Cpap machine advice

[Cloud Nine]

Hello all,
I have been using a CPAP machine for one year in October, struggling and not enjoying the tubes and equipment. I believe I am supposed to be checked by a physician at least once a year as required by either the insurance company or by Medicare.
I received extremely poor education on its use…. About 20 to 30 minutes tops.
What I am requesting is advice on a new medical practice who will help me and reeducate in Cpap use.
Currently, I am with Ocala Lung and they keep scheduling me and then canceling appointments. This has happened twice this month.
Any suggestions for a new medical practice?
Thank you

[BrianL99]

Hello all,
I have been using a CPAP machine for one year in October, struggling and not enjoying the tubes and equipment. I believe I am supposed to be checked by a physician at least once a year as required by either the insurance company or by Medicare.
I received extremely poor education on its use…. About 20 to 30 minutes tops.
What I am requesting is advice on a new medical practice who will help me and reeducate in Cpap use.
Currently, I am with Ocala Lung and they keep scheduling me and then canceling appointments. This has happened twice this month.
Any suggestions for a new medical practice?
Thank you


Turn it on, put your mask on, go to sleep. Nothing complicated.

I believe the requirement for "durable medical equipment" as it applies to CPAP, as your provided gives you the machine and monitors the first 90 days, in which you have to use it, something like 70% of the time. I may be different with Medicare, as I've never been monitored.

The company what provided your CPAP should have all the information you need. I've never heard of any requirement for "on going care" or monitoring. If you have Sleep Apnea, you got it ... it's not going away.

There are a zillion Internet Forums for CPAP users & folks with Sleep Apnea. Tons of good information.

Here are a couple, but there are plenty more.



CPAP and Sleep Apnea Message Board | CPAPtalk.com (https://www.cpaptalk.com/CPAP-Sleep-Apnea-Forum.html)

Apnea Board - Sleep Apnea discussion forums, CPAP Manuals and advice (https://www.apneaboard.com/)

[Keefelane66]

Here s your refresher course.

The process is straightforward and follows a series of steps.
Find a Good Space to Put the CPAP Machine. ...
Check the Filter. ...
Attach the Hose to the CPAP Machine. ...
Attach the Hose to the Mask. ...
Set Up the Humidifier (When Applicable) ...
Plug in the CPAP. ...
Put On and Adjust the Mask. ...
Turn On the Device.

It's not rocket science.

[Babubhat]

Phillips and Resmed have instructional videos on YouTube. One month should be sufficient to find if setup works for you. Try changing your type of mask if uncomfortable. A nasal mask is least restrictive but each person is different

Philips Respironics - YouTube (https://www.youtube.com/user/PhilipsRespironics)

https://www.youtube.com/results?search_query=resmed+cpap+machine

https://www.youtube.com/results?search_query=philips+cpap+machine+

I have no experience with this but it’s close by

Welcome To Our Practice | Village Sleep Lab | The Villages, FL (https://www.villagesleeplab.com/)

[GpaVader]

I have been a CPAP user for almost 10 years. I did follow up with my pulmonologist about 6 months after I got on my machine, but after that it was an every other year appointment so I could get my prescription refills for supplies. I got my primary to take things over.

Use is pretty much as described above but two things to keep in mind:
1) surpirised no one said to keep the gear clean, I clean mine weekly but also use a So Clean to clean the mask and hose nightly. I don't run it through my machine because it is not rated for that. But I clean the resivour hose and mask weekly in mild detergent as was recommended by physician and the durable medical device provider.
2) you do have a few settings you may want/need to tinker with depending on the time of year and your sleeping habits. The main one I watch is the humidity levels. This is important, especially during the summer, so you don't end up with a bunch of water in your hose. Ask me how I know... the settings are usually something you work with your doctor if you are not sleeping well with it.

If you are struggling with the device sometimes its not the device but the type of mask you are using. This relates back to how you sleep. I sometimes sleep with my mouth open so I opted for a full face mask as opposed to just over the nose. I've tried both and find I get better results with the full face. I do have times where I wake up closterphobic and I have to take it off but that only happens on rare occasions. Good luck with the CPAP, it's made a world of difference for me but it does take some getting used to.

[asianthree]

Are you speaking of the pressure, that are being delivered, or just general use. Todays cpap can be monitored, pressure changed without a personal visit.

