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+--- Thread: I am so angry at "the system" right now. (/Thread-I-am-so-angry-at-the-system-right-now)
RE: I am so angry at "the system" right now. - awoodby - 04-08-2016
What insurance do you use? Have you talked with them about what your "compliance" is? I know my blue cross requires I wear it 70% of the time for 30 days (21 of 30 days, over 4 yours) somewhere in the first 90 days. That's it. Other insurances of course require other things. Definitely figure out what your insurance requires, should be an easy phone call to find out!
You do definitely want to have some inkling of what you're doing and not just be randomly changing settings. Or, not changing them a LOT at least
Personally with good recordkeeping I doubt small changes would hurt anything if you take your time either My defense to the dr would be simple: I need care in a more timely fashion than the once a month or 2 I can get in for appointments. Your life and time are being greatly affected and you're trying to get better care, can't wait the typical sleep apnea "we'll talk to you again in a month" timeframe for every single step.
--Alex
RE: I am so angry at "the system" right now. - Inspired - 04-08-2016
(04-07-2016, 10:22 AM)OpalRose Wrote:Opal Rose:(04-07-2016, 09:57 AM)Want2SleepInMT Wrote: I just had another pointless follow up with the PA at our sleep clinic. She has known since the morning after I changed my settings, the exact same time that my DME found out. Now, today, she wanted to force me back to straight pressure, which, works for some, but leaves me waking up feeling good some days, and like a mac truck hit me on others. There is no point in continuing if the "treatment" I am forced into makes me feel worse than I ever did before starting on this road. She was mad that I "didn't call her" to get the issues worked out. Now, part of me is afraid I'll be marked "non compliant" and be screwrd.
How long have you been on Cpap therapy? Compliance must be met within the first 90 days.
To meet compliance rules, you must show that you have used the device at least 4 hours per night on 70% of nights for a 30 day consecutive period during the first 90 days after starting treatment. You must also have a face to face doctor appointment anytime after the first 31 days, but before the 90 days is up.
Nowhere does compliance have anything to do with changing pressure settings. Your insurance could care less.
You are being bullied by your doctor/PA/sleep clinic.
Now if you haven't met compliance, and if insurance is paying, they can take your machine back. So you do have to play their game (to some extent) untill the compliance period is over.
I received my cpap machine 1/11 and then had the follow up MD visit on 2/2 which was before 31 days of machine use (but after 31 days of testing). My next appt is in May. Does this fail to meet the timeline you mentioned? My Sleep Study was on 12/9 . Hassles with the orders and DME delayed receipt of the machine and I am wondering if I need another MD visit .
RE: I am so angry at "the system" right now. - PollCat - 04-09-2016
The 90 days usually starts when you start using your machine. If you've used it every night since 1/11 you would now have about 88 days of use. OpalRose is correct; you really should wait until the compliance period is over before changing anything on your machine.
RE: I am so angry at "the system" right now. - awoodby - 04-09-2016
"compliance" is defined by your insurance company specifically, call them and get them to define it, first of all. If you were with mine you'd be hitting the end of the period. Are you using it every night? Far as I know that's the main requirement with most of them, but I don't know very far. Either way, go straight to the source, find out what your insurance considers "complying".
Either way though, changing settings, i really doubt that's going to be noncomplying, compliance in every case I've read means just using the thing. But still, give them a call on monday.
RE: I am so angry at "the system" right now. - Want2SleepInMT - 04-09-2016
Argh! I had a huge post written, hit the wrong button, and lost it.
Short version, sleep center P.A. does not believe in using auto settings for patients, due to machines "chasing leaks." (Old school thought, and total B.S. with newer machine algorithms.)
She couldn't meet me in the middle, and "fired" me as a patient.
Called the DME RT, and told him I was done, packing up the machine, and was turning it in, because of her firing me, and me not wanting to continue a single pressure setting, which some days was "ok" and others I woke up feeling like a Mack truck ran over me. He said hold off, come in Monday, and talk to the manager, and see if he is willing to accept what the insurance company has paid out and what I have paid out, as paid in full.
I also have an appointment Friday with my Primary, in which, I am going armed with binders full of my every day encore pro 2, and sleepy head data, along with the correlating info on what mask, what medications, and all other confounding combinations from any given night. (Yes, I have a sleep journal) hopefully, I can convince him with knowledge and due diligence on my part, that he would be willing to manage my prescription for supplies.
I have also met compliance, as of January 10th this year, so the insurance company should be okay unless she reported me as "non compliant with treatment plan" in which case, I will have to appeal using my primary to fight the insurance company.
RE: I am so angry at "the system" right now. - OpalRose - 04-09-2016
(04-08-2016, 11:54 PM)Inspired Wrote:(04-07-2016, 10:22 AM)OpalRose Wrote:Opal Rose:(04-07-2016, 09:57 AM)Want2SleepInMT Wrote: I just had another pointless follow up with the PA at our sleep clinic. She has known since the morning after I changed my settings, the exact same time that my DME found out. Now, today, she wanted to force me back to straight pressure, which, works for some, but leaves me waking up feeling good some days, and like a mac truck hit me on others. There is no point in continuing if the "treatment" I am forced into makes me feel worse than I ever did before starting on this road. She was mad that I "didn't call her" to get the issues worked out. Now, part of me is afraid I'll be marked "non compliant" and be screwrd.
