Anyone gone rogue? (No insurance)

[TheMCP]

The machine does not report data to your insurance company. The machine reports data to the manufacturer who merely stores it. The doctor obtains the data from the manufacturer and looks at it to determine if they can recommend anything to make your treatment more effective, and sometimes (rarely, but it happens) they may contact you to talk about changes to your machine settings, and they can place an order (with the manufacturer, who sends it to your machine) to adjust the settings. 


Your insurance company does not look at the data. They contact the doctor and ask "is the patient meeting the standard we have set?" (In your case, that's 4 hours a night, you say.) The doctor says yes or no and the insurance company acts on that. 

So what the insurance company gets is "yes" or "no" and the data is used to make that "yes" or "no" and otherwise the data is used for the doctor to see what is going on and talk to you about how to improve your health.

I understand that some people may want to do it themselves, particularly if they have a high deductible and getting a test is very expensive for them, particularly if the sleep center wants a lot of appointments and multiple tests and followups, all of which are expensive. Also sometimes the insurance requires you to deal with a DME that is very expensive, and often it's a "rent to own" agreement in which the patient ends up paying 3-4 times as much as the machine is worth before they own it. 

I think it's better to involve a doctor in some way, even if you're not going the insurance route. There are at-home tests you can buy which will send real data to a real doctor resulting in a real prescription by which you can adjust the settings on a machine at you purchase from the vendor of your choice. (There are certainly a lot of vendors online which are much cheaper than your local DME.) Depending on your specific problem and your machine needs, it may be very easy to set up (with almost any machine) or you may need a doctor to specify the exact machine and exact settings.

[Sleeprider]

The machine does not report data to your insurance company. The machine reports data to the manufacturer who merely stores it. The doctor obtains the data from the manufacturer and looks at it to determine if they can recommend anything to make your treatment more effective, and sometimes (rarely, but it happens) they may contact you to talk about changes to your machine settings, and they can place an order (with the manufacturer, who sends it to your machine) to adjust the settings. 


Your insurance company does not look at the data. They contact the doctor and ask "is the patient meeting the standard we have set?" (In your case, that's 4 hours a night, you say.) The doctor says yes or no and the insurance company acts on that. 

So what the insurance company gets is "yes" or "no" and the data is used to make that "yes" or "no" and otherwise the data is used for the doctor to see what is going on and talk to you about how to improve your health.

I understand that some people may want to do it themselves, particularly if they have a high deductible and getting a test is very expensive for them, particularly if the sleep center wants a lot of appointments and multiple tests and followups, all of which are expensive. Also sometimes the insurance requires you to deal with a DME that is very expensive, and often it's a "rent to own" agreement in which the patient ends up paying 3-4 times as much as the machine is worth before they own it. 

I think it's better to involve a doctor in some way, even if you're not going the insurance route. There are at-home tests you can buy which will send real data to a real doctor resulting in a real prescription by which you can adjust the settings on a machine at you purchase from the vendor of your choice. (There are certainly a lot of vendors online which are much cheaper than your local DME.) Depending on your specific problem and your machine needs, it may be very easy to set up (with almost any machine) or you may need a doctor to specify the exact machine and exact settings.

I completely disagree. I don't think there is anything a sleep specialists can bring to my condition or therapy that would improve my therapy in any way, but there are many ways that specialist could draw incorrect conclusion that run counter to my interests and efficacy I have found with a bilevel machine (Aircurve 10 Vauto).  A sleep specialist is a sell-out to the insurance industry in most cases, and the system is stacked to ensure you get the cheapest, least capable machine possible.  I have NO DEDUCTIBLE or copay with CPAP and will not submit to a sleep specialist recommendation.  I'd just get a lower level machine and have to live with it.  I buy used bilevel machines out of pocket and Medicare and my primary insurance have no problem providing abundant mask, cushion, tube, humidifier chamber and filter replacements.  I currently have two machines.  I'm not going to submit to a sleep test when I can buy a machine for under $200, like my last one.  I can't begin to describe the misery of a clinical test, or why it is designed to extract money from insurance, not to treat you better.

[RayBee]

Seeing as how Kaiser's sleep doc / department fumbled the ball for nine months trying to figure me out, that's a big fat "get lost" from me once I had my script in hand.

Kaiser measures time in weeks to months when an appointment is needed. Here on AB it's a few minutes (90% of the time) to a few hours (10% of the time).

I wish I knew some of the home addresses of the guys and dolls here on AB because they would certainly be on my Christmas cookie list.

[SarcasticDave94]

The sleep specialists I've been dealing with haven't been very helpful. Their specialty seems to be misdiagnose, not listen, and fail to do about anything right. I've been told by my RT that she's surprised I'm not an RT, and that I know more than the doctors.

[Gideon]

To those that are expressing appreciation for the help they have received from AB or OSCAR, a donation to AB would be appreciated. AB supports OSCAR with a separate development forum and host the only official OSCAR download sites.

Even a little helps

[Hydrangea]

It would be worth calling your insurance directly, to determine if they truly do require compliance.

My DME told me my insurance requires compliance. I called my insurance company to ask about that, and the lady laughed and said "If we required compliance, none of our customers would have CPAPs." So I went back to my DME and was empowered to tell them *my* insurance company does *not* require my compliance, AND thus I will not be sharing my data with them (via modem) unless I so choose.

