CPAP Use - Dr out of business

[wolfson292]

I've reviewed the other CPAP thread at length, but didn't see a specific answer to my question. I am currently in a Part 141 program and working to get my medical certificate. I've used a CPAP machines nightly for many years, but when I went to get my records found that my Dr went out of business sometime in the last 2-3 years and I can't reach him or anyone with my records. When I spoke to the AME I was going to use on the phone he stated he needed a letter from my pulmonologist saying my apnea was under control for the last year and the date he had last seem me. That's obviously not possible, and if I went to a new Dr there would be limited history he could speak to. I am correct in reading Dr. Bruce's comments that an AME if presented with the output of my CPAP machine showing 30 days of compliance, should be able to sign off himself? Is there something I can point my AME to that describes that or should I find a new AME?

 

[Matthew]

In my experience - you need a letter from your "treating physician". In most cases, that's your family doc. He will need to write up a status report saying he has examined you, is satisfied that you are in compliance, and that you show no effects of excessive daytime sleepiness.

You take that report and the report from your CPAP and give both to your AME. The AME then can issue a Special Issuance medical. About 8-12 weeks later you'll get a confirmation letter from the FAA saying they have reviewed your case and are satisfied (or not).

So what the AME told you is basically what's in my first paragraph. If your "treating physician" is no longer around, then you need to get another "treating physician".

The report from your doc and from the machine need to be less than 90 days old for the AME.

(Note: I am not an AME)

 

[wolfson292]

Thanks for the response. I've got to visit my "family doc" anyways to get a letter about blood pressure, so at the same time I'll see if they are willing to write the letter on Apnea or if they want to refer me to a new pulmonologist.

So even with the letters the AME can't issue on the spot, it needs to go through the Special Issuance process? The AME mentioned that if I brought both letters he could issue on the spot.

 

[Matthew]

Dang - had a good response and it disappeared!

--
Sorry for the confusion:

The AME can issue, as long as you have the proper paperwork.

There are two things at play here, one is your medical, the other is the Special Issuance.

Back in the old days (until last year), only FAA could generate the Special Issuance. The AME was allowed to renew it, but only FAA could grant it. The first time you saw the AME with OSA, he would have to defer the decision to FAA and that would take 8-12 weeks to wait for them to get back. FAA would then issue the SI, give you instructions on how to renew it every year, tell you the expiration date (normally 6 years), and include your medical.

Now, the AME is being allowed to grant you the SI so that you don't have to wait. He still has to send everything to FAA and after 8-12 weeks you will get a letter from them confirming the SI has been properly issued, and will tell you when it expires (still normally 6 years) and how to renew it annually.

I'll include a couple of links as soon as I can find them.

(Again, I am not an AME! Hopefully I got everything right in the above explanation.)

 

[wolfson292]

Got it, so during that 8-12 week period I would be good to go, but the FAA could come back and deny it in which case it would be revoked until worked out.

 

[Matthew]

Got it, so during that 8-12 week period I would be good to go, but the FAA could come back and deny it in which case it would be revoked until worked out.

If they aren't satisfied with what the AME was given, they can always overrule. I think they generally will want more info and will give you some time to get it together.

 

[Matthew]

Here is the info from FAA:

http://www.faa.gov/about/office_org...ices/aam/ame/guide/dec_cons/disease_prot/osa/

Pay attention to the Quick Start PDF. It will say that you fall into Group 2:
http://www.faa.gov/about/office_org...s/aam/ame/guide/media/Quick Start for AME.pdf

Then, follow the flowchart:
http://www.faa.gov/about/office_org...es/aam/ame/guide/media/FAA OSA Flow Chart.pdf

The flowchart says you will be given Spec Sheet A. This is the request for your CPAP and doc reports which you will already have in-hand:
http://www.faa.gov/about/office_org...ia/OSA Spec Sheet A - Information request.pdf

And it also says "Issue, if otherwise qualified."

It's good that you already talked with your AME in advance, so that you can both understand the situation and prevent surprises.

 

[AggieMike88]

Since this is your first time asking your treating physician to write the letter, go to your AME and ask if they have a boilerplate example of what the letter should say.

When gotten from the AME, this increases your chance of passing on the first go.

Then write an example letter for your doc, include "Your Letterhead here" and "Your Signature here" and other things that make it 5th grader simple for him to complete. Make it fill in the blank too.

With the FAA and status letters, simple language is better. Never let your doc drag out his medical thesaurus.

Once you have your letter from the treating physician, fax/email it to your AME asking him/her to review it to see if all he and the FAA want is there. BEFORE you go for your exam is the time to get that figured out, giving you a chance to talk to your doc for an edit if one is needed.

