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[Equipment] Doc won't prescribe the CPAP I want
#1
Question 
I'm a newbie and need some advise/guidance. I had a sleep test but haven't started therapy yet. My doc has prescribed a ResMed AirSense 10 CPAP from a local DME supplier. I said I want to get the AirSense 10 AutoSet (reasons below), but she rattled off some unrelated anecdotes and in so many words told me "no". My sleep test indicates that I have mild OSA; she is prescribing a start pressure of 4, increasing to a constant 6.
Reasons I want an autotitrating machine:
1) It can be set to CPAP mode (so the doc's prescription can be followed) and I can compare results to using it in APAP mode.
1a) After my sleep test I had a belly full of air. Doc said, "That happens." I suspect that the constant pressure during the test may be the cause and so want an APAP fall-back option.
2) I recently developed OSA, expect it to get worse over time, and don't want to go in for another sleep test - ever.
3) I want the option to analyze all data from the machine's SDD card; data is plentiful from the Airsense 10 AutoSet, but not so much (?) from the AirSense 10 CPAP.

I am covered by Federal BCBS, but am willing to skip insurance coverage and buy on-line, including paying for a home test kit and a new on-line prescription, just to get a device that suits me.

So, I ask you, Am I Nuts, or What? Huh And why does my doc not want me to have a device that provides options? Thinking-about
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#2
You're not nuts -- you're doing your research up front so you won't get stuck with a machine that doesn't afford you the data you want to keep your therapy on track. Good for you.

You don't need another sleep study. If you haven't already, get a copy of your prescription. And your sleep study. If you want to use your insurance, you might be able to get a more with-it doc to write you a new Rx specifying the Autoset with a range of pressures. Any of your doctors (even a dentist) can write a CPAP Rx. So can a nurse practitioner. They would probably want to see a copy of your sleep study report before writing a new Rx for you.

OR: If you prefer to private pay (bonus: skip all the insurance compliance hassles), you can use your current Rx with an online retailer and you shouldn't have a problem getting the Autoset. The thing is, prescriptions are written as billing codes. Whether it's straight CPAP or an APAP, the billing code is E0601. So a DME can certainly give you an APAP with your current Rx, though most won't because they make less profit when they supply an APAP -- insurance pays DMEs the same for CPAP and APAP. However, unlike most of the DME's that deal with insurance, the online suppliers are not motivated to give you the cheapest machine possible. Quite the opposite. I'm pretty sure that Supplier #1 on the Supplier list above will give you an Autoset with your current CPAP prescription as long as it specifies E0601. Give them or online supplier of your choice a quick call to confirm this.

So you have a couple of ways to go with this.

Why would the doc stubbornly refuse to write the Rx specifically for APAP? Some really don't know that much about machines and the differences among the various models. In some cases the doc has a relationship with the DME supplier (or is the DME supplier), so has the same $$$ motivation to issue the least expensive machine possible.

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#3
Welcome
Get the doc to write the Rx on paper for you.

Check out Supplier #2 (see list above) for their open box specials.
You can get the 10 series Autoset from them for $789 US.
FAX what your doc writes to #2 and ask if they'll accept it for the machine you wish.
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"Since this country was founded, each generation of Americans has been summoned to give testimony to its national loyalty. The graves of young Americans who answered the call to service surround the globe." JFK Jan 20, 1961
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#4
Hi grumbledore and welocome
Maybe the doctor doesn't have the balls to write the script for AutoSet but inform him that insurance only care about hours using the machine and pay the same money for a brick or AutoSet, same billing code 0E601

The doc need to brush up about the new machines capabilities, AirSense 10 CPAP is basic entry level machine and does not provide full data on the machine LCD sleep report or detailed data on the SD card like its cousin AirSense 10 Elite
Of course the AutoSet is preferable as can be used either CPAP or AutoSet modes (2 machines in 1)
If push comes to shove, AirSense 10 Elite is fixed pressure full data capable machine and is second best
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#5
Quote: she is prescribing a start pressure of 4, increasing to a constant 6.
Reasons I want an autotitrating machine:

That will be Ramp start at 4 and gradually climb to 6 after Ramp period end
6 is on the lower end of pressure scale, you can do quite well with fixed pressure machine but make sure its Elite model, not CPAP model
Not having Autoset is not the end of the world
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#6
Hi grumbledore,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you as you start your CPAP therapy and with getting the machine you really want.
trish6hundred
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#7
Hi grumbledore! I've just done lots of research into this very subject. I would like the autoset for similar reasons to you, but am not able to get one. However, the AirSense 10 Elite provides full data unlike the AirSense 10 CPAP which only gives you the hours used for compliance reasons. I will be getting an A 10 Elite model.

Good luck!
APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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#8
You are not nuts. I had a similar argument with my sleep doc... and in my case the data showed that after a several week trial of an autoset, my pressures ranged from 14 to 19, my 95th percentile pressure was 19, and the titration study came up with a result of 14.

I insisted on an APAP prescription, and paid out of pocket for the machine that *I* wanted. Up here in Canadia, that means I paid close to $2000 for the machine, mask, etc. I haven't regretted it for one second.
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#9
I'm with Chanlon.
Amazing to me that a lot of dr's still dont get it.
Sleep is *dynamic*, always changing.
That is where the autoset shines.
Later on in therapy some folks decide that a straight pressure works fine for them but
when you are just starting out, there is NO WAY you can know this.

Stick to your guns and MAKE them WORK for YOU!

Best of luck!

Smile
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#10
Go back and tell her to rewrite the script for an AutoSet machine. You will have this machine for 5-8 years and I think it's wasteful to buy old technology when the latest technology is only a couple of hundred more. In addition, the Autoset allows you to set it for 2 algorithms (3 if you get the Autoset For Her) to address future needs over the next 5 years. If she was buying a computer would she go with one that is based on 8 year old technology or what came out last year?

Before that appointment, make sure you have a copy of your sleep study and doctor's notes. I will tell you though, I know of 2 older men who went back to their doctor after talking to me and said they wanted an Auto machine because of my experience requiring higher pressure during the haze from the fires as well as allergies. One doctor was fine with that and rewrote prescription. The other did not recommend an auto machine for that patient because of blood pressure issues (someone else on this board mentioned that, although I can't recall who - or is it whom?).
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