[Cloud Nine]

Thank you everyone for all your valuable information. I’m not having issues using it or understanding how to use it. My continuous issues are feeling comfortable with it and finding a medical practice/ doctor that is easier to deal with …… I will refer to some of the websites suggested.

[Babubhat]

I have had a cpap for over 15 years and Never had a follow up appointment. Hope you find a comfortable solution. They now make an implant with no hose or mask

Inspire(R) Device for Sleep Apnea (https://health.clevelandclinic.org/dont-like-cpap-an-implantable-device-is-another-option-for-your-sleep-apnea)

[CoachKandSportsguy]

I have had a cpap for over 15 years and Never had a follow up appointment. Hope you find a comfortable solution. They now make an implant with no hose or mask

Inspire(R) Device for Sleep Apnea (https://health.clevelandclinic.org/dont-like-cpap-an-implantable-device-is-another-option-for-your-sleep-apnea)

From people who have had the implant, they are reporting very good results in the hospital circles. Not sure who qualifies for them, but if you are not comfortable with the machine, the implant might make sense

[asianthree]

From people who have had the implant, they are reporting very good results in the hospital circles. Not sure who qualifies for them, but if you are not comfortable with the machine, the implant might make sense

When the implant questions came up spouse had a long discussion with 2 colleagues that are pulmonologist, our granddaughter who does sleep studies, and 2 residents who does procedure and a nurse at sleep clinic.

Qualified as a candidate, did extensive research on negative issues, on why there could be failures. So 6 extensive conversations, each with the same in-depth information. Possible implications of implant issues, and some positive real time results, such as no more equipment, hoses masks.

Negative was some have issue with the device because it is located from the back of the throat. Gag reflexes are a problem. The constant buzz they sometimes can wake you. Some patients still end up back on Cpap with the implant, to alleviate some issues.

The fail rate was higher than I expected, plus…

If you have had mastectomy, scar tissues may not allow proper placement of implant.
Spouse was offered the implant and procedure at no cost, and turned it down. With history of gag issues, a mastectomy and the sleep clinic pass fail rate and possible return to Cpap need, it was a hard NO.

[Haggar]

Thank you everyone for all your valuable information. I’m not having issues using it or understanding how to use it. My continuous issues are feeling comfortable with it and finding a medical practice/ doctor that is easier to deal with …… I will refer to some of the websites suggested.

There's all sort of different equipment - full mask or not a full mask.

I've got one the tube is the top of my head rather than in front of my nose. Much more comfortable. There are those with humidifiers and other with heated humidifiers.

I worked with my ENT to find one that is comfortable. I find I sleep more through the night with it on but it makes more noise if it is not a tight fit on my nose. And then my wife wakes me up to tell me to adjust it.

[Caymus]

I have been a CPAP user for almost 10 years. I did follow up with my pulmonologist about 6 months after I got on my machine, but after that it was an every other year appointment so I could get my prescription refills for supplies. I got my primary to take things over.

Use is pretty much as described above but two things to keep in mind:
1) surpirised no one said to keep the gear clean, I clean mine weekly but also use a So Clean to clean the mask and hose nightly. I don't run it through my machine because it is not rated for that. But I clean the resivour hose and mask weekly in mild detergent as was recommended by physician and the durable medical device provider.
2) you do have a few settings you may want/need to tinker with depending on the time of year and your sleeping habits. The main one I watch is the humidity levels. This is important, especially during the summer, so you don't end up with a bunch of water in your hose. Ask me how I know... the settings are usually something you work with your doctor if you are not sleeping well with it.

If you are struggling with the device sometimes its not the device but the type of mask you are using. This relates back to how you sleep. I sometimes sleep with my mouth open so I opted for a full face mask as opposed to just over the nose. I've tried both and find I get better results with the full face. I do have times where I wake up closterphobic and I have to take it off but that only happens on rare occasions. Good luck with the CPAP, it's made a world of difference for me but it does take some getting used to.

Do you know what the Medicare charges for the machine and supplies would be? My current ResMed was obtained while I was on private health insurance. I found that out of pocket replacement parts from Amazon were more convenient and less expensive than from the original provider. I notice that I can buy a new CPAP machine online (including a "prescription") for less than I paid originally in insurance deductibles. I would also not need to prove that I met the reimbursement usage levels.