 

[Norman]

This page may be of some help in locating your medical records.

http://patients.about.com/od/medica...s-If-Your-Doctor-Is-No-Longer-In-Practice.htm

 

[Matthew]

Adding to and commenting on what Mike (AggieMike88) said: I think you have the right idea, don't be passive about this. It's your medical, so take charge of it. Mike has a good point, work with the AME before you see him for the medical exam. You'll end up being better informed, and you and your AME will have a working relationship that should help on other things down the road.

--

Once you get the SI, you'll need to renew it annually. You can either mail FAA copies of your annual status report and CPAP report and wait for them to review and mail your fresh medical (no charge), or you can go to your AME and he can renew it while you wait (AME will charge for his time). If the AME renews it, you will still get a follow-up letter from FAA. On years where your physical is due, the AME can do the exam and renew the SI at the same time.

Eventually, after 6 years, your SI will expire. When that happens, the follow-up letter from FAA will generally tell you that a new SI has been issued and will include the new expiration date. If they want, they can request another sleep study or other info, but that's never happened to me.

 

[murphey]

Contact your state Medical Board or whatever it's called and track down the doctor and/or the records. Depending on the state, the retention period is anywhere from 5 yrs to infinity

https://www.healthit.gov/sites/default/files/appa7-1.pdf

Each state has different rules for the retiring physician. For example, in Georgia, the state rule is
"(i) An individual provider who has retired from or sold his or her professional practice if such provider has notified the patient of such retirement or sale and offered to provide such items in the patient´s record or copies thereof to another provider of the patient´s choice and, if the patient so requests, to the patient; or"

What state was the physician located?

Also check with the AMA, he may have been a member and may still be a member but in a category other than "active".

 

[DFH65]

Just printed my report out today going to see me "treating physician" my primary care doc tomorrow for my annual physical.

For the whole year I was 97% days used, only 4 days not used I know at least a couple of those were days I was traveling commercial I got to bed at 11 and had to get up at 3 to catch a flight so packed the machine ahead of time. I had 5 other days just under the 6 hours.

I think I am compliant.

Will really be happy if this hoop jumping ever goes away. Go see my doctor for a physical then go see the AME two weeks and a bunch of money later to verify the same information. Then a year from now pay more money to prove it again.

If they don't do that how about they create an expiring SI. A person demonstrates compliance for the first few years then all they should need is a note from the doctor at their regular AME visit that says you are good to go just like the BP.

 

[Doggtyred]

I've reviewed the other CPAP thread at length, but didn't see a specific answer to my question. I am currently in a Part 141 program and working to get my medical certificate. I've used a CPAP machines nightly for many years, but when I went to get my records found that my Dr went out of business sometime in the last 2-3 years and I can't reach him or anyone with my records. When I spoke to the AME I was going to use on the phone he stated he needed a letter from my pulmonologist saying my apnea was under control for the last year and the date he had last seem me. That's obviously not possible, and if I went to a new Dr there would be limited history he could speak to. I am correct in reading Dr. Bruce's comments that an AME if presented with the output of my CPAP machine showing 30 days of compliance, should be able to sign off himself? Is there something I can point my AME to that describes that or should I find a new AME?

So... no follow up visits with the pulmonologist? No requirement from the medical equipment company to have an annual prescription for equipment/consumables/supplies? No monitoring of your data required by your insurance company? Were you operating on a cash basis for all of this and no insurance, follow up or anything?

I've been on CPAP for 8 years.. on my third machine... have a visit with SOMEBODY every year, and in the last 3 years with the current insurance, its been an annual visit to the pulmonologist just to shake their hand and hand over my data card... I'm having a hard time seeing how you have a medical condition that requires a specialists input and you haven't seen them in 2-3 YEARS?

Looks like you get to start over with a new doc. Perhaps you can get your old records - the doc has to have made arrangements for medical record keeping for a set period of time... (not sure if its "law" or just the common and usual accepted practice when closing a medical practice)...

And moving forward, keep an ongoing relationship with the lung doc.. annually or more frequently, even if nothing is wrong.

 

[Matthew]

I could go forever with no doc visit if it weren't for the FAA. My high deductible insurance plan means I pay cash, on-line, for the CPAP and gear. No insurance requirements for follow up visits. The online companies are normally supposed to get a copy of your script whenever you order supplies, but once they have a copy on file, they have met their side of the requirements and you can order parts whenever you need from then on.

3 machines in 8 years? Were they replaced on a schedule or did they quit working?

You can save a lot by working around the insurance companies and their equipment suppliers.

