OSA test from non-VA

[rpowell01]

Back in late 2014 or early 2015 I had sleep study conducted at the Tampa VA. Of course they came back saying I was fine and didn't have Obstructed Sleep Apnea. But my PCP sure sent me to the ENT clinic to allow them to do surgery by taking out my tonsiles and clipping my uvula (spelling).  Of course I refused because something did not feel nor sound right.

I would and still do wake up with shortness of breath, heart racing and in sweating from head to toe.

So I decided to go outside of the VA and well, well, well they said I have severe OSA and my NON VA PCP said I NEEDED a CPAP. Well after about 6 months they had to come and pick up the CPAP because I could not use it. I tried both the mouth and nose fittings but I would rip it off every single time.

The OSA is still there and I haven't found a way to deal with it. I have had enough and talked with NON-VA Pain Management and he told me exactly what I needed to do to overcome me ripping off the mask at night. So I get a hold of my VA PCP to see if he will order me a  CPAP and again he wants to send me to the pulmonary clinic to have the test done again.

I just sent him a message asking him if I give him the sleep study test report outside of the VA will he order CPAP.

My question is this, is the VA mandated to accept NON-VA medical reports on studies like this? Because one study done by the VA didn't show I had OSA doesn't mean I don't have OSA because another study shows I have it.

What is the VA's policy about this? You would think since this is a very import issue where I could end up dying in my sleep he would accept the report. He has not answered yet but I would like to know ahead of time just in case he says they cannot use NON-VA test reports.

This is not about filing claims and I am NOT going to file a claim on this issue, I am done with filing claims since I am P&T even though I know I can get the extra schedule. I just want to get a CPAP because I cannot take this any longer!!!!

 

I know this is in fact a secondary issue I want the VA to provide the CPAP because with medicare its too expensive.

Edited January 24, 2018 by rpowell01

[broncovet]

Since you are at 100 percent, Im gonna assume this isnt about compensation, but about healthcare.  

My first question is did you discuss this discrepency with your PCP?  If you didnt tell them, well why are you suprised they wont do anything about it? 

Ok, lets assume you did discuss this with your PCP, and he said, "heck no, we wont accept a private sleep centers OSA diagnosis, you have to have one from VA."   

This is somewhat common, VA does not fill private care docs prescriptions usually.  

It did not help your case for a cpap that you did not use the cpap.  If you kept ripping off the mask, then you needed to see them and tell them you needed another type of mask or maybe different cpap pressure, etc.  There are things they can do, tweaking it, maybe you even need a bipap instead of a cpap.  

Now, you have some options:

a)  Go back to where you got the cpap, and tell them you want to try it again with a different mask, different pressure etc. 

b).  Go to "another" VAMC and get your care there..at least as far as sleep apnea.  They may pay for travel pay for the drive in some circumstances.  

c)  Work with your present VAMC.  If you have tried everything else, go to your patient advocate, explain the problem, and if that fails, go to the VAMC directors office.  (Remember the chain of command).  You can even go up from there to the regional vista director, email the secretary and use the white house hotline.  

     I have seen Vets who do all 3...some wont set foot in a VAMC, some go to the directors office and complain, some go to another VAMC, and still others insist on private care.  Its even possible to do some combination of the three.  For example, use your local VAMC for everything but sleep apnea, and use private care for sleep apnea.  

      One more thing.  My wife, used her Humana Medicare advantage plan, and got a cpap at no cost (she probably had already paid the annual deductable for drugs, I dont know for sure).  So, you may consider switching from medicare to medicare advantage, if they are unacceptable.  

[Vync]

@rpowell01

Almost the exact thing that happened to you happened to me. I had very similar symptoms, so I used my voice activated tape recorder (used it when in college) and set on the table beside me while I slept. When I awoke, it had recorded snoring, gasping, and choking throughout the night. The VA did their own so-called sleep study and said I was fine. I went outside the VA and had a sleep study done via my private medical insurance and they said my OSA was so bad that they gave me a CPAP machine in BIPAP mode (higher pressures). I tried the full face and also the nose mask, but would awaken with it off. I tried every kind of mask they had at the time with no luck. The only way I could keep the mask on at night was with a lot of pain medication, sleep meds, and muscle relaxers. I just barely got past their compliance trial period, so I didn't have to give mine back.

Last year, I went back to the VA with copies of my non-VA sleep clinic medical records and sleep studies. They gave me a replacement CPAP machine (humidifier gave out) and a new kind of nose mask that doesn't cover my nose, but it has two silicone pads that rest just inside my nostrils. It doesn't feel like I have a bear trap on my head and I am better than 95% compliant.