[villagetinker]

Thank you everyone for all your valuable information. I’m not having issues using it or understanding how to use it. My continuous issues are feeling comfortable with it and finding a medical practice/ doctor that is easier to deal with …… I will refer to some of the websites suggested.

My wife uses one of these, and she has had to go through several different masks until she found ones that work. She uses MyDMEDOC in Spanish Springs and they have been very helpful in getting the correct mask. I understand they were just merged with another company, so no idea if this will still work for you. However, if you are using another supplier, you should be able to have them work with you to get a mask that works well.

[Garywt]

No idea where you should go but my wife uses one. She went through 4-5 different attachments until she found one she was comfortable. The company just kept sending her stuff for free. Masks did not work and various nose things didn’t work. Currently she has a hose that comes from above her head and down to her nose and it works great for her. I hope you can get it all straighten out so you can sleep well.

[BrianL99]

Do you know what the Medicare charges for the machine and supplies would be? My current ResMed was obtained while I was on private health insurance. I found that out of pocket replacement parts from Amazon were more convenient and less expensive than from the original provider. I notice that I can buy a new CPAP machine online (including a "prescription") for less than I paid originally in insurance deductibles. I would also not need to prove that I met the reimbursement usage levels.

I did the same thing for 10-12 years. Once I decided to let Medicare pay for everything, I had to go through the process. You'll have check with your Insurer to ascertain the deductible for durable medical equipment. I think I paid around $200, but that's a guess.

You'll need a new sleep study and a new prescription. I understand you can do the sleep study at home.

You can select your own provider, usually for the sleep study and for the equipment. Contact your PCP and he can simply send the order to whoever you specify for the sleep study and have who ever performs the sleep study, send the resultant prescription to the equipment provider you want to use. You can also choose what CPAP machine you want and your provider will get it for you.

Next think you know, you'll have a brand new CPAP and be bombarded with free supplies. Medicare authorizes a ridiculous amount of supplies & parts replacements.

The whole secret in my opinion, is getting the right "mask". Your equipment provider is REQUIRED by Medicare, to send a person out to you, to "train" you on CPAP use and help with mask selection. You'll normally get 30 days to test drive a mask and if you don't like it, you can get another one.

I don't use heat or the humidifier, they're a PITA and unnecessary in my opinion. if you don't use water, you won't have to deal with all the cleaning BS. I clean mine, *maybe* once ever month or two and don't have any issues.

I have severe Apnea, with 100's of events/night. With CPAP, no humidifier, nor moisturizing, I average less than 1 event/hour. The goal is to be under 5.

[Maker]

Many people that have issues with their mask is really driven by being annoyed from the hose. One trick to try is having the hose loop up above you and hang down to the mask. Some use a retractable cord to keep it above you, but still allows it to easily move down as you move around.

[upstate]

I’ve been using this instead of the machine and it’s made a definite improvement regarding my snoring and quality of sleep. It’s not for everyone, though you may want to look into it. Good luck.
https://somnomed.com/en/

[TommyT]

Remember the Phillips recall !!!

[Cloud Nine]

Thank you all for such excellent information! You guys rock ! Only one slightly sarcastic line in all of these fantastic replies. When does that ever happen in so many of these online sites?

Yes, I do struggle with a Cpap machine not because I’m stupid but because I began using it at the tail end of Covid pandemic and was not allowed to even try various masks fit….plus cursory instructions on its use. I think many of you have nailed it. It’s all about the comfort of the mask in the long run.

I’ve just got to go back to the drawing board and also maybe join a group that offers assistance.

I hope this thread may help someone in the future who struggles with the whole process of having hoses, masks, head gear and continuous air pumping through your nose when you’re trying to relax comfortably for sleep.
Again many thanks to all who took time to answer and offer help with my problem.

[bowlingal]

according to Medicare, at least 4 hours a night is required. I see my doc every 6 months where he reads the sim card and reports findings back to Medicare, which is required. Medicare pays for your machine for the first year, if they don't get the required information, they can take the machine back, or make you pay for it. I just changed supplier companies to NewAir located in Eustis 352-589-6247 and they are excellent. I used to go to Five Star in Fruitland Park, but they closed up. You are supposed to get new supplies every 3 or 6 months. New water basin, new tubing, new pillow inserts, or new mask if that is what you use that Medicare pays for. My doc gave me a list of supplies you are supposed to get according to Medicare. Ask your doc for that. I use Resmed products.