 

[JimNtexas]

Dr. Bruce is the man for this question. Contact him. For a few bucks he'll tell you exactly what you need to do!

Back when the FAA was really on the warpath about OSA he was able to give me an OSA SI on the spot!

Three years and fifty pounds latter he had the SI canceled.

You don't need to use Dr Bruce for your physical, just get him to tell you exactly what the FAA is looking for right now.

You'll save time, money, and aggravation.

 

[DFH65]

I could go forever with no doc visit if it weren't for the FAA. My high deductible insurance plan means I pay cash, on-line, for the CPAP and gear. No insurance requirements for follow up visits. The online companies are normally supposed to get a copy of your script whenever you order supplies, but once they have a copy on file, they have met their side of the requirements and you can order parts whenever you need from then on.

3 machines in 8 years? Were they replaced on a schedule or did they quit working?

You can save a lot by working around the insurance companies and their equipment suppliers.

This is my experience as well. My primary care does what I need for this. I am just over 2 years with it and machine runs like a champ. I am high deductible as well so I buy supplies online when I need them.

Don't know the FAA's view on this but I understand any doctor can write a CPAP script including a dentist. If the FAA really cared about pilots health they would come up with systems that doesn't discourage people from going to the Dr. and seeking treatment for fear of the cost to prove to them everything is OK.

 

[Matthew]

Back to the OP for a minute: What FAA might want to see is a copy of the original sleep study, since they don't already have it. Your doc based his OSA diagnosis on it, and FAA will probably want that report, too. If you can't find your doc, you might be able to get a copy from the sleep lab.


--

As far as prescriptions go, I suppose anybody can write one. But for an OSA diagnosis itself, there is probably some standard that means only an MD/DO can do it.

The on-line vendors (cpap-supply.com is my favorite, and is pilot owned), are supposed to get a copy of your script. They don't like it, and I don't either. I can understand the need for that when they configure the CPAP, but for masks and other supplies it doesn't make sense. It's like requiring a prescription for the tennis balls you cut open and stick on the bottom of a walker. Most will sell/send you whatever you need on the honor system - as long as you "promise" to email them a copy of the prescription.

If you rely on your insurance co and their preferred durable medical equipment supplier, you'll get a little extra service (free setup, adjustments, replacement warranties, and the like), but you may not be given a choice in what you are provided, and the price will usually be much greater than you can get on-line.

 

[weilke]

Contact your state Medical Board or whatever it's called and track down the doctor and/or the records. Depending on the state, the retention period is anywhere from 5 yrs to infinity
[

Those records should be available somewhere. At times, a local hospital will take custody of a retiring providers charts. The other possibility is that the practice was sold to one of the national DME rackets.

Now itsounds like he needs a letter. For that, finding the notes from a visit years ago wont help.

 

[wolfson292]

Just to assure everyone who was worried, my Doctor wrote my an RX with multiple refills for as many new masks as I needed. I buy them online, as its cheaper than paying my deductible on them at 5X the price per mask. Since I don't file for insurance, never needed to go back to the Doctor recently. I regularly review the data in writes to the SD card with SleepyHead to ensure its working well for me. I do see now that I'll need to visit a doctor regularly to keep my SI up to date.

I also appriciate the suggestions on places to go check for my records. Sounds like someone should have them. I do have copies of my sleep studies so no issues there.

Also, I'll take the multiple suggestions of following up with Doctor Bruce directly. My local AME seemed a little fuzzy on the process and I want to ensure I am 100% prepared when I show up.

 

[Blindrage]

I can add to this since I just went through it all.

I moved in February of last year, and decided to take up flying in September. I went to the AME blind, and got deferred for a few reasons, but one was OSA.

Well since I had not seen my sleep doc, back where I moved from, in well over a year, she was not willing to write up anything without seeing me. I ended up taking a years worth of data from my machine in to my new family doc, and he gave me a physical. Since I had the proof of using the machine, and he could find nothing that indicated a problem, he wrote the letter saying I was in compliance and well treated.

It took over 2 months from the date I sent in all my paperwork to OK, and after the first month I started calling once a week to "check the status," but last week I finally got my 3rd class medical.

So here is the down side. I had 5 reasons for being deferred (sucks getting old), but the CPAP use seems to be the one the FAA is most concerned about. My medical is a special issuance and is only good for one year. Either thru the AME, or by doing all the paperwork myself, I have to re-certify my CPAP compliance once a year to keep the medical valid. That essentially means filling out the self report on CPAP usage and getting the doc to write another letter saying I using it and seem to be in good health. Everything else is once every two years.

So it can be done, you just have to find a family doc willing to look at the data and write it up.

