Whats your impression of the medical system?

[Allen]

My sleep report and the graphs were supplied to me by my sleep specialist. The difference is probably due to each state running it's own hospital system and how much importance they give to sleep problems

[idahocouchpotato]

I had to vote "good" based on my personal experience. The only part I have found lacking is that I won't be able to see my sleep doctor for another six weeks, and all his receptionist would tell me over the phone regarding my sleep study was that I has severe OSA, and needed biPAP. She told me my pressures were relatively high, but would not tell me the numbers.

In their favor, the receptionist went online to the webpage I directed her to to see the machine I liked, and offered to print it out and send it to my RT to make sure they knew what I wanted.

I have read of others' plights in dealing with DME suppliers and so I chose mine very carefully, and spent 20 minutes on the phone with their office before deciding to have my RX sent there. I'm saddened by all of us who have been less fortunate and had to deal with unscrupulous DMEs and I am glad I found this board to read through before making my choice.

My RT set up my machine, showed me how to use and maintain it, and had me try on several different masks before asking me to choose one. All this was done in a private exam room with a bed so I could try the masks laying down in comfort for 5 minutes or so each. When I asked her about my pressures she was surprised the sleep doctor had not seen me yet and she pulled out my sleep study and showed me some of the charts, and explained the results. I even got a wallet card with my prescribed pressures and mask size, pre bipap AHI, etc.

I even got the cleanable dishwasher safe tub for the H5i without having to ask for it because she only sends out machines with the equipment she would use herself. In fact both she and her husband use xPAP therapy at home, and that is all they sell in their store.

[zonk]

Source: FindLaw Australia

Who "owns" my medical records?
Australian law says that an individual does not own his/her medical records. A private practitioner, eg, your GP, owns the medical record.

Can I gain access to my medical records?
Yes - but there are exceptions.

If a practitioner or hospital (public or private) decides that it would be harmful to a patient to allow him/her access to their medical records, access can be denied. However, you can challenge a decision by a hospital/doctor who denies you access to your records

Will it cost me any money?
Yes. Hospitals and practitioners impose fees for retrieval of your records and photocopying expenses.

Public hospitals currently charge $33.00 (including GST) for access to a copy of a "reasonable" size medical record.

Additional costs are imposed for lengthy documents, eg, admissions to the intensive care unit.

How do I get access to my medical records?
Your request must:

1- Be in writing;
2- State your name and address;
3- Identify the medical records you seek (ie, the date/s of admission to hospital or the date of consultation with the doctor);
4- Specify how you wish the information to be provided.

Private Hospitals are entitled to make other arrangements for access to Health Information they hold. Each facility will have a specific procedure and paperwork that must be completed and followed before access will be granted.

Private hospitals differ in their fees and charges. You will obtain that information from the medical records department.

[big_dave]

I voted for dysfunctional.

When I asked my PCP for a referral for a sleep study, he told me that sleep centers generally accept self-referrals. There are two local sleep centers affiliated with hospitals, and operated by the same medical group. There is a third sleep center that sells CPAP equipment. I called one of the hospital-affiliated sleep centers to schedule a sleep study. They had an opening within a week, but they do not accept self-referrals, contrary to what my doctor told me. I spent the next week facilitating the communication between my PCP (who is part of a large medical group), the sleep center, my insurance company, and my employer’s human resources office to set up my initial consultation. I felt that I was caught between four bureaucracies that all had their own conflicting ways of doing things. My PCP seemed disinterested in providing the referral, and the process seemed unfamiliar to him. By the time I got it worked out, someone else got the opening at the sleep center, and I had to wait several weeks.

When my sleep doctor read my questionnaire, he said that there was a 100% chance that I would be diagnosed with OSA, and he scheduled a split sleep study two weeks later. I had great difficulty sleeping, and I went home the next morning believing that I had blown my sleep study, and would not have insurance coverage for another one since I was too exhausted to continue working. I was struggling on the job and my performance was declining. Out of desperation, I purchased an S7 Autoset Respond on Craigslist (an outdated brick), and I spent the rest of the day searching the internet to find out how to set it up. That is what brought me to the board.

