Thanks!

[SoCalCpapGuy]

I hope this is the right place to put this, but I just wanted to thank everyone for all the amazing information on here... I did my sleep study about a month ago - my AHI was 26 - then a week ago I had my second sleep study/titration... which showed that using a CPAP brought my AHI down to 0...

Today I went to see the doctor who referred me, and because of the Board, I was prepared with all the information I needed to get a prescription for a Resmed Airsense 10 AutoSet with a Heated Humidifier and a Heated Hose... The doctor told me he wished all his patients were as knowledgeable and knew what they wanted...  I left there with copies of all my Sleep Studies and a Prescription for the exact machine and mask.

Because of all the info on here, I had checked out all the DME suppliers my insurance will work with within 30 miles, and after checking with a few, found one that seems willing to work with me... I sat down with them and made it clear that I knew what I wanted, and their job is to give me the machine I want, not what's going to make them the most profit. They're now getting authorization from my insurance, and will be ordering the Airsense...

Once it gets authorized, and they let me know they have the machine, I'll be using the clinician manual to make sure the machine is new.

Considering I knew NOTHING about Sleep Apnea, AHIs, sleep studies, machines and how to get the right one before I started coming here, I can't thank everyone enough.

[Ockrocket]

Welcome.. 

The journey begins for you, there will be some challenges along the way... much information can be found among the members and posts here. 

Good luck going forward. 



Cheers, 
Ock.

[Apnea Infant]

What a way to start..........

Well done!! Indeed there might be challenges along the way dialling into your numbers but with this kind of fore knowledge and prep, you are well on your way.........

This is such a great place to be with the wealth of knowledge and a community so willing to share. 

Do let us know how you get on.

[zonk]

Wishing you best luck and a successful therapy 

[Sleeprider]

The rest is easy...you get to sleep without the apnea. Well done on getting everything arranged up front, we might have a new author for the Wiki section.

[gwc2795]

Please post this in http://www.apneaboard.com/forums/Thread-...-Post-Here so other users can learn of the benefits of being informed.

[SoCalCpapGuy]

I don't think I should be adding my experience to the CPAP success stories yet... Things sure fell apart quite quickly.

Things didn't go like I planned...  I got the prescription from the Pulmonary Physician, then after researching the DME's listed as my plan's choices on Blue Shield's website, I happened to have an appointment with my Primary Care Physician, who said that everything needed to be done through them, and the specialist was "wrong" giving me a prescription.  When I told her I would at least like the request marked "stat", she laughed and walked out of the room.  Needless to say, it wasn't marked stat.

The medical group's authorization department then called me a few hours later and told me that I wasn't allowed to use the DME that Blue Shield had listed because the group doesn't have a contract with them.  They gave me names of four DME's and told me to choose one.  Right then.  On the spot.  I basically was bullied into picking a DME over the phone that I know nothing about.

So, I went from having everything set up to being told it will take a week to ten days for their authorization, and that they get to decide everything - not the in-network specialist that they sent me to.

When I called to their "Patient Support Center" to complain, I was told that I shouldn't use the Blue Shield list of providers and that I am "their" patient, not Blue Shield's patient - and I shouldn't even look at Blue Shield's online info for members.  When I told them I wanted to file a complaint, they said, "we made a note of it, anything else we can help you with?"  So I was basically blown off by them.

I went from being treated like an equal partner in my healthcare decisions by the Pulmonary specialist, to being treated like a child by my medical group.

What fun, instead of sleeping my usual 5 hours a night, I managed to sleep two hours last night because I'm so upset.

The only bright spot is Blue Shield told me that a machine would be fully covered with no copay.  I just hope that some bureaucrat doesn't decide that I can only choose a junk CPAP.

I just want to say "screw you" to my Healthcare Group, pay for and order the machine I want online - and start using it ASAP.   Instead I'll probably just wait the week to ten days to get the authorization. Buying it somewhere else would wipe out my FSA for the year. 

At this point, I have filed a complaint with the California Department of Managed Healthcare. 

I think it's time to start trying to find a better medical group.

[Walla Walla]

If you have the prescription from the specialist what's stopping you from picking your own DME? They can't make you go through them. Find another Doctor to handle the followups for insurance and ignore the medical group as far as your sleep apnea treatment goes.

[Sleeprider]

Unfortunately, you got one of those....Get your sleep study copy and the prescription as required under HIPAA. If your sleep doctor will not work with a DME of your choice, then take a copy of your sleep study to your primary care physician, explain the situation and request to transfer all care to him. Give your PCP a copy in writing of your expected prescription and choice of DME with phone and fax number. Most PCP docs will cooperate. The best approach is discuss this with the head nurse or doctor, and they will probably consult privately before agreeing to transfer continuing treatment and prescription.

Suggestions for prescription:
Patient has moderate obstructive sleep apnea and is recommended to be prescribed Resmed Airsense 10 Autoset CPAP with integral heated humidifier.
E0601 Auto adjusting CPAP Minimum pressure 7.0 cmH2O, Maximum Pressure 20.0, EPR 2. Patient to self-titrate.
A4604 Heated tubing
A7030 or A7034 Patient choice of full face or nasal interface mask frame, cushion and headgear.
Replacement supplies, filters, humidifier chambers, masks as needed.
(You can look up HCPCS CPAP codes online if you want more)

Your doctor's office will complete the details on a form of their choice or fax the information on request. As long as they have the study Dx they are covered for issuing prescriptions on behalf of their patient. I have done this for years and have never seen a specialist since my original Dx in 2008. We normally cover CPAP use and efficacy in an annual discussion. You will need an appointment with your doctor within 90 days of dispensing the equipment to go over compliance and efficacy for insurance purposes as you will be required to demonstrate 70% compliance (21 of and 30 day period in the first 90 days).

Hope this helps.

[SoCalCpapGuy]

If you have the prescription from the specialist what's stopping you from picking your own DME? They can't make you go through them. Find another Doctor to handle the followups for insurance and ignore the medical group as far as your sleep apnea treatment goes.

They made it sound like I have to go through them or it won't be paid for... This whole thing has thrown me for a loop... I guess I can contact the Pulmonary doc... When he gave me the prescription, he said they could call him and he would authorize it... and he's the one I'm supposed to meet with in 3 months to go over everything.

I'm suddenly really confused...  Maybe I need to check with Blue Shield to make sure it would be paid for if I go on my own without my medical group "approving" it...