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02-27-2023, 08:30 PM (This post was last modified: 02-27-2023, 08:37 PM by Sorfosh.)
What to expect from DME
Hi all,
I finally got diagnosed with sleep apnea (I am happy to know my sleep can be improved)! I always have had bad sleep and it never came to mind I could have sleep apnea until my new girlfriend told me all worried about how I choke and gasp for air at night. I am attaching the report of the at home sleep study I had. I do want to point out that according to my girlfriend (who could not sleep and stayed up most of the night) when I was doing the sleep study she did not notice me choking so much, which makes me think the sleep study was on a good day.
Anyway, I did the sleep study through Geisinger. They apparently work with some sort of middleman called "Tommorow Health", who then contacts a DME provider near me and works out the CPAP logistics (is that standard?). Could anyone tell me what to expect exactly? What should I be ready for when they call me? Should I pick the machine I want before-hand so I can make sure I get what I want? I am planning on being adamant about not getting a "brick" CPAP machine but I am not sure if I can be assertive enough. I contacted the insurance and the CPAP machine will be 250$ + 10% of the cost of the machine. I feel like since I pay 10% the cost should not matter to me.
Any advice that would prepare me would be very helpful and I look forward to checking back once I have the machine!
Thank you!
EDIT: What in the world happened in the attachment lol. I will try to fix that.
Your sleep study seems to show that your apneas and hypopneas are strongly positional. In other words the problem is predominantly when you are supine. When you are not supine, the rate of events is very much lower, and perhaps does not require CPAP treatment.
Did you discuss with your physician whether a positioning device might be more appropriate for you? This could be a simple as a tennis ball sewn into the back of your pajama shirt, or a wedge pillow or similar.
Do some research on using a "middleman" when dealing with your sleep doctor/clinic and/or DME. It just seems logical that there may be "extra" costs associated when a 3rd party is involved.
Get a list of DME providers that your insurance company has contracted with and go from there. Be sure you know your exact coverage.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(02-28-2023, 02:08 AM)EddyDee Wrote: Your sleep study seems to show that your apneas and hypopneas are strongly positional. In other words the problem is predominantly when you are supine. When you are not supine, the rate of events is very much lower, and perhaps does not require CPAP treatment.
Did you discuss with your physician whether a positioning device might be more appropriate for you? This could be a simple as a tennis ball sewn into the back of your pajama shirt, or a wedge pillow or similar.
Thank you for pointing this out. I have not discussed this with my physician for the following reason: For the longest time I would sleep exclusively on my stomach until I developed massive back pain. Since then it was recommended to me that I should sleep on my back for the sake of my back. The transition was hard but I managed to do the 180 and started sleeping on my back. This helped with my back pain, however, I do sleep on my side sometimes and back pain is not an issue. So perhaps you are right. I need a new pillow anyway as my neck has been in pain. Do you have any recommendations? The wedge pillow seems interesting but wouldn't that be technically supine position?
(02-28-2023, 06:29 AM)OpalRose Wrote: Do some research on using a "middleman" when dealing with your sleep doctor/clinic and/or DME. It just seems logical that there may be "extra" costs associated when a 3rd party is involved.
Get a list of DME providers that your insurance company has contracted with and go from there. Be sure you know your exact coverage.
Where/Who should I contact about the "middleman"? Should I call the insurance? I do feel like it is silly, why can I not just get the prescription and go to a DME myself? Would be quicker I assume. I will let it play out and see who contact me DME or the middleman.
Thank you for the links, they were very helpful I will be sure to have that checklist of question with me when I am talking about the machine.
I did a lookup on Tomorrow Health, and they provide a healthcare management layer that automates the process of re-supply, ordering, insurance approval etc. but I'm not clear on how they get paid. https://www.fiercehealthcare.com/health-...-equipment They are a relatively new startup and seem to be burning investment cash so far, but it appears they will be providing services to providers and insurers rather than taking fees directly from patients. Most likely the first money being exchanged is the referral fee being paid by Tomorrow Health to Geisinger for control of your health care (I might be a cynic).