[Sherkugawa]

Dr. Albino in Lady Lake. However, that was all the instruction I was given. The pulmonologist does not provide the instructions. You should contact the company who provided you the equipment and describe what problems you are having.

Hello all,
I have been using a CPAP machine for one year in October, struggling and not enjoying the tubes and equipment. I believe I am supposed to be checked by a physician at least once a year as required by either the insurance company or by Medicare.
I received extremely poor education on its use…. About 20 to 30 minutes tops.
What I am requesting is advice on a new medical practice who will help me and reeducate in Cpap use.
Currently, I am with Ocala Lung and they keep scheduling me and then canceling appointments. This has happened twice this month.
Any suggestions for a new medical practice?
Thank you

[Snowbirdtobe]

Dr Albino has a sleep lab that will do a study and try different masks during the process to ensure a good mask fit.
There is also a support club in the villages that meets at Bridgeport Rec center on the second Monday of the month. Next meeting is Feb 12th at 6:30.
I have found no good equipment suppliers in TV area. I have been trying for 15 years and always found suppliers that are just ok.

[MidWestIA]

Get this mask have straps just touch your skin when on slide around and adjust straps to stop leaking air. It's design makes it suck to your face to seal and does not have to be tight

Mirage Activa™️ LT nasal mask - ResMed Healthcare Professional (https://www.resmed.com/en-us/healthcare-professional/products-and-support/masks/mirage-activa-lt/)

[Cliff Fr]

I tried a cpap machine a few years ago and gave up on it. I just found a very small machine that goes under the nostrils. No hoses. It's battery powered. Sold by Vixily. I just ordered it. I'm a little skeptical because of the very low price but I will try it.

[jmpate]

I don't have a recommendation for a medical practice but do have several suggestions for it's use.
1. Yes, cpap effectiveness should be checked annually by MD pulmonologist or CPAP technician for effectiveness & changing of pressures. A whole host of events can cause ur machine to not to work effectively.
2. Annual check can be done on site or in person.
3. Washing tubing, masks etc at least q2 days in hot soapy water is required. Baby shampoo the best. Otherwise pulm infections can and do occur & when they do, they're hard to treat.
4. Change mask & tubing q6mos from supplier.
5. Change white filter monthly.
6. Call supplier to schedule another education class & make sure they cover cleaning requirements.
7. Call supplier for recommendations on MD practices that will manage ur use & changes.

Ur sleep quality is the key to successfil medical condition mgmt. Otherwise, don't bother using the machine!

Hope this helps!

Hello all,
I have been using a CPAP machine for one year in October, struggling and not enjoying the tubes and equipment. I believe I am supposed to be checked by a physician at least once a year as required by either the insurance company or by Medicare.
I received extremely poor education on its use…. About 20 to 30 minutes tops.
What I am requesting is advice on a new medical practice who will help me and reeducate in Cpap use.
Currently, I am with Ocala Lung and they keep scheduling me and then canceling appointments. This has happened twice this month.
Any suggestions for a new medical practice?
Thank you

[peggyb]

I go to Dr Juan Albino. he has a sleep lab on premises. my DME is New Air, and have been wonderful. Came to my house for initial setup and education, I can call them at any time with issues if needed. I see Dr Albino every 4 months, although that will now go to yearly. He is right next to Villages Hospital.

[loufromnewjersey]

My cardiologist put me on CPAP. Any of your doctors can do it.

[BlueStarAirlines]

I have been trying for 15 years and always found suppliers that are just ok.

I'm still using my supplier from my former state. My local pulmonologist updated the script or whatever documentation they needed and they just ship me my supplies as I request them.

[WickedMike]

I tried a cpap machine a few years ago and gave up on it. I just found a very small machine that goes under the nostrils. No hoses. It's battery powered. Sold by Vixily. I just ordered it. I'm a little skeptical because of the very low price but I will try it.
I tried the little battery powered cpap advertised. Used it one night. Was much louder than I thought it would be and was not comfortable, to me ! I look at it as a gimmick!