I got my prescription a week later. I was surprised to learn that they were able to get enough data for a diagnosis (my AHI was 40). My sleep doctor offered me a choice of either an auto-CPAP or a titration study. I was fortunate to find a doctor who does not insist on a fixed pressure.

The sleep center provided my prescription to a national DME. They offered me a choice of any DME, but I didn’t know anything about any of them. My insurance company called me a week later to verify that they had set me up with a machine, but I had to tell them that I was still waiting for them to call me. I was shocked that the DME would attempt to bill my insurance before scheduling an appointment with me. I called them and another national DME to ask about pricing on an S9 Autoset, but I could not get a straight answer from either one. Meanwhile, I was worried about my pending loss of insurance coverage. I felt that I couldn’t trust either company, and I couldn’t pay their bills. I took my time searching for deals, and purchased an S8 Autoset II on Craigslist a month later.

During the past six months I have searched for deals on CPAP supplies on the internet continually. I figure I have spent about the same amount out of pocket as a typical CPAP patient would pay in co-pays with insurance--but I have two machines and several years worth of supplies stockpiled.

Maybe I could have kept my job if I could have started on CPAP sooner. There was a monthlong delay between when I asked for a referral for a sleep study and when I started treatment. I probably would have had to wait another month if I had waited to get a machine from a local DME. From what I’ve read on the boards, other patients have experienced far longer delays. I have to accept some of the blame since I put off getting a sleep study for a year.

To answer zonk’s questions:

1. My PCP gets an F. Getting the referral for a sleep study was rather difficult.
2. My sleep doctor gets an A on diagnosis, but I have to wonder why he didn’t start me on CPAP on a trial basis when he was 100% certain I had OSA.
3. Again, my sleep doctor gets an A. I needed a pressure adjustment prior to my follow-up, and his PA was helpful assisting me with it.
4. My follow-up appointment was a non-event. Since I was downloading my own data and my therapy was going well, my doctor really didn’t have much to tell me. I am certain that he provides appropriate follow-up care as needed.

[Shastzi]

I have to give it 'D' for dismal.

If you dont have health insurance or enough money to cover things yourself in the USA, you almost don't have a prayer.
I guess they just let you die. (Mitt Romney: "Hell, who cares? Just let 'em die!") Obamacare isn't working.
Hell, next year they want to fine me if I don't sign up.
Ah well...

I had to collect all my own data the hard way and present my case to my Primary Phys. (She gets an A++)
Then I was able to get a decent machine to work with. The old Brick was working...but not a nice machine to sleep with.
The system in general stinks from within.
Bleah.

[DocWils]

Of course, I have little to say about the US (beyond how we Europeans are dumbfounded by the lack of universally mandated insurance, and the controversy "Obamacare" has raised). In terms of quality of training, the US still holds its own, with areas of specialisation that is world quality - general medicine is a bit more spotty IMHO, but that is from observation of a a limited set of cases.

Swiss medicine is of very high quality as a whole, and the care system functions well enough - we do need to tweak it, in some areas a lot, especially in certain chronic treatment and care areas, and in streamlining the insurance system, which has gotten a bit unwieldy, but on the whole, if you have a problem like suspected apnoea, the flow from GP to specialist is relatively simple and direct, unless you live far from one the sleep study centres, and from there you are handed over to the LungenLiga, which is a state sanctioned and paid for citizen's advocacy organization, so most people have a relatively similar experience here. The downside, if you happen to be of the US persuasion, is the lack of choice of DME, the LL being pretty much it, so far as I know, and of course the higher costs of equipment (this being Switzerland, everything is more expensive. Spitting is more expensive), but on the plus side, the default equipment is usually the upper end stuff.

