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BiPap taken away/Medicare rules
BiPap taken away/Medicare rules
Hi All, 
I was wondering if anyone else has had this problem. Sorry this is long.
I have been on BiPap for 8 years.  It has definitely helped me sleep, and definitely has helped me during the day as to how I feel.  I had my original sleep study in January 2010, had sats in the 70's, had apnea and hypopnea, and the diagnosis was made.  I have mostly central apnea, some obstructive due to my weight and a short neck.  

I had another study done in December 2015, which didn't go well.  I never really fell asleep, they did not have the proper mask for me, after telling me I did not need to bring anything.  They used a very small, tight, ill fitting mask;  I am use to the Liberty Mirage mask/hybrid.   I complained to my pulmonary doctor.  He just said it showed I still had apnea.

I went on Medicare in October 2016.  I went to my pulmonary doc for the 'Medicare' visit that month.  He supposedly filled out all the paperwork.  Apria apparently never sent paper work to Medicare for my BiPap machine, the monthly 'rental', during this whole time period.    Apria kept calling me about the bill.   I had made many calls back to Apria during this time period, and never once did they tell me anything about 'Medicare guidelines'.  They kept telling me the doctor needed to send this paperwork or that paperwork.  They put me in the middle, they made no calls to the doctor's office until the end of this mess.  I now have a $1200 bill that has been sent to a collection agency.

I saw my pulmonary doc in February and again told him about the mess.   He said let's get another sleep study.  First he did a home sleep study, which showed I had 5 or less episodes of apnea/hypopnea per hour.  He then ordered a lab sleep study.  I had some trouble getting to sleep.  The next thing I know, the tech is waking me up at 4:30am, telling me I had only 1 episode of apnea, and several episodes of hypopnea per hour.  He said my sat never fell below 88.  He said I didn't have enough episodes to go into the second part of the test, to test me on bipap. 

So when I visited my pulmonary doc after the testing.  He said the study in Dec. 2015 showed no apnea and that's what he had sent to Apria.  He said the current study showed I had few episodes.   He says I don't need to be on bipap!!  It didn't matter that my app on my phone, linked to my machine, said I had nights with varying episodes of apnea and hypopnea.  Sometimes I'd have 1-2 episodes per hour, sometimes 8-9!  It didn't matter that my husband notes at night, that when I sleep without the Bipap (like when I had the respiratory flu in January), I still have loud snoring, gasping and irregular breathing.  It didn't matter that the bipap helps me get a better night sleep and I wake up alert and rested.   NO...I don't qualify under Medicare guidelines for Bipap anymore!! 

So now I am without a Bipap machine!  I do not know what I can even do about it!  Has anyone else had this problem, and how did you handle it?

Tired, groggy, foggy, headachy, angry.... Dont-know
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RE: BiPap taken away/Medicare rules
I don't know if there's anything you can do after two tests that don't qualify you under Medicare. If it were me I'd go on Amazon and buy one. Than I'd use the resources here to get setup. But before I bought one I would ask for a copy of both sleep studies and post them here for feedback.
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RE: BiPap taken away/Medicare rules
You have two separate problems here and both were caused by your doctor. First, did the doctor tell you to stop using your machine 3-5 days before any of these tests? If not, your doctor failed you. It is not uncommon for someone who has regularly been using their device to not have a problem for a night or two and then BAM, they are back to their apnea full force again. Secondly, there was no reason whatsoever to do a new study when you all you needed was the correct paperwork that they refused to send. Got your doc some money though didn't it? First, a home study (which isn't typically appropriate for a bipap patient). Then for the lab study. Probably needed extra funds for his retirement fund (yes I'm cynical). So you've been screwed twice over by this doc. The really sad thing is that you didn't even need a sleep study to get a new machine - Medicare accepts sleep studies up to 10 years old.

I don't know how to resolve the Apria situation, especially now that it's gone to collections. I'll leave that to those who are more knowledgeable, but I think you are stuck for it.

If you no longer have the machine or have to return it, they do show up on Craigslist. It's unfortunate lots of people come here after the fact. A lot of us are cynical about sleep docs for a reason. People just don't stop having apnea without a major health improvement.
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RE: BiPap taken away/Medicare rules
Thank you Walla Walla.  I have a copy of the last sleep study, in which I had less than 4 hours of sleep.  I'll see if I can get copies of my other 2 and post them here. 

I'm wondering if this whole issue with Medicare and Apria could have been avoided by me just buying the machine.  If so, then why did my pulmonary doc never suggest this?  I found his whole attitude at my last appointment very nonchalant.

Will be back when I have more info.

(I had a previous account here, but have not been on here for some time, so I had a message saying it was deleted. So this is a new account)
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RE: BiPap taken away/Medicare rules
Thanks for your reply! 