[Burgy]

Hello all,
I have been using a CPAP machine for one year in October, struggling and not enjoying the tubes and equipment. I believe I am supposed to be checked by a physician at least once a year as required by either the insurance company or by Medicare.
I received extremely poor education on its use…. About 20 to 30 minutes tops.
What I am requesting is advice on a new medical practice who will help me and reeducate in Cpap use.
Currently, I am with Ocala Lung and they keep scheduling me and then canceling appointments. This has happened twice this month.
Any suggestions for a new medical practice?
Thank you
I also have a like/hate feeling about Cpap. Some do great but many get poor support. The first supplier never called or replaced anything after I got the machine. So I asked for a different supplier and now have Southern Respiratory which I find maybe even overzealous in wanting to send stuff that ":is Medicare covered" Well it is but there are some copays. However you may want to call them and request a visit or demo from a therapist. I think the doctors just order the settings and rely on others for fitting and supplies.

[RickyLee]

Hello all,
I have been using a CPAP machine for one year in October, struggling and not enjoying the tubes and equipment. I believe I am supposed to be checked by a physician at least once a year as required by either the insurance company or by Medicare.
I received extremely poor education on its use…. About 20 to 30 minutes tops.
What I am requesting is advice on a new medical practice who will help me and reeducate in Cpap use.
Currently, I am with Ocala Lung and they keep scheduling me and then canceling appointments. This has happened twice this month.
Any suggestions for a new medical practice?
Thank you

I had real problems with CPAP, changed to a BiPAP, much better solution for me. I also use the dreamware mask that the hose comes in on top of the head. Nasal pillows for me with heated humidity. In my opinion, The clincher was BiPAP. With BiPAP it's less forceful air and I'm able to breathe fairly normally. Good luck

[Lea N]

Hello all,
I have been using a CPAP machine for one year in October, struggling and not enjoying the tubes and equipment. I believe I am supposed to be checked by a physician at least once a year as required by either the insurance company or by Medicare.
I received extremely poor education on its use…. About 20 to 30 minutes tops.
What I am requesting is advice on a new medical practice who will help me and reeducate in Cpap use.
Currently, I am with Ocala Lung and they keep scheduling me and then canceling appointments. This has happened twice this month.
Any suggestions for a new medical practice?
Thank you

Maybe a home health agency nurse could show you exactly what to do? If Ocala Lung can't get you in maybe your primary care physician could write a prescription for home health. I'm not sure if this would work or not but you could start by calling a few home health agencies to find out if they do this sort of thing.

[Rando]

Thank you everyone for all your valuable information. I’m not having issues using it or understanding how to use it. My continuous issues are feeling comfortable with it and finding a medical practice/ doctor that is easier to deal with …… I will refer to some of the websites suggested.

My provider recommended an ESON mask (nose spelled backward) and I love it. I think the trick is finding the mask that works for you.

You should be able to go to a cpap durable medical provider and try and be fitted with different masks to see what works for you. Not the doctor's office but the equipment provider.

Good luck!

[TSO/ISPF]

I don't have a recommendation for a medical practice but do have several suggestions for it's use.
1. Yes, cpap effectiveness should be checked annually by MD pulmonologist or CPAP technician for effectiveness & changing of pressures. A whole host of events can cause ur machine to not to work effectively.
2. Annual check can be done on site or in person.
3. Washing tubing, masks etc at least q2 days in hot soapy water is required. Baby shampoo the best. Otherwise pulm infections can and do occur & when they do, they're hard to treat.
4. Change mask & tubing q6mos from supplier.
5. Change white filter monthly.
6. Call supplier to schedule another education class & make sure they cover cleaning requirements.
7. Call supplier for recommendations on MD practices that will manage ur use & changes.

Ur sleep quality is the key to successfil medical condition mgmt. Otherwise, don't bother using the machine!

Hope this helps!

what is q2 days?

[BrianL99]

I don't have a recommendation for a medical practice but do have several suggestions for it's use.
1. Yes, cpap effectiveness should be checked annually by MD pulmonologist or CPAP technician for effectiveness & changing of pressures. A whole host of events can cause ur machine to not to work effectively.
2. Annual check can be done on site or in person.
3. Washing tubing, masks etc at least q2 days in hot soapy water is required. Baby shampoo the best. Otherwise pulm infections can and do occur & when they do, they're hard to treat.

5. Change white filter monthly.

6. Call supplier to schedule another education class & make sure they cover cleaning requirements.

7. Call supplier for recommendations on MD practices that will manage ur use & changes.

Ur sleep quality is the key to successfil medical condition mgmt. Otherwise, don't bother using the machine!