 

[Matthew]

I can add to this since I just went through it all.

I moved in February of last year, and decided to take up flying in September. I went to the AME blind, and got deferred for a few reasons, but one was OSA.

Well since I had not seen my sleep doc, back where I moved from, in well over a year, she was not willing to write up anything without seeing me. I ended up taking a years worth of data from my machine in to my new family doc, and he gave me a physical. Since I had the proof of using the machine, and he could find nothing that indicated a problem, he wrote the letter saying I was in compliance and well treated.

It took over 2 months from the date I sent in all my paperwork to OK, and after the first month I started calling once a week to "check the status," but last week I finally got my 3rd class medical.

So here is the down side. I had 5 reasons for being deferred (sucks getting old), but the CPAP use seems to be the one the FAA is most concerned about. My medical is a special issuance and is only good for one year. Either thru the AME, or by doing all the paperwork myself, I have to re-certify my CPAP compliance once a year to keep the medical valid. That essentially means filling out the self report on CPAP usage and getting the doc to write another letter saying I using it and seem to be in good health. Everything else is once every two years.

So it can be done, you just have to find a family doc willing to look at the data and write it up.

Is your only SI for the OSA?

If so, then schedule an annual physical with your doc, ask for the status report at that time. No special trip necessary, and you'll get a regular checkup to go with it. Good to know your BP and blood sugar levels are OK before you see the AME. Then, if this is a year where you only need to renew the SI but don't require the full AME exam, you have two choices: Mail the report and your CPAP report to FAA Medical (and include the renewal paperwork) and wait about 8-12 weeks for them to send your renewed medical (no charge). Or, see your AME and give him the same documentation and he can generate a renewed medical while you wait (and charge for his time).

Maybe someday FAA will do away with the need for that annual renewal if you've showed some level of compliance in the past. But until then, the OSA SI is a pretty simple renewal.

 

[SkyHog]

So... no follow up visits with the pulmonologist? No requirement from the medical equipment company to have an annual prescription for equipment/consumables/supplies? No monitoring of your data required by your insurance company? Were you operating on a cash basis for all of this and no insurance, follow up or anything?

I've been on CPAP for 8 years.. on my third machine... have a visit with SOMEBODY every year, and in the last 3 years with the current insurance, its been an annual visit to the pulmonologist just to shake their hand and hand over my data card... I'm having a hard time seeing how you have a medical condition that requires a specialists input and you haven't seen them in 2-3 YEARS?

Looks like you get to start over with a new doc. Perhaps you can get your old records - the doc has to have made arrangements for medical record keeping for a set period of time... (not sure if its "law" or just the common and usual accepted practice when closing a medical practice)...

And moving forward, keep an ongoing relationship with the lung doc.. annually or more frequently, even if nothing is wrong.

In all fairness, as a CPAP user myself, I recognize the scam that is the sleep study industry. Because they are almost all associated with an on-site DME, you will rarely every escape without having something new and expensive prescribed.

As a result, I manage my apnea myself using analytical software. I do better than the sleep study folks have ever done with managing my apnea. I don't think I'll see another doctor for it until my machine breaks and I need a new one.

 

[wolfson292]

In all fairness, as a CPAP user myself, I recognize the scam that is the sleep study industry. Because they are almost all associated with an on-site DME, you will rarely every escape without having something new and expensive prescribed.

As a result, I manage my apnea myself using analytical software. I do better than the sleep study folks have ever done with managing my apnea. I don't think I'll see another doctor for it until my machine breaks and I need a new one.

\

You nailed it with your comment.

On a good note, while trying to track down my records with the local hospital system, they gave me a pager number for the Dr that happened to be his cell phone. He was forced to temporarily shut down his office due to personal issues, but he very quickly e-mailed me my records and agreed that he could produce a signed letter saying my condition was well managed if I could get a DME company to provide an official print out of my machines SD card. Luckily I have some family connections to a local company and I'll be able to get that print out quite easily.

 

[AggieMike88]

Wolfson, for the report printout from your blower, are you aware of the Sleepyhead software? http://www.sleepfiles.com/SH2/

 

[wolfson292]

Wolfson, for the report printout from your blower, are you aware of the Sleepyhead software? http://www.sleepfiles.com/SH2/

That's what I've been using myself the last 3 years (99.4% compliance), but my Dr said he needs a print out that is "official" for him to write me a letter. It's easy enough for me to hand my SD card to someone and get a print out on letterhead.

