New member re Online Sleep Doctor

[Pandacat53]

My sister has aneurysms. She just completed a new sleep study that showed she had complex apneas both obstructive and central. She has to leave messages for both her sleep doctor office as well as the equipment store. They take days to get back to her and she has to keep calling and emailing them. Her bp has been running very high. She had an ASV machine before and they told her she didn’t need to use it and told her to return it.

Because her bp was high she asked for a new sleep study. She had to start with a CPAP because they told her Medicare required it. She has used it over a month and asked for a new sleep study which showed she had both central and obstructive. The doctor told my sister she was recommending an ASV. Today she learned the manager at the CPAP place has denied the ASV because “she didn’t need it.” She says the doctor and the equipment place was the only ones within 40 miles of her.

Has anyone ever used one of the online sleep doctors with any success? I’m afraid these people’s ineffectiveness is going to kill her.

[ozij]

A "manager" denies a script that a "doctor" recommends?

Since when do eqipmment providers override a physician's recommendation?

Get the prescriptin from the doctor you have, and look for a place where you can buy the machine online or offline.

What would an online doctor do for you that the offline doctor did not?

You need your machine to be physically in you sister's home, not on the internet.

Are you confusing the DME (distributor of medical equipment) with the insurance's willingness to pay?

Is it a financial issue you're struggling with?

[Janknitz]

Could you please clarify by answering the questions Ozij asks? The reason we are confused is that it appears your sister has the prescription for the ASV and it is a current prescription. So it's unclear #1 why the Durable Medical Equipment (DME) provider would say "you don't need it" (the DME is NOT a doctor and has no business saying that) and you are asking for another sleep doctor, when your sister already has one who has seemed to write the appropriate prescription. So something does not add up.

There is additional documentation required for Medicare to cover the ASV, and perhaps your sister's doctor didn't provide the appropriate documentation. If that is the case, the DME should be calling the doctor to explain exactly what is needed in terms of documentation so that the DME can be assured of proper Medicare payment for the more expensive device.

So I suspect it's one of those two things:
1. Improper documentation, which can easily be fixed by your DME contacting the doctor for what is needed. OR
2. Your DME doesn't want to swap out your CPAP machine (now a used machine) for the more expensive machine and start the billing process all over again. And/or your DME doesn't want to contact the doctor for proper documentation. In other words, a bad DME--this is probably most likely.

It may be worth a 50 mile or more trip to find a better DME who can do the job properly--assuming your sister has the correct written prescription. In some cases, this can be done without an actual visit to the DME--these days, in most cases, they don't deliver in person but drop ship anyway. And since your sister used ASV in the past, she doesn't need in-person training on how to use the machine. The DME should make the correct settings on the machine before it is shipped or delivered.

If all else fails, we have a member here who often sells used ASV's in very good condition for very low prices. Reach out to the member whose user name is LSAT. It may cost your sister less than any co-payments and deductibles she has to pay with her insurance--the co-payments are higher on ASV units, depending on her supplemental policy.

I also think your sister should be calling the prescribing doctor about what the DME said, and hopefully that doctor will be ripping the DME a new one.

One more question: Does your sister have Medicaid? If so, is the vendor a certified provider for Medicaid? Medicaid imposes even MORE paperwork requirements for coverage, and that may be why the DME is giving your sister a hard time. Again, there may be a better DME farther away.

[Pandacat53]

Izij and Janknitz,
Thanks for your responses. I find the situation she is in ludicrous.

Both the doctor group and DME place are difficult to reach according to my sister. She lives in another state and I have been appalled at how difficult it is for her to reach any of them. Her blood pressure has been dangerously high. I told her I think the sleep study that showed she did not need a machine was in error and that she needed to talk with her doctor about a new sleep study. (We are identical twins. I have an ASV). She did and that sleep study showed she had complex sleep apnea but the equipment place said she had to begin with a cpap machine. She had used an ASV before but they made her turn that one in because they said an earlier study showed she didn’t need ANY sleep equipment.

I also questioned how the equipment manager could deny the prescription. My equipment place mails me supplies each month. She had never received new supplies from them. They tell her to email them if she wants something. Like so many places these days according to her she can’t talk with anyone without leaving a message first.

I think your suggestion about getting the prescription was a good one and passed it along to her. I was trying to think of a way to get her an easier route to a sleep doctor and equipment. Thus my question about an online sleep doctor.

I don’t think money is a problem for her but she is always talking about expenses like they are destitute but they are pretty well off. I suggested she just buy one and she said they are so expensive. I said told her it is her life that we are talking about. Because she has aneurysms and high blood pressure struggling to breathe at night could easily kill her. She has regular Medicare. She has an appointment with the doctor next week. With something like this I could just call my doctor and talk with the nurse and they would get on it right away. I did suggest she find a different sleep doctor and equipment place but she says they are all she has available. I told her I live in a rural town and we have 3 different cpap equipment places.

Anyway you have provided some great suggestions. Thank you for all of them.

[chunkyfrog]

#1: take care of her health.
If insurance is stalling, contact Medicare directly!
Document all attempts to get care--and follow through.