You don't have to accept this referral. Do your own homework on what DME providers are in-network for your insurance. This is not difficult to research from your own insurance website or a call. You may prefer a provider that has a local presence or there may even be one with a better reputation. Mostly you want to be dispensed the Resmed Airsense 10 Autoset CPAP and not a substitute from China or Philips. There is a huge difference in quality and Resmed has really separated from the field. They are also more expensive to the insurer and supplier and so are often not the first machine off the rack if you don't insist. We have a Wiki on Dealing with a DME http://www.apneaboard.com/wiki/index.php...with_a_DME Remember it is your choice, or you can be handed off and referred like a trading chip. I recommend you know your supplier and make the effort to research this rather than just accept what comes your way. Get a copy of your prescription so it is portable to the provider of your choice.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(03-01-2023, 04:24 AM)EddyDee Wrote: There is information on positional apnea in the wiki. There are also many threads on this forum, for instance this one is currently live:
Thank you for the link. Immidietly purchased all of the things and see what helps (cervical collar/wedge and cervical pillow). I am excited to see if they make any difference, not that I will be able to quantify it without the CPAP machine.
(03-01-2023, 08:47 AM)Sleeprider Wrote: I did a lookup on Tomorrow Health, and they provide a healthcare management layer that automates the process of re-supply, ordering, insurance approval etc. but I'm not clear on how they get paid. They are a relatively new startup and seem to be burning investment cash so far, but it appears they will be providing services to providers and insurers rather than taking fees directly from patients. Most likely the first money being exchanged is the referral fee being paid by Tomorrow Health to Geisinger for control of your health care (I might be a cynic).
You don't have to accept this referral. Do your own homework on what DME providers are in-network for your insurance. This is not difficult to research from your own insurance website or a call. You may prefer a provider that has a local presence or there may even be one with a better reputation. Mostly you want to be dispensed the Resmed Airsense 10 Autoset CPAP and not a substitute from China or Philips. There is a huge difference in quality and Resmed has really separated from the field. They are also more expensive to the insurer and supplier and so are often not the first machine off the rack if you don't insist. We have a Wiki on Dealing with a DME Remember it is your choice, or you can be handed off and referred like a trading chip. I recommend you know your supplier and make the effort to research this rather than just accept what comes your way. Get a copy of your prescription so it is portable to the provider of your choice.
I told my machine preference to the doctor (through the patient portal) so hopefully they will include it in the prescription. If not, I will fight for it tooth an nail for the machine I want with the DME. Worst case I will order online and deal with the insurance later. Regarding what you say at the end there. I asked why can I just not get the prescription and go to the DME myself (to avoid Tomorrow Health and the red tape that comes with it) and their response was simply and I quote :
"We have to submit the order into Tomorrow Health, you can not take a paper copy in to the supply company and expect it to be filled when everyone has policies that we need to adhere by."
Which sounds a little BS to me but I will not push further unless this process takes too long. Thanks everyone for the advice/information
Beware of DME of the sleep center tecs connection. They are incentivized to sell and rarely supervised by quality medical experts. Much better to start with and continue with pulmonologist and have them guide you. When there is bad or no judgment, it is your body, health and life, not a commodity on sale. On DME, they are incentivized entirely by sales and more importantly by "refills", which can come as often as every month. I threw away away bags of them that I could not use. If you have a copay on insurance you are paying 20% of the mask cushion at $100 (Medicare reimburses an they accept around $20 for my no copay insurance)
Here is an article that may help to fight the B.S. and understand what is going on. https://medtrade.com/news/billing-reimbu...suppliers/ Since Medicare and insurance generally prohibit any financial relationship between sleep labs, and DME suppliers, a middleman organization can help to hide any kickbacks or incentives that might be taking place. This arrangement does not usurp the freedom of a patient to have access to records or to select the provider of their choice. If you want a question answered truthfully, ask the payer...insurance. Get a list of in-network providers. Ask about Tomorrow Health and any third party arrangements. Ask if you have to accept a referral to a particular provider or health coordinator.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