 

[labbadabba]

I've reviewed the other CPAP thread at length, but didn't see a specific answer to my question. I am currently in a Part 141 program and working to get my medical certificate. I've used a CPAP machines nightly for many years, but when I went to get my records found that my Dr went out of business sometime in the last 2-3 years and I can't reach him or anyone with my records. When I spoke to the AME I was going to use on the phone he stated he needed a letter from my pulmonologist saying my apnea was under control for the last year and the date he had last seem me. That's obviously not possible, and if I went to a new Dr there would be limited history he could speak to. I am correct in reading Dr. Bruce's comments that an AME if presented with the output of my CPAP machine showing 30 days of compliance, should be able to sign off himself? Is there something I can point my AME to that describes that or should I find a new AME?

I had a similar situation. I moved away from my treating physician and I didn't get a new one in time. My AME told me to bring in my compliance report and he re-upped my special issuance and called himself my treating physician.

 

[gkainz]

In all fairness, as a CPAP user myself, I recognize the scam that is the sleep study industry. Because they are almost all associated with an on-site DME, you will rarely every escape without having something new and expensive prescribed.

As a result, I manage my apnea myself using analytical software. I do better than the sleep study folks have ever done with managing my apnea. I don't think I'll see another doctor for it until my machine breaks and I need a new one.

Do you have an APAP? Which one?

 

[wolfson292]

I use a ResMed Autoset S9 Auto with humidifier. I'd love something smaller for traveling all the time. Getting it all set up for sleeping on a 16 hour commercial flight is a serious pain.

 

[gkainz]

I use a ResMed Autoset S9 Auto with humidifier. I'd love something smaller for traveling all the time. Getting it all set up for sleeping on a 16 hour commercial flight is a serious pain.

same one I have ... I thought your comment about self-managing implied you had APAP not CPAP - my mistake.

Apparently you get enough info from Sleepyhead to stay on top of any changes you need? How often do you end up making changes to your settings?

Do you have any experience with an APAP or C-Flex or whatever the latest re-branding buzzwords might be and compare to doing it yourself with Sleepyhead?

 

[wolfson292]

same one I have ... I thought your comment about self-managing implied you had APAP not CPAP - my mistake.

Apparently you get enough info from Sleepyhead to stay on top of any changes you need? How often do you end up making changes to your settings?

Do you have any experience with an APAP or C-Flex or whatever the latest re-branding buzzwords might be and compare to doing it yourself with Sleepyhead?

It is technically an APAP. There are multiple models of the S9, but this one is fully auto. It just has a Min/Max setting and adjusts by itself throughout the night. You really don't need to change anything so long as you are in compliance.

 

[SkyHog]

Do you have an APAP? Which one?

I do, but I don't use the APAP settings, I go into the "Physician's Mode" and set the CPAP settings myself using my own analysis in SleepyHead.

Oh, and I don't recall the model, but it is a DevilBiss.

 

[gkainz]

It is technically an APAP. There are multiple models of the S9, but this one is fully auto. It just has a Min/Max setting and adjusts by itself throughout the night. You really don't need to change anything so long as you are in compliance.

Well that's interesting! Mine says it's a S9, Autoset, EPR but I don't see any settings that hint it's any more than just a CPAP ... no settings or reports on anything related to auto adjusting anything ... I wonder if they can disable the Auto part and make it a dumb CPAP?

 

[wolfson292]

Well that's interesting! Mine says it's a S9, Autoset, EPR but I don't see any settings that hint it's any more than just a CPAP ... no settings or reports on anything related to auto adjusting anything ... I wonder if they can disable the Auto part and make it a dumb CPAP?

Yes, your DME can program it to just be a dumb device. I've seen them charge more for the same device programmed different. Google for "resmed s9 clinician mode" and you'll find directions on how to get int the programming mode to enable to the auto feature at your own risk.

 

[gkainz]

yep, found the clinician mode info, ResScan software (had Sleepyhead but upgraded computers and didn't re-download it) ...

Edit - ResScan is Windows 7 or earlier only, and my PC upgrade was to a Mac again ... Virtual Box has Windows 8.1 (just shoot me) so downloading SleepyHead again.

 

[SkyHog]

yep, found the clinician mode info, ResScan software (had Sleepyhead but upgraded computers and didn't re-download it) ...

Edit - ResScan is Windows 7 or earlier only, and my PC upgrade was to a Mac again ... Virtual Box has Windows 8.1 (just shoot me) so downloading SleepyHead again.

From PIREPs I've seen, SleepyHead is more powerful anyway. If you don't already, you should check out cpaptalk.com - there's a lot of great info available for those that have identified the great DME scam and choose to manage their own sleep health.

 

[gkainz]

I think I was on cpaptalk for a while years ago ... may have to check back in there. Thanks!