No one told me about being off my Bipap for 3-5 days prior to my sleep study!  And the more I think about my doc at my last appointment, he was pretty nonchalant about me suddenly not having a lot of apnea/hypopnea on this last study.  I had trouble sleeping and there was less than 4 hours of info gathered.  At my appointment with him in July, he said even if I lost some of my weight, I would still need Bipap because of my short neck, and wide tongue.

I have pulmonary fibrosis, now stable for 5 years.  When I was newly diagnosed, he did not want to do the HRCT (high resolution CT) or bloodwork to confirm my IPF, and to make sure I didn't have any autoimmune issue going on.  I went down to the UCLA ILD clinic (paid out of my own money) and got their opinions/recommendations and brought them back to him.  He finally consented to the bloodwork, and ordered my CT.  However, after the CT, I discovered it was not a HRCT !!  The whole purpose of the HRCT was to differentiate whether I really had IPF, or something similar.

I'm thinking I may need a new pulmonary doctor.  And as I answered to Walla Walla, I'm wondering if I had just paid for the Bipap machine outright, would it have avoided this whole issue?  And why didn't he use my original study?....maybe you're right....$$$

Will post again after I sort out a few things, thanks!
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RE: BiPap taken away/Medicare rules
(03-17-2018, 12:33 AM)RMOrion Wrote: I'm thinking I may need a new pulmonary doctor.  And as I answered to Walla Walla, I'm wondering if I had just paid for the Bipap machine outright, would it have avoided this whole issue?  And why didn't he use my original study?....maybe you're right....$$$

Will post again after I sort out a few things, thanks!

I think this is the crux of the matter.  Your doctor is apathetic to your best care. In particular, this one should not be managing your sleep therapy.  PF is a progressive disease that results in increasing pulmonary resistance. Patients often need ventilation assistance as the disease progresses, regardless of apnea.  There are more reasons to prescribe BPAP than simple sleep apnea.  If you cannot adequately ventilate your lungs during sleep, bilevel pressure or even noninvasive ventilation can make a great change in life quality and comfort.  Apnea may or may not be an issue for you, but it should not be the only focus.  The way you feel without ventilation support is probably related to your PF and may be affected by obstructive apnea as well. 

A home sleep test may not measure important criteria like tidal volume, minute vent and respiratory rate other than pauses.  If your minute vent rate is impaired, it is very difficult to measure hypopnea, although anomalies should show up in an SpO2 graph. We would have to see the study to determine what was monitored.  I'm just offering that you may have good cause to change your sleep apnea/ventilation needs to a different physician, and considering your chronic condition and apathy of your pulmonary specialist, I would be surprised to see you continue with this individual.  Consider your potential needs beyond the need for treatment for obstructive sleep apnea, and the bilevel becomes justified over mere CPAP.

Let me emphasize that CPAP is prescribed for OSA, but the complication of PF is sufficient comorbidity to justify Medicare authorization for BiPAP. Someone on your health care team is really letting you down and not looking at your "big picture" health.
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RE: BiPap taken away/Medicare rules
(03-17-2018, 12:33 AM)RMOrion Wrote: ...
  And as I answered to Walla Walla, I'm wondering if I had just paid for the Bipap machine outright, would it have avoided this whole issue?

"I know nothink!" -- Sgt Schultz (Hogan's Heroes)

Having established that, my oh-so-humble Dielaughing opinion is that it wouldn't have had the best outcome should you have just bought the {blank} machine. You need a proper test, and as Sleeprider has pointed out, someone on your health care team is really letting you down and not looking out for your best interests. Frankly, it seems to me that both the medical practitioner and the DME technicians/salesmen have abused you.

I really, really have no education, experience, or training that would enable or permit me to offer any advice. I will share with you that I would handle a set of circumstances like yours by seeking some advice from a professional who could advise how to resolve the issue(s) with your medical practitioner(s) and how to resolve the charges of the DME. And I will comment that time is of the essence.

I join the other folk in wishing you the best in this tribulation.
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RE: BiPap taken away/Medicare rules
IMO you need another doctor. This Duck/quack is only in it for money. As others stated, get hard copies of any and all full, not summary, sleep studies and prescriptions. If you have that, get the machine yourself if you want. If it were me, I'd still vehemently state to the doctor and the DME to get with it and fix the delinquent balance that the doctor caused by failing to handle the paperwork properly. And call the insurance as well to see if they have suggestions on both the previous and current situation. I did this stuff myself, advocating for me to get my ASV machine. Believe it or not, the insurance was the good guy of the 3 I was dealing with. Best to success.

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience and researched info regarding CPAP therapy and should not be considered medically professional directions or advice.

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RE: BiPap taken away/Medicare rules
Hi RMOrion,
WELCOME BACK! to the forum.!
I am sorry you have been through such a run around.
Hopefully, you are able to switch to a dock that is more attentive to your needs and that you can get another bi-level machine like what you had.
Keep up posted on how things go for you.
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