How long have you been on Cpap therapy? Compliance must be met within the first 90 days.
To meet compliance rules, you must show that you have used the device at least 4 hours per night on 70% of nights for a 30 day consecutive period during the first 90 days after starting treatment. You must also have a face to face doctor appointment anytime after the first 31 days, but before the 90 days is up.
Nowhere does compliance have anything to do with changing pressure settings. Your insurance could care less.
You are being bullied by your doctor/PA/sleep clinic.
Now if you haven't met compliance, and if insurance is paying, they can take your machine back. So you do have to play their game (to some extent) untill the compliance period is over.
I received my cpap machine 1/11 and then had the follow up MD visit on 2/2 which was before 31 days of machine use (but after 31 days of testing). My next appt is in May. Does this fail to meet the timeline you mentioned? My Sleep Study was on 12/9 . Hassles with the orders and DME delayed receipt of the machine and I am wondering if I need another MD visit .
Inspired,
I would double check with insurance to be sure, but the information I posted comes from the Medicare site. Most insurances follow Medicare guidelines.
If your started on 1/11, then one of the requirements would be a "face to face" follow up after the 31 days, but before the 90 days is up, which would be before 4/11 for you. Some doctors/DME's don't seem to know this. I would play safe and schedule an appointment before 4/11.
RE: I am so angry at "the system" right now. - OpalRose - 04-09-2016
(04-09-2016, 03:15 AM)Want2SleepInMT Wrote: Argh! I had a huge post written, hit the wrong button, and lost it.
Short version, sleep center P.A. does not believe in using auto settings for patients, due to machines "chasing leaks." (Old school thought, and total B.S. with newer machine algorithms.)
She couldn't meet me in the middle, and "fired" me as a patient.
Called the DME RT, and told him I was done, packing up the machine, and was turning it in, because of her firing me, and me not wanting to continue a single pressure setting, which some days was "ok" and others I woke up feeling like a Mack truck ran over me. He said hold off, come in Monday, and talk to the manager, and see if he is willing to accept what the insurance company has paid out and what I have paid out, as paid in full.
I also have an appointment Friday with my Primary, in which, I am going armed with binders full of my every day encore pro 2, and sleepy head data, along with the correlating info on what mask, what medications, and all other confounding combinations from any given night. (Yes, I have a sleep journal) hopefully, I can convince him with knowledge and due diligence on my part, that he would be willing to manage my prescription for supplies.
I have also met compliance, as of January 10th this year, so the insurance company should be okay unless she reported me as "non compliant with treatment plan" in which case, I will have to appeal using my primary to fight the insurance company.
Good for you, don't take any crap.
Just know that they can't report you as non compliant for changing pressure settings. See compliance rules that I have posted earlier in this thread.
RE: I am so angry at "the system" right now. - Sleeprider - 04-09-2016
All of this would resolve so easily if you simply asked your doctor to change the pressure prescription to Auto and a pressure range YOU have found effective. There is no reason to argue with a RT who is simply mandated to follow the prescription and help you use the equipment.
RE: I am so angry at "the system" right now. - 0rangebear - 04-09-2016
(04-07-2016, 09:57 AM)Want2SleepInMT Wrote: I just had another pointless follow up with the PA at our sleep clinic. She has known since the morning after I changed my settings, the exact same time that my DME found out. Now, today, she wanted to force me back to straight pressure, which, works for some, but leaves me waking up feeling good some days, and like a mac truck hit me on others. There is no point in continuing if the "treatment" I am forced into makes me feel worse than I ever did before starting on this road. She was mad that I "didn't call her" to get the issues worked out. Now, part of me is afraid I'll be marked "non compliant" and be screwrd.
I do not know if this is possible for you because it depends on your insurance provider, your Doctor, and anyone else that you have to report compliance to....I FIRED MY DME
When I first started changing my own setting in the software in saw someone else was also changing them remotely. I called my DME and found out it was them. I insisted they stop and although they put up an argument, I called my insurance company and told them not to pay the DME any more when I found out all they need is the prescription and compliance report approved by my Doctor.
So I started giving my Doctor reports out of sleepyhead. At first my insurance had some issues with sleepy head not being what they called "approve software". Do I gave my Dr. both ReScan and Sleepyhead reports. When I go see him, he signs them like he does any other Lab test and sends a copy to the insurance company
I bought my fist replacement supply's the other day on-line for 20% of the DME price and got free shipping to my home.
I come to see these DME's as non value added Middlemen
RE: I am so angry at "the system" right now. - FrankNichols - 04-09-2016
(04-09-2016, 03:43 PM)0rangebear Wrote: I come to see these DME's as non value added Middlemen
I think the only real value added that DMEs bring to the game is handling the Insurance pre-authorization and billing. Most people like me have no desire to learn the process and prefer if possible to just let the DME handle it. So far I have been lucky, but I am certainly will to fire them if I have to.