[DenD746]

I voted for Poor. My PCP was great at getting me a sleep study. The sleep study was pretty much a disaster - 90 minutes sleep, no REM and almost no sleep in the titration phase. My first sleep doctor first suggested the ProVent approach. Later he wanted a new sleep study. But I had found this board and did a lot of research so I told him exactly what I wanted (S9 Autoset) and how I wanted to go about doing self titration. He said he didn't do it that way so I said I would find someone else or not do CPAP at all. He then agreed to give me a script for what I wanted but told me I would need to find another sleep doctor. I did. The new sleep doctor doesn't even want to see any detailed results from the S9, just the stats. He said he doesn't have time to learn the different software packages. This doctor is OK but I probably won't see him again as I don't see any value added. Current plan is to just see my PCP and use my S9. I have been on it for 13 months and I now own it. The DME has been OK, gotten me what I wanted but really doesn't know anything. They have never been able to download my data, not even the basic stat data - I do a report for them and drop it off. If it weren't for this board and some other sleep apnea sites, I would not be on treatment at all. I think this whole sleep medicine thing is really just designed to run up a lot of medical costs at the sleep centers run by hospitals - anyone can call himself a sleep specialist - no board certification as far as I can tell. My PCP knows better than the sleep doctors.

[FireInCairo]

I say the system is extremely poor because of the current beaurocratic bs one must go thru to get the machine requested. Years ago I called my primary car doc and told him I was constantly tired. He called a referral for a sleep study where they did the study, titration, and ordering of the machine REMstar pro the same day. Simple, quick, and efficient. My machine finally crapped out (6 years). I didn't use a cpap for a couple years. By then I had changed primary care doc. When I called my doc she scheduled an appointment which I had a $40 copay. She made a referral for a sleep study(2weeks wait) in which they determined I had an AHI of 38. Referred to a pulmonologist (another 9 days wait) who saw me for 15 minutes max, and he scheduled the titration study (another weeks wait)....Another $40 copay, and another long drive to town with added expense. After the titration study the doc interprets my study and spends about 5 minutes with me to give me the script another.... $40 copay. Then the real fun begins. After driving 70 miles to speed up getting my new cpap The DME supplier tries to give me used equipment which I refused. Called the doctor to prescibe "new equipment" I originally was supposed to get a DS260. The therapist arrived at my home (4 days later) with an older DS150 which didn't have cflex. I was P*ssed. Probably spent at least 2 hours on the phone talking with insurance company, distributor, doc, and DME company. DME companies are CROOKS. Unless you walk in with cash and a prescription for a specific model/mask they will do their best to give you a less capable machine. It took me 5 weeks, 5 long drives and much frustration to get my machine. This has been nothing but a pita for me. There may be reputable companies out there, but not the one I dealt with. I have read of many other horror stories in dealing with DME companies. Perhaps a thread with companies names that have been less than professional should be started? I will be reporting the company I dealt with for Medicare fraud even though I don't have Medicare. I know Medicare/Medicaid policies, covered services, and limitations as I work in the health field. This DME company is not gonna be happy. They have messed with the wrong person. I have my documentation of all calls, dates, times, persons spoken with. They may lose their contract with the insurance company I have, if I can prove they have defrauded with them.

I had a similar experience recently, so I feel your pain.

It seems primary care physicians are hopelessly unaware of just how bad the effects of apnea can be for working people. Additionally, making people languishing under the effects of apnea wait 5+ weeks to see a specialist (which is what I've had to do) is apathetic at best, and merciless at worst.

The real issue, I'm noticing, is that long-term support and treatment for people who have changed jobs, and or, insurances, makes treatment highly dysfunctional.

This is all compounded by the money-making scheming aspect of this whole system. Between primary care doctors, medical suppliers, sleep centers, insurance agencies and any other entities the insurance agencies like to throw into the mix to avoid accountability (hi care corps national!) we're outnumbered and out-boondoggled in this affliction.

[Schnauzers 5]

I have a friend in up state New York with a husband and two young kids who has been trying to get Health insurance since before last Sept. Claim they need things she already submitted and gets the run around over and over and then after 90 days it all expires and she needs to resubmit info they claim they never have. Unbelievable!