Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

BiPap vs Auto Cpap
#1
BiPap vs Auto Cpap
I have used a bipap for 12 years set at 6/3 after my sleep study back then. I have polio so I was told it works like a respirator for me at night and sometimes during the day.
Got a new home sleep study done in Jan 2019 and my insurance approved me to have a new machine, mine is 12 years old.  The study said I needed adjustments from 5 to 15.
The insurance approved a Dreamstation  DSX 500 H11C which the company says is an auto cpap, but I have tried it for a week and wake up more tired than when I went to bed. I am also bloated and have pains in my ribs.  My doctor sent a report to say I needed a bipap but he is a gp, not a sleep specialist and I got told I had to use the one the insurance approved.  I gave up on the new one after a week and went back to my old machine because I was waking up with 88, 89 PO on my pulse ox.
Is there a way for me to prove to the insurance company what I need, I was told if I don't use it for 3 months I have to pay the full amount for the machine.
Sorry for such a long first post.
Megan
Post Reply Post Reply



Donate to Apnea Board  
#2
RE: BiPap vs Auto Cpap
Megan, welcome to Apnea Board. Your long post will be shorter than my response. As a user of bilevel therapy, with the comorbidity of childhood polio, it should be very easy to be approved for bilevel. Insurance usually follows Medicare guidelines for approval of a bilevel machine.  Section 60-9 of the Medicare Coverage Issues Manual provides that ventilators are "covered for treatment of neuromuscular diseases, thoracic restrictive diseases, and chronic respiratory failure consequent to chronic obstructive pulmonary disease. This includes both positive and negative pressure types." There are no national coverage guidelines on RADs specifying criteria for meeting the conditions for its intended use.

The criteria for upgrading from CPAP to bilevel is simply the doctor's statement of medical necessity, which in your case is very easy. Your intolerance of CPAP vs BiPAP, as demonstrated by your results and need to return to your old machine, is further evidence of medical necessity.  The simple explanation is that bilevel positive air pressure unloads some of the respiratory effort from you to the machine. Your inability to sustain a good minute vent and tidal volume is sleep is directly related to your medical history, and this history qualifies you for coverage of bilevel therapy, absolutely no question about it. Your doctor merely needs to form an opinion of medical necessity based on what he knows about your and your medical history. This is supplemented by your poor response to CPAP, and the known efficacy of your previous bilevel therapy.

The CPAP machine you were prescribed is the worst choice. Had you been provided a Resmed Airsense 10 Autoset, you could have had at least 3-cm of pressure support. The Resmed machines provide exhale pressure relief that works like bilevel with up to 3-cm pressure difference between IPAP and EPAP.  You could have had the Airsense 10 Autoset provided with a minimum pressure of 7.0, maximum pressure of 15.0, and EPR at a setting of 3.  This would have offered a range of 7.0/4.0 to 15.0/12.0 in true bilevel delivery.  Of course the Aircurve 10 Vauto offers even more pressure support to treat your neuomuscular respiratory deficiency.  I think you will need to be persistent and try to get the Resmed Aircurve 10 Vauto bilevel machine.  If you have relatively high deductibles or things get ridiculous, just have your doctor prescribe it, and you can get one relatively inexpensively (about $750) from Supplier #2.

You can discuss this with your GP and use these linked resources to understand how insurance approves these devices (Respiratory Assist Device (RAD) with or without a backup rate).
https://www.resmed.com/us/dam/documents/...elines.pdf
https://www.cms.gov/medicare-coverage-da...AAEAAA&
https://www.cgsmedicare.com/jc/mr/pdf/mr..._e0471.pdf
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#3
RE: BiPap vs Auto Cpap
Thank you so much for your help, I will be contacting the insurance again today.
Post Reply Post Reply
#4
RE: BiPap vs Auto Cpap
It is important to emphasize you don't have conventional obstructive sleep apnea, but neuromuscular hypoventilation. You may have some obstruction as well but you seem to have been successful at low pressures. Again, it is the pressure support (difference between inhale and exhale pressure) that makes it easier for you to breathe and remain oxygenated. The alternative might be supplemental oxygen delivered from an oxygen generator. It's not a bargain for your insurance company to deny bilevel.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply



Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Auto bipap? Haroldsdrifting 7 179 Yesterday, 07:34 AM
Last Post: jaswilliams
  Best portable Auto CPAP machine? stevewerth 12 915 08-19-2019, 10:27 PM
Last Post: stevewerth
  First 2 weeks of BiPap, looking to dial it in AFAIK 6 164 08-14-2019, 10:01 PM
Last Post: Dormeo
  Auto CPAP makes a big difference? SunHu 13 394 08-14-2019, 03:54 AM
Last Post: SunHu
  [Equipment] Is there an Auto CPAP machine that does NOT light up at all? willo 24 1,173 08-12-2019, 12:59 AM
Last Post: Hydrangea
  Regarding settings on a replacement bipap?? RosieB08 32 544 08-05-2019, 07:41 PM
Last Post: RosieB08
  6 weeks in on bipap, still centrals, still sleepy bemused 20 834 07-31-2019, 12:42 AM
Last Post: jaswilliams


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.