[Hydrangea]

My problem with masks is that they all leak- a lot.

Have you tried the F20 *with the memory foam*?  That is the one FFM that doesn't leak on me; and I don't have to crank it tight to my face.

[TheMCP]

I think it's better to involve a doctor in some way, even if you're not going the insurance route. There are at-home tests you can buy which will send real data to a real doctor resulting in a real prescription by which you can adjust the settings on a machine at you purchase from the vendor of your choice. (There are certainly a lot of vendors online which are much cheaper than your local DME.) Depending on your specific problem and your machine needs, it may be very easy to set up (with almost any machine) or you may need a doctor to specify the exact machine and exact settings.

I completely disagree. I don't think there is anything a sleep specialists can bring to my condition or therapy that would improve my therapy in any way, but there are many ways that specialist could draw incorrect conclusion that run counter to my interests and efficacy I have found with a bilevel machine (Aircurve 10 Vauto).  A sleep specialist is a sell-out to the insurance industry in most cases, and the system is stacked to ensure you get the cheapest, least capable machine possible.  I have NO DEDUCTIBLE or copay with CPAP and will not submit to a sleep specialist recommendation.  I'd just get a lower level machine and have to live with it.  I buy used bilevel machines out of pocket and Medicare and my primary insurance have no problem providing abundant mask, cushion, tube, humidifier chamber and filter replacements. I currently have two machines.  I'm not going to submit to a sleep test when I can buy a machine for under $200, like my last one.  I can't begin to describe the misery of a clinical test, or why it is designed to extract money from insurance, not to treat you better.

I said "I think it's better to involve a doctor in some way", and you ranted at length about the evils of "sleep specialists". I specifically said "even if you're not going the insurance route" and you ranted at length about the evils of the insurance route. You used these as reasons why you "completely disagree", but your rants really don't relate to what I said.

I think it's better to involve a doctor in some way because hypochondriacs are a real thing - there are people who will convince themselves they have sleep apnea because of some nonsense when they really don't, and it's better for both their wallet and their health (not tot mention the sanity of people around them) if they don't try to treat a condition they don't really have. Also there are people who sincerely think they may have sleep apnea for real reasons and just don't, and same story, not only would they potentially be harming their health (I know CPAP is generally harmless, but if they mess with the settings enough, it may not be) by treating a condition they don't have, but they could in the process be ignoring a real (and potentially life threatening) condition that they do have. For example, cardiac failure can cause someone to exhibit fatigue and brain fog. If they decide it's sleep apnea and go about getting CPAP without talking to a doctor, potentially their heart may stop while they're worrying about why CPAP doesn't seem to be helping.

You then evangelize at length about how you buy your own BiPAPs without insurance and this is so much better. Good for you, I'm glad you are getting benefit from this. And as I said, I understand that there are people who choose not to go the insurance route and that there are reasons for this, so I am not going to argue that you have to. 

On the other hand I have a buddy who got BiPAP last week without insurance - he may even have the same machine you do, I haven't seen it yet. He in fact does have doctor direction, he didn't just get this out of thin air, but he chose to just pay out of pocket for the machine so that he wouldn't have to do the insurance dance of multiple sleep studies, trying multiple machines, paying a huge deductible for it all, etc. Again, I understand that there are reasons for this. When he told me of his intent I didn't even argue, especially because I knew he had talked with a real doctor who had told him to get BiPAP. 

That said, he literally is an engineer with a degree from MIT, and he told me that setting it up was really hard and he had to try several vastly different sets of settings, in consultation with an actual expert, before he found what works for him. Without my prompting he explicitly told me that he doesn't think an average person should get BiPAP and set it up themselves, it's too complex. And remember, this is literally coming from a man who is actually a genius and actually an engineer and actually has a degree from MIT.

You go on at length about how "sleep specialists" are there to push you into the cheapest machine possible so the insurance doesn't have to pay for it. I don't know about you, but my doctors will say "here is what we think is best for you and here is what the insurance will pay for," and if there is a gap between the two they will work with me on what hoops we have to jump through to get the insurance to pay for what they really think I need. Also if I tell them "forget about insurance, I am going to pay for this myself," they will just tell me what they think is best for me and be done with it - so if I tell them I am going to pay for it myself, if they think BiPAP is the thing for me, they will recommend it and not try to push me into a cheaper machine, but then I will have a doctor to help me set it up correctly. 

I stand by my thought - I think a doctor is a good idea even if you have chosen to ultimately go without insurance. A doctor can help insure you aren't imagining you have sleep apnea, help see if you have some other problem entirely that needs to be treated so you don't die of it, and help you set it up if you need that.

[staceyburke]

An engineer with a degree MIT and he had problems setting it up - give me a break!!  I got mine VAUTO without any medical help, no techs, just 2 times I got help from this site and I was done. I think he needs to send his degree back

[SarcasticDave94]

OK maybe Apnea Board may not be a good fit for you then. This forum is about self advocating Apnea therapy. The settings cannot harm you. There's no place in this thread that says don't see a doctor. I myself know more than the doctors I've seen recently and that's what is referred to. The supposed sleep specialists don't know how to treat patients with Apnea, but that's what they're supposed to be expert at. These specialists get it wrong far more often than get any of it right. They get machine choice as in type wrong, they don't know how to set up the PAP machine, and so on. I know how to set my ASV when the first RT that set this up had to guess. Try to have a nice day anyway.