The VA accepted my non-VA sleep study and treatment records which showed I had OSA. If they don't accept your records and at least offer you the chance to trial each of their mask designs, then it would be time to escalate your complaint. You're 100% and they are required to provide treatment. VA patients bill of rights says you have the right to choose your provider. With Broncovet's recommendations, you should be able to get the VA to help you out, especially since the first CPAP machine didn't cost them a penny.

The replacement machine I got is linked below. It is so much better than the old one because it has Bluetooth and an app for my phone. I wake up in the morning and can pull up a report showing what happened while I was dozing off.

https://www.usa.philips.com/healthcare/product/HCNOCTN447/dreamstation

A couple of other things that really helped was the VA gave me a "snuggie" for the CPAP hose. The hose is ribbed and always cold, so it is more like a sock you put over it and makes the hose less distracting. A couple of months ago, I also went to a non-VA ENT doc who did a CT scan and said my nasal turbinates were a big problem, as well as a severely deviated septum. He did surgery to straighten the septum and reduce the size of the turbinates. It made a huge difference in my ability to breathe, smell, and I even feel like I have more energy. The nasal pads for the CPAP mask work so much better now and I hardly snore any more.

[Gastone]

Question regarding Private OSA DX acceptance by VMC, problems using masks, Medicare equipment costs, where to begin?

Your VMC will definitely accept the results of a Non-VA Sleep Study and the OSA DX & Rx rendered by a Non-VA Board Certified Sleep Specialist. Your non-VA Sleep Dr provided you with an Rx for the necessary CPAP or BiPap and Supplemental 02 if required. Hand delivery of the most recent SA DX & Rx to your VMC PCP will get it in your VMC Records and get you a referral to the Sleep Dept for your CPAP Machine and supplies. Your over 40% SC, so no cost to you.

How many masks have you used? I've been 100% BiPAP Compliant since 2010 and have tried about 7 different Masks. I'm currently using what I consider as the easiest and most comfortable to wear Mask of all that I've tried, the Philips/Respironics DreamWear under the nose mask.

As to Medicare, if you don't have a Supplemental Plan like AARP's United Healthcare, you get hit with a 20% Co-pay. Full Boat, small deductible but no Co-pays cost me $145 per mos without Rx coverage. I use both VA and Medicare for followup care.

You indicate you're 100% SC, is that CSC 100% or IU paid at the the 100% Comp Level? Are you certain that your OSA DX cannot be Secondary connected to 1 of your SC Conditions?

Any chance you could post redacted copies of the 2014 VA Sleep Study Results/Clinician Treatment Notes and also the most recent non-VA Sleep Study Results?

[broncovet]

Im also using the Dream Ware, but was okay with the nasal pillows prior to that.  At my VAMC they have to special order the Dreamware, but it comes in the mail.  The nasal pillows were stocked at my VAMC

 

 

[rpowell01]

I asked the question right after I sent a secured message to my PCP and he just responded yesterday stating he did not know about the outside study that showed OSA. I just replied and told him to look back at the secured messages as I told him back in Sept or October 2015 I had the study done outside of the VA because I felt the VA was completely wrong on their study or something went wrong with it to show a negative result which does happen a lot with these crappy home studies they do. So he wants me to fax the report of the study not the prescription to CPAP clinic (pulmonary I'm guessing).

 

FINGERS CROSSED!!! And thanks for the Info.

And yes I could have filed a claim on this even though I'm 100% and it would fall in as an extra scheduler but like I said in my original post this is about my health not about filing any claim. I haven't had a good nights sleep more than two days in a row in over 2 years!!!! I may get one good nights sleep once in awhile but it doesn't happen that much.

 

I have read that the medical marijuana helps with the sleep apnea so I am now just waiting for the Florida Department of Health Compassionate Use to set me up on their side. My Pain management doctor has already done his part and I've sent them all the applications and fees. Just waiting for them. I cannot wait, I've been off the Morphine Sustain Release for over 2-3 weeks now (been in a lot of pain though) and I'm only on the Oxycodone. Once I get approved for the medical marijuana I am going to do a quick wean off the Oxycodone because I am telling you those opioids have caused so many problems all by themselves that its not worth taking them any longer. From my Thyroid being totally  messed up for the rest of my life to Sleep Apnea its just not worth it any longer!!!

 

[Gastone]

What are you referring to when you posted "it would fall in as an extra-scheduler?" Extra-scheduler what?