Hope this helps!


Overkill to the nth degree. CPAP machines are about as durable and dependable as a Toyota Camry.

All you need to do, is check your AHI and if you're under 5, you're nearly perfect. Less than 15 is acceptable.

I clean my machine about every month or two. Medicare will send you so many hoses & masks, you hardly ever have to touch them ... just put it on every night.

I have 2 machines, at 2 homes. One is 3 years old, 1 is 10 years old. I don't fill them with water, nor use the "heater". I'm traveling this week and I split my machine in half and left the water reservoir at home, to save on luggage space. My AHI is always under "2". and "mask fit" over 99%. That's the only thing you really need to be concerned about, is results.

[jump4]

I suggest you start with a Dreamwear nasal mask. If that doesn't work because you breath through your mouth, change to a Dreamwear full-face mask. Make sure the CPAP machine is set to slowly ramp up the pressure when you start treatment each night.

Once you get a setup like you like, you'll probably love sleeping with it. And your health will be much better off.

[BrianL99]

I suggest you start with a Dreamwear nasal mask. If that doesn't work because you breath through your mouth, change to a Dreamwear full-face mask. Make sure the CPAP machine is set to slowly ramp up the pressure when you start treatment each night.

.

Do you know the OP? Do you know the size of his head? Shape of his head? His nose? Ear location? Do you know how he breathes? In what position he sleeps?

There are 100's of masks available. To suggest a specific mask is better or more appropriate for someone you likely don't know and have never ever seen sleeping, is ludicrous on its face.

What works for you, could be the antithesis of what's proper and might work for someone else.

[JRcorvette]

A lot of people are on C-pap machines because they are overweight. After I lost weight I no long longer needed to use one and I was much healthier overall. I hated using one.

[BobGraves]

I go here. Very satisfied.
Lake Pulmonary And Sleep Disorders Clinic
501 Medical Plaza Dr Ste 102, Leesburg, FL, 34748
(352) 728-0709

[jerseyvillager]

If you have moved to an Inspire device - at what step is the device set at for your use?

[nn0wheremann]

Dr Balingit, and Southern Respiratory.

[Velvet]

What seemed to have worked for sleep apnea for hubby, is a facial slimming wrap. The wrap keeps him from opening his mouth too wide, especially if he wears the wrap a bit forwards, gives him good sleep and a bonus nice jaw line. He measures his blood oxygen level at night using the Apple Watch (which does it automatically all night long). It costs less than $16 from Amazon. (I think it only comes in pink but he has zero masculinity issues.) I’m just sharing.

[dpmers]

There's a lady in the Ocala Lung office that specializes in CPAP machines and she is very good and helpful, try to get an appointment with her, its worth it. In 10 months I have learned to really like my machine after 3 different types of masks/nose pillows

[dadspet]

When the implant questions came up spouse had a long discussion with 2 colleagues that are pulmonologist, our granddaughter who does sleep studies, and 2 residents who does procedure and a nurse at sleep clinic.

Qualified as a candidate, did extensive research on negative issues, on why there could be failures. So 6 extensive conversations, each with the same in-depth information. Possible implications of implant issues, and some positive real time results, such as no more equipment, hoses masks.

Negative was some have issue with the device because it is located from the back of the throat. Gag reflexes are a problem. The constant buzz they sometimes can wake you. Some patients still end up back on Cpap with the implant, to alleviate some issues.

The fail rate was higher than I expected, plus…

If you have had mastectomy, scar tissues may not allow proper placement of implant.
Spouse was offered the implant and procedure at no cost, and turned it down. With history of gag issues, a mastectomy and the sleep clinic pass fail rate and possible return to Cpap need, it was a hard NO.

I recently questioned 2 different Pulmonologist on INSPIRE alternative to CPAP and both were not what I would consider positive on the implant. I'm not a fan of CPAP (Noise, dry mouth, comfort, maintenance> believe me I tried a bunch of masks) and wish there was a different simpler alternative. When they didn't recommend it I didn't push the issue. Their opinion could be relative to me and different for you of course. I have a pacemaker and watchman scheduled and one comment was I had enough equipment in my body. If the Dr isn't trying to make more money by doing a procedure on you that good enough for me