS!

[Rich66]

You are legally entitled to copies of your report. None of my sleep studies have been at the DME office -- they've been at the doctors sleep study location. You can ask the DME for copies of the results, but they may tell you to get it from the doctor. My study reports have been about 7 pages long. It seems doctors don't give them out unless asked. Also, ask your DME what brands of machines they can get -- some are limited to an agreement to sell only one brand. And it's all about their profit -- not your health. Ask them if you'll get a new machine, or a used one.
Medicare will pay for medical equipment and supplies on their schedule. Basically, the machine is a rental unit until you show "compliance" in your useage for 13 months. Then you become the owner of it. Compliance is 70% of a 30 day period with over 4 hours of useage each day. Check your Medicare manual for more information.
You might check into what other DME you could switch to -- ask your doctor if they have a recommendation. My doctor, when it came to a recommendation, acted flustered and wondered which DME to send me to, knowing they all are terrible at customer service.
Another "funny" aspect, is they like you to believe they are monitoring you. In my case, no one is monitoring me. I had to figure that one out on my own.
You'll find numerous links on this site about how to deal with DME's and doctors. If you haven't read through a lot of those, you should take the time to do so. The most education help you're going to get is right here on this site. Also, check into downloading Oscar, links are on this site. Its free, and then you can post results and ask questions and get some real help. So you'll also want to make sure any new machine is equipped with an SD card so you load the info on your computer.

[Night Train]

Thanks Rich. Great info there. Yes, I had read the WiKi article and expect some of those issues to come up. In a previous iteration of myself I was a manufacturer's rep for a few medical equipment manufacturers. This gave me reason to be in all of the DME companies in this area, and great insight into the workings of the industry. Questions:

1. Can the usage hours be wiped completely clean on a used machine so that is shows zero hours of use?

2. Can the machine be locked with a password such that only the DME tech can change the settings?

My problem in part is that I get so relaxed that for all intents and purposes, I just stop breathing. Obstruction issues for sure, but many time it's just volume and rate issues! THat's why I need to see the study report: so I can digest what they report as the problem. That way i can be sure that I am getting the right equipment with the correct settings... BEFORE accepting delivery of the equipment.

[Rich66]

1. Most people on here say that the hours cannot just be wiped off. When I was using my Phillips Respironics, it had to be sent to the "factory" for repairs -- OR -- the DME was flinging mud and they did the repairs. But when I look at the hours on the machine and for how many hours I've used it, it just doesn't add up properly, not even close. It had to get zeroed at some point.
2. I'm not familiar enough with all the machines to answer that, and I don't even know of any that can be locked out. YouTube videos are always a good source of how to get into clinician modes.

You say "I just stop breathing". That is what I've been diagnosed as well -- The doctor says my brain doesn't send the signal to my lungs to breathe, and I have awoken during the night having to sit up and gasp for oxygen and try to catch my breath. The doc called it Complex Sleep Apnea. The machine for that issue is an ASV machine -- so, of course, maybe due to insurance, they had me start on a CPAP machine. I couldn't use it, so quit, then they switched me to another machine I couldn't use, then another machine I couldn't use. I guess it's just part of 'jumping through the hoops' as far as insurance is concerned (and it took 4 sleep studies also to finally get my ASV machine).

[Crimson Nape]

There is (on a Resmed) an STM-8 chip located on the pneumatic block (blower) that stores the run hours. If for some reason the pneumatic block was replaced, it is conceivable that you would be resetting the hours. Since this is the only wear item anyway, it probably doesn't make that much difference.

[Night Train]

Yeah Rich, I've gone from having swimmer's lungs from fifteen years of age-group and college swimming to having old man lungs from not doing any workouts.  Always breathed slow but deep from all the cardio.  Now I still breathe slow, but shallow!  I guess I need a portable respirator.  They use to put people in iron lungs for this...

[Rich66]

I feel your pain. I was always a big time swimmer also. I loved it, it felt natural, and I was completely at home in the water. Lakes, rivers, or the ocean. As a kid, my parents belonged to a tennis club with 3 swimming pools -- one was Olympic size. I'd swim and then play handball or paddleball. Now, old age has set in and I have some kind of lung growth that prevents 48% of the oxygen receptors to be plugged up. Catching my breathe can be a real chore. I barely have enough power in my lungs to blow my nose. I'm hoping workouts will help me too, best of luck to you.

[Sleeprider]

Night Train, I'm a bit concerned that you said your using a one-stop shop for the sleep study, and DME. This is often a conflict of interest and very few of these providers "accept assignment" from Medicare. Read the rules https://www.medicare.gov/coverage/contin...re-devices Now verify this provider is a listed Medicare provider that accepts assignment which means they accept Medicare coverage as payment in full (80%) https://www.medicare.gov/medical-equipment-suppliers/ If you have an Advantage plan your 20% copay may be covered as well.

If this supplier is not enrolled with Medicare, you need to find out immediately, what the costs are and whether they accept assignment from Medicate, or if you will be asked to pay what Medicare does not cover. Regarding your question on results, you have the right under HIPAA to receive any records by a health care provider, including test results, prescriptions and other reports, notes, etc. You should insist on getting the results, not only to help prepare for a discussion, but in the event you choose not to use their DME services. Your test should be portable to any provider. This sleep center/ DME may turn out to be just fine, but I have seen many that are not, and it's easy to feel trapped into using their services and products, while being charged higher costs or settling for inferior service. Watch your 6.