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Denied an APAP
#1
So, at my 30 - 91 day follow up with my Doctor (GP, not sleep Dr) for compliance/insurance reasons she agreed with my suggestions that I upgrade to an Auto CPAP for better data collection and tracking etc. And wrote a prescription accordingly. However, she wasn't comfortable setting a pressure range since it's not her area of specialty. When I got the DME, the Respiratory Nurse said she can't set a range with out a prescription (reasonable), but that she didn't understand why I wanted an auto CPAP since most people aren't using them full time, just for a 30 day trial. Also, since they cost more, I might not be able to upgrade form my (now used) CPAP to a new Auto CPAP.

Soo... I'm not sure where to go now. I'm still in the compliance phase and trying to make sure I get my 4 hrs a night, so I guess I'll stick with the brick CPAP for now? Should I get a referral to a sleep Dr? How often do you see them?
------------
Allynpsych --- Psychology Professor, wife, and mother of a 4-yr old... in need of a good night's sleep. Dreaming
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#2
Well, every DME and Insurance company is different. I ask the sleep doctor to write a script for a ResMed AirSence 10 Elite so I would have data collection and he had said I did not need APAP. The DME told me they only carried the CPAP (Brick) and Autoset, so they filled the script with the Autoset, and set it to CPAP mode.

You could ask your doctor (gp) to write the script for the specific model you want (ResMed AirSence 10 Autoset) by name/model and then specify that it be set in CPAP mode with a fixed pressure. That "should" get your DME off the hook and allow the doctor to specify a fix pressure for you.
I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
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#3
Any chance you can swap the brick out for an Airsense Elite on the grounds that your doc wants the extra data?

While the Elite is not an APAP, it does record all the same data that the AutoSet does. And with that you can still self titrate, although the process is slower.
Questions about SleepyHead?
See my Guide to SleepyHead
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#4
(04-25-2016, 12:21 PM)allynpsych Wrote: So, at my 30 - 91 day follow up with my Doctor (GP, not sleep Dr) for compliance/insurance reasons she agreed with my suggestions that I upgrade to an Auto CPAP for better data collection and tracking etc. And wrote a prescription accordingly. However, she wasn't comfortable setting a pressure range since it's not her area of specialty. When I got the DME, the Respiratory Nurse said she can't set a range with out a prescription (reasonable), but that she didn't understand why I wanted an auto CPAP since most people aren't using them full time, just for a 30 day trial. Also, since they cost more, I might not be able to upgrade form my (now used) CPAP to a new Auto CPAP.

Soo... I'm not sure where to go now. I'm still in the compliance phase and trying to make sure I get my 4 hrs a night, so I guess I'll stick with the brick CPAP for now? Should I get a referral to a sleep Dr? How often do you see them?

That is such typical DME crap. This just isn't true, lots of people use APAP. I for one have mine set for auto and I like it that way. Some like to use auto to find a suitable pressure then go into CPAP mode at that fixed pressure. If your doctor isn't comfortable setting pressure then an APAP is what you need as she can leave it set to default which is usually 4-20 and let the machine figure out what is correct. I like the auto machines and they have advantages that a fixed machine doesn't so keep pushing for it.
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#5
Tell your Doctor that setting the machine for pressure 4-20 lets the machine auto titrate and find the correct pressure for you, this is what the auto means. Your Doctor should be okay with that.

Your DME will provide you with what ever your Doctor tells them to and if not call your insurance and tell them that your DME will not fill your doctors prescription. This will get them moving.

A "brick" costs the DME less and they bill insurance the same so more profit for them and not having to deal with a returned machine. This is not your problem, get what you want.
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#6
My prescription was for CPAP, but it was not difficult to convince the DME technician that an APAP machine, even if initially programed for a single pressure, was a better choice in my case. The first machine she pulled out of the store-room was for a CPAP/BiPap machine which I immediately said was not appropriate. If I am going to have features I am not using right now, I would rather have features I *might* use someday, rather than ones I would not. And since my apneas are clearly REM-related (I showed her the oximetry studies I had run myself with a CMS50D), it was quite likely that APAP would be in my future, and I would rather have that machine.

Sleep studies, and the doctor's initial prescription are not based on the pattern of your apenas over the night - they are based on averages and other statistics. *I* look at the graphs first. Doctors do not have time for this.

The technician agreed with my point and went back to the store-room and found they did have the APAP equivalent in stock.

I did also verify that the Resmed A10 wireless reporting feature goes back to the DME technician, not to the doctor. The doctor can request a copy, if he wants.

On my way out the door, the technician told me that she thought everybody should get APAP machines to start with, not single-pressure CPAP machines, for exactly the reasons I had outlined.
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#7
Will the DME give you the APAP machine without setting a pressure range for you?

If they can do that legally, that would work fine, wouldn't it?

I'm finding it difficult to feel much sympathy for them since they gave you a CPAP machine with no data reporting capabilities.




(04-25-2016, 12:21 PM)allynpsych Wrote: So, at my 30 - 91 day follow up with my Doctor (GP, not sleep Dr) for compliance/insurance reasons she agreed with my suggestions that I upgrade to an Auto CPAP for better data collection and tracking etc. And wrote a prescription accordingly. However, she wasn't comfortable setting a pressure range since it's not her area of specialty. When I got the DME, the Respiratory Nurse said she can't set a range with out a prescription (reasonable), but that she didn't understand why I wanted an auto CPAP since most people aren't using them full time, just for a 30 day trial. Also, since they cost more, I might not be able to upgrade form my (now used) CPAP to a new Auto CPAP.

Soo... I'm not sure where to go now. I'm still in the compliance phase and trying to make sure I get my 4 hrs a night, so I guess I'll stick with the brick CPAP for now? Should I get a referral to a sleep Dr? How often do you see them?

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#8
allynpsych,
You don't really need a sleep doctor, any doctor can write a script. Just call you doc and say you understand she is not comfortable setting a pressure range, but your DME won't give you an APAP without a pressure range on the script. Ask her just to write 4 minimum and 20 max (4-20).
That is the default setting. The DME will then have no choice but to give you what you are asking for. We can help you with settings later.

This is the reasoning with the DME: Insurance pays them the same whether you have a straight Cpap or an APAP, so they make a bigger profit by talking you out of an APAP
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#9
Do what you have to do to get that data capable APAP machine. There is plenty of help here to adjust the settings if need be.

Rich
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#10
(04-25-2016, 02:20 PM)Sn00zeAlarm Wrote: My prescription was for CPAP, but it was not difficult to convince the DME technician that an APAP machine, even if initially programed for a single pressure, was a better choice in my case. The first machine she pulled out of the store-room was for a CPAP/BiPap machine which I immediately said was not appropriate. If I am going to have features I am not using right now, I would rather have features I *might* use someday, rather than ones I would not. And since my apneas are clearly REM-related (I showed her the oximetry studies I had run myself with a CMS50D), it was quite likely that APAP would be in my future, and I would rather have that machine.

Sleep studies, and the doctor's initial prescription are not based on the pattern of your apenas over the night - they are based on averages and other statistics. *I* look at the graphs first. Doctors do not have time for this.

The technician agreed with my point and went back to the store-room and found they did have the APAP equivalent in stock.

I did also verify that the Resmed A10 wireless reporting feature goes back to the DME technician, not to the doctor. The doctor can request a copy, if he wants.

On my way out the door, the technician told me that she thought everybody should get APAP machines to start with, not single-pressure CPAP machines, for exactly the reasons I had outlined.

+1

There is NO reason for you not to have the machine you want......and I would not accept anything less.
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