Uncovering the Sleep Apnea Industry – Preparing & Visiting My Doctor

cpap sleep issues doctor visit

After realizing that I have snoring and apnea sleep issues, I started looking into CPAP medical equipment costs, as well as the cost of CPAP Clinical Sleep Studies.

Deciding that I have enough basic knowledge of the sleep industry, I started thinking about visiting a local doctor.

One bright side of my insurance is there is a flat co-payment of $50 for a doctor visit. Even better is that they have a telemedicine / online physician copayment of only $10.

So I started with an online appointment.

Unfortunately, my visit with an online medical professional was fruitless as the physician’s assistant (I believe) could not prescribe a sleep study. She said I would need to see a doctor in person and recommended I see my general practitioner.

She also said I could likely go to a Quick Care facility and get a doctor to write a prescription, but that a general practitioner would be better as the sleep study facility needs a place to send the results.

General practitioner??!!  What’s a General Practitioner??!!

Apparently, it’s that doctor you are supposed to see first before going to a specialist.

That’s an HMO thing… For the longest time I’ve had PPO insurance which allows me to go directly to a specialist without a referral (PPO plans here in Nevada are becoming non-existent.  My “PPO – Preferred Provider Organization” was replaced with an “EPO – Exclusive Provider Organization”, which means there’s no out-of-network coverage).

So I dialed up my insurance provider’s website and using their finder, started making calls to find a doctor that I could get into within a reasonable amount of time.   And to my surprise, I found a doctor that I could get into the next week.

So I booked the appointment and went.

The doctor did the usual basic doctor stuff, and had me answer a ridiculously simple sleep questionnaire with questions like, “How likely are you to fall asleep while reading a book?”, “How likely are you to fall asleep if you take a nap during the day”. The ratings were one to five, with five being the most likely.

I put five for all of them.

He also asked if my wife had witnessed me snoring and/or stop breathing, to which I truthfully answered yes to both.

So he referred me to a sleep study facility… AND THIS is where my research had paid off.

The doctor didn’t give me any choices, he just sent in an electronic referral to their practice’s preferred facility.

Before he kicked me out, I kindly requested the doctor also write me a general prescription for a sleep study on his prescription pad so that I could easily shop around; because I didn’t want to get financially screwed by blindly going down the path he was sending me.

As an ethical doctor, he likely is not in on the sleep study profit game, but I guarantee the company he works for is in on it in some way.

Before obliging with a written prescription, the doctor gave me a small bit of pushback, saying the referral he gave me was a “one-stop shop” and would take me all the way through the process.

But as with just about everything I’ve discovered (due to my overly analytical personality condition) is that his process would be a LOT MORE EXPENSIVE and I would definitely be paying for that convenience of being walked through the process, because when there’s no competition, as with a blind referral like this and other medical procedures tend to be, the facility doesn’t have much incentive to be competitively priced.

I thanked the doctor and left.

The next day, prescription in hand, I started calling online CPAP retailers and asking what they needed to sell me a machine. The overarching answer was either a sleep study diagnosis or a direct prescription for a sleep study from the doctor.

Apparently, the typical process goes like this…

The first step is to have a sleep study performed, usually at an over-night sleep clinic. The results from the overnight sleep study are sent back to your doctor and if diagnosed with sleep apnea, you are sent back to the sleep center for a “titration” sleep study. The titration results are sent to your doctor and your doctor writes a prescription for the CPAP machine to be calibrated to the pressure discovered during the titration study.

A lot of back and forth.

But what struck me as interesting was that the sales person said to me the doctor could directly write me a prescription for an auto-titrating CPAP machine without a sleep study.

She said it’s currently rare, but she’s seen it done and therefore has been able to make the sale of the CPAP machine and supporting equipment without an actual sleep study.  She said the person had a good relationship with his doctor and simply told the doctor that his wife witnessed him snoring and stopping breathing in his sleep.

Unfortunately, I basically just picked my doctor off the street, so I don’t have that kind of relationship yet.

Anyway… the mention of the auto-titration machine caused me to start digging deeper on that path.

It turns out, according to the salesperson, the machines have gotten so sophisticated that they can accurately sense what pressure needs to be output to keep your airways open while you sleep. In her words, the auto-titration machines are able to adjust to “give you the support when you need it” and they are “easier on your body as they don’t unnecessarily pump the same continuous pressure of air regardless of whether or not you need it”.

I did hear some salesmanship in that response, so I queried further about pricing, figuring she was making more profit on the auto-titration machine than the fixed pressure machine. But she said the auto-titration machines are only about $50 more expensive than their fixed counterparts and that she wasn’t on commission.

So with that knowledge, I figured I could save some money by looking into an at-home sleep study and subsequently purchasing an auto-titration CPAP machine.  I started looking into at-home sleep studies and will write more about my experience in another post.


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