Are Medical Bills from a Parallel Universe?

snow

soiset wrote: »

Your two cents are worth less than that, as apparently you have failed to absorb the essential fiscal details revealed in this thread before responding. Basically, an $850 service billed at $2900. In addition, that fee is far less than what would be half of the "fix." It's all in the thread, just try reading it.

Well look at it in a positive light as possible. Once you have paid this off you will have met your deductible. No matter how much further testing, or a machine or other supplys may be you would still have to meet that first and still be out 2k. I suggest if you have other elective procedures needed get em done now.



REGARDS SNOW

avelanchefan

snow wrote: »

Well look at it in a positive light as possible. Once you have paid this off you will have met your deductible. No matter how much further testing, or a machine or other supplys may be you would still have to meet that first and still be out 2k. I suggest if you have other elective procedures needed get em done now.



REGARDS SNOW

I could not agree more. Stick it to them the rest of the year.

bobman1235

soiset wrote:

You have somehow read things in this thread that haven't actually been written.

Wasn't necessarily directed at you, your complaints are about billing, a few others are complaining about more ridiculous things.

cnh wrote: »

Why do we allow the AMA such power when there are thousands of bright, compassionate and caring men and women who would be excellent doctors. I've met lots of doctors, a lot. My personal physician is a woman, not a male! Because I've met so many 'wonderful' MALE M.D.s. There's a guy who I'm going to have to sue for his arrogance and incompetence, his two colleagues suffer from the same problem.

Are there great Doctors? Yes! Surely, but our system does not encourage 'service' but something else.

I think you overestimate the effect of the "cap" (it's not really a cap) the AMA puts on the number of doctors. I have no idea why you emphasize gender in your post either. Is it really that shocking to you?

I do not claim that the system is perfect or even good. But, people seem to always get this idea in their head that when there's a problem, it's because someone is being evil. The system can just be broken without thinking doctors are all villains.

Also, thanks for suing someone. Way to be part of the problem.

soiset

avelanchefan wrote: »

I could not agree more. Stick it to them the rest of the year.

I'm pondering that possibility. There are surgical procedures, such as fixing my deviated septum, that could help. They also do surgeries on the palate that can help, but none are as effective as the CPAP.

I'm going to have to start looking for things to fix on me.

Hobbyguy

The problem Soiset is that you like most americans are the victim of the quick fix society. It did not sound to me that you had a complete history and physical examination. It sounded like you went in....must be sleep apnea here is the test to prove it and here is the treatment. A more thorough physician (and believe me there are still many of us that are) would have tried to identify causes of your apnea....poor diet, poor exercise, obesity, medications, allergies, depression, stress from uncertain future, newborn, metabolic disturbance, hypothyroidism, smoking...etc and then told you that cpap is temporary until the causes can be removed/treated.
The first two causes...poor diet/exercise are a huge contibutor to many maladies, and I see this as a failure of modern medicine from intervening at the school level. Schools no longer teach children physical fitness....they teach sports. Sports are played for so little in ones life and yet the potential for long term injury is enormous. Weight training balanced with cardio training can be done safely throughout our lifetime and yet I see no schools advocating this. Nutrition is the other half and what is taught in schools about this? The ridiculous food pyramid....there are so many better diets out there, unfortunately nutrition is poorly taught in medical school and at the time I thought was irrelevant.
If you currently do not exercise regularly and have a poor diet then I bet if you were to change this your sleep would improve.
I am tempted to post my before and after pictures of me when I did not exercise and ate mcdonalds compared to now....the change is remarkable and I feel sooo much better.

shack

Hobbyguy wrote:

It sounded like you went in....must be sleep apnea here is the test to prove it and here is the treatment. A more thorough physician (and believe me there are still many of us that are) would have tried to identify causes of your apnea....poor diet, poor exercise, obesity, medications, allergies, depression, stress from uncertain future, newborn, metabolic disturbance, hypothyroidism, smoking...etc and then told you that cpap is temporary until the causes can be removed/treated.

If you currently do not exercise regularly and have a poor diet then I bet if you were to change this your sleep would improve.

As an orthopedic surgeon and not a sleep disorder specialist, I think you may agree some of the statements above are not based on the latest information available. Even GPs who have a good basic knowledge of sleep disorders do not have the most up to date info. Yes, all of the things you mentioned may have a bearing on the severity of the apnea...but to assume that CPAP treatments are temporary is just wrong. What has proven to be temporary are many of the surgical treatments that a lot of ENTs wanted to perform to remove the soft tissue that led to snoring. Severe apnea is often seen in patients who have none of the "risk factors" you mentioned above. Most of the patients with severe sleep apnea will use a CPAP for the rest of their lives as it is the most effective and efficient way to treat the disease. A basic sleep study will confirm the presence of apnea...but not necessarily the cause. In your scenario, to "confirm" the root cause of the problem may be more intensive, costly and time consuming and in the end the root cause may not be determinable. I'm sure in your practice, that given a certain set of circumstances and symtoms...based on basic test results...that you make a diagnosis and treat based on that information...then see if it works and and if it does move on.

I'm sure you are a very good surgeon and physician. I'm not sure telling the OP that he did not get good advice is the correct thing to do. He may not have the cheapest prices or most efficient billing system and there really is no reason to not do the sleep and CPA test in the same night (IMO). But there is no basis to assume that a good diagnosis was not made.

Hobbyguy

You are right of course Shack...I do not have all of the data to draw a conclusion.
I do recommend further reading from Soiset.

http://www.mayoclinic.com/health/sleep-apnea/DS00148

This is where I did my training so I am somewhat biased.

soiset

shack wrote: »

As an orthopedic surgeon and not a sleep disorder specialist, I think you may agree some of the statements above are not based on the latest information available. Even GPs who have a good basic knowledge of sleep disorders do not have the most up to date info. Yes, all of the things you mentioned may have a bearing on the severity of the apnea...but to assume that CPAP treatments are temporary is just wrong. What has proven to be temporary are many of the surgical treatments that a lot of ENTs wanted to perform to remove the soft tissue that led to snoring. Severe apnea is often seen in patients who have none of the "risk factors" you mentioned above. Most of the patients with severe sleep apnea will use a CPAP for the rest of their lives as it is the most effective and efficient way to treat the disease. A basic sleep study will confirm the presence of apnea...but not necessarily the cause. In your scenario, to "confirm" the root cause of the problem may be more intensive, costly and time consuming and in the end the root cause may not be determinable. I'm sure in your practice, that given a certain set of circumstances and symtoms...based on basic test results...that you make a diagnosis and treat based on that information...then see if it works and and if it does move on.

I'm sure you are a very good surgeon and physician. I'm not sure telling the OP that he did not get good advice is the correct thing to do. He may not have the cheapest prices or most efficient billing system and there really is no reason to not do the sleep and CPA test in the same night (IMO). But there is no basis to assume that a good diagnosis was not made.

From my limited reading, CPAP is favored by sleep doctors because it is 95% effective. But, that 95% is culled from a 50% compliance rate. Many patients just can't tolerate the intrusion and inconvenience. I figured with a 50% compliance rate, and such resounding success otherwise, the thing must be pretty unpleasant.

Also, with my rating of 13 events per hour (5-15 = mild OSA) I figure that my condition could improve adequately from one of the less effective measures - principally the "intraoral device" fitted by a dentist, that holds the lower jaw forward.

Though I feel disappointed that my doctor did not want to discuss the CPAP and my tolerance of it, and apparently is not interested in other, easier solutions, I suppose the CPAP titration could deliver positive proof that increasing my air supply would solve my deep sleep problems. It is a logical possibility that my shortage of deep sleep could be due to a separate problem, but of course the first logical place to look is the air supply, which has already been measured as deficient.

Then, if that shows positively that more air = super-me, then we could investigate alternatives to the CPAP to getting more air in my lungs at night.

Regarding hobbyguy's inquiry about my fitness - I've maintained my physical fitness conscientiously and often intensively for many years, and I know that even when I've been in my very best condition, I've still experienced excessive daytime sleepiness. I remember so many times burning along with a heart rate of 130, 30 minutes into a run, YAWNING. My third set on the bench press, having just racked the weight, and just closing my heavy eyelids while lying on the bench. So I'm pretty sure it isn't a matter of cardiovascular fitness, bodyfat percent, or strength.

I have, however, been on depression meds of one sort or another for about as long as I've suffered sleepiness. Chicken or egg? Tough to say.

As Shack believes, it is worth a great deal of money to have this problem fixed well. I am so sick of always wanting to nap. I have a lot of ideas, and a lot of things I want to do, but my potential fulfillment and enjoyment of life is very unrealized because I mostly just want to sleep.

Like right now. 9.5 hours of sleep last night, and I have to go nap again.

shack

soiset wrote:

I figured with a 50% compliance rate, and such resounding success otherwise, the thing must be pretty unpleasant.

I actually got used to it fairly quickly and no it poses no problems for me at all. My sister finds it uncomfortable (but she is like Mikey...she hates everything :rolleyes:). I use a full mask that covers my entire nose and straps around my head. There are now the “pillows” that basically just fit over the opening of the nostrils with a small strap around the head. I understand they are very comfortable and non-evasive. I may try one for my next mask. Even if it did bother me a little, it would be a small price to pay for the results! Most of the friends I have that use a CPAP swear by its benefits as well. The one complaint most want to throw out is that is ruins their love life. Not a problem for me. I sleep when in bed and there is lots of time and places for the fun stuff.

soiset wrote:

As Shack believes, it is worth a great deal of money to have this problem fixed well. I am so sick of always wanting to nap. I have a lot of ideas, and a lot of things I want to do, but my potential fulfillment and enjoyment of life is very unrealized because I mostly just want to sleep.

Like right now. 9.5 hours of sleep last night, and I have to go nap again.

I was to the point that I could go to bed and "sleep" for 12 or more hours and get up exhausted. I never would even get close to REM sleep. My oxygen levels were in the 60% range and would go through several hundred events per night. The purpose of the CPAP is not to force more oxygen into the lungs, it is to keep the air passage open to prevent the snoring to prevent the events that lead to the low oxygen levels and the stress on the heart. It was cool to look at the chart and see for the first 4 hours I hovered at levels just barely below waking consciousness and within minutes of putting on the CPAP I bottomed all the way into REM and stayed there. Now I can get by on 5 hours of sleep a night. I know the CPAP improved the quality of my life and I am also convinced the CPAP ultimately saved my life because I was probably a heart attack waiting to happen.

Airplay355

My fat uncle has one of those masks. One summer morning when the family was staying at a cabin in Maine we (the kids) walked into the living room where he had set up a blow up mattress and was sleeping with his wife. We heard a hissing air sound and thought hit big **** had busted the mattress and the bed was deflating. It was hilarious until we found out it was just his darth vader mask.