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[Equipment] New DME, New Machine - Respironics 640 ??
#11
Just remember, MAPnea, that even if they drive 70 miles to get to you, do not accept anything other than the machine you want. If you feel guilty about them wasting their time you can offer to pay for their gas. Once you accept delivery of a machine that possession is nine-tenths of the law thing applies and you are stuck!
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
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#12
(07-04-2014, 02:02 PM)robysue Wrote:
  • Model 460: The System One Series 60 CPAP Pro with C-Flex+. This is a full efficacy data fixed pressure CPAP machine.
  • Model 560: The System One Series 60 CPAP Auto with A-Flex. This is the APAP in the PR lineup. It is a full efficacy data machine.

If your script is for a CPAP, my guess is that you have a dyslexic DME clerk who misread "model 460" as "model 640"

Hi MAPnea,

I think you do need to be much more assertive here.

I recommend you do not let anyone make an appointment to drive over to you until your doctor has changed the prescription to an APAP pressure range and after you KNOW exactly what machine will be delivered and you are happy with the type of machine. For example, the PRS1 Model 560 RemSTAR Auto, and make sure the prescription includes heated hose.

BUT: If you use EPR, how much EPR do you use on your present ResMed AutoSet?

The PRS1 models do not have EPR, they have Flex (which can be turned off). And Flex FEELS very much different than EPR, because Flex pressure relief ends about half way through the exhalation period and (if you are used to EPR instead of Flex) feels like the machine is rushing you to inhale again before you are finished breathing out.

Flex drove me crazy during a titration study; I positively hated it because I was used to EPR instead of Flex. I asked the sleep technician to turn Flex pressure relief completely off, but she claimed she couldn't. She was a student and I think she simply did not know how. (Imagine, insurance paying thousands of dollars for a titration which is performed by an incompetent student!)

I think you can probably get used to Flex instead of EPR, but it may take a few days or weeks.

ONE OPTION IS to ask the doctor to prescribe a ResMed S9 AutoSet and heated hose and to ask him to write "Dispense as written" and ask him to specify a RANGE of pressure instead of one fixed pressure.

Take care,
-- Vaughn



Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#13
I must strongly second all the good advice you've gotten here. You MUST INSIST that the DME provide you both what meets your doctor's requirements AND what you can live with successfully in the long term. The first point is legally stronger, the second is what matters most.

Call the DME today and leave a message, send an email, etc. If they drive 140 miles round trip but can't fill your Rx correctly even after you and your doctor (and your friends on ApneaBoard) have tried to keep them straight... you may still be generous enough to give them common courtesy - but offer them not one penny for fuel! When the issues are 100% their fault - "courtesy" does not extend to taking any blame away from them. (*not until you are fully and properly provided for by them - and only then you can be "apologetic" as you wish to be - as long as you keep all the therapeutic devices you needed in the first place. Smile )

Does your new sleep doctor believe a PRS1 460 (a NON-auto machine) will work as well for you as your current ResMed S9 Auto? It isn't clear to me (which doesn't matter) but it needs to be crystal clear for you. As long as you and your new sleep doctor are on the same page, it sounds like you'll do fine - as long as the DME does right by you!

I wasn't nearly assertive enough in my first 4 years of apnea treatment - and am paying a price for it now - I don't want the same to happen to you.

P.S. I envy your night skies. Enjoy!
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#14
(07-04-2014, 09:42 PM)Sleepster Wrote: Just remember, MAPnea, that even if they drive 70 miles to get to you, do not accept anything other than the machine you want. If you feel guilty about them wasting their time you can offer to pay for their gas. Once you accept delivery of a machine that possession is nine-tenths of the law thing applies and you are stuck!

Good advice, Sleepster, thanks. I am determined to have a good talk with my sleep doctor before I make any appointment with the DME for delivery. I can't wait for Monday when everyone will be (?) back in the sleep clinic.
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#15
(07-05-2014, 01:41 AM)vsheline Wrote: BUT: If you use EPR, how much EPR do you use on your present ResMed AutoSet?

The PRS1 models do not have EPR, they have Flex (which can be turned off). And Flex FEELS very much different than EPR, because Flex pressure relief ends about half way through the exhalation period and (if you are used to EPR instead of Flex) feels like the machine is rushing you to inhale again before you are finished breathing out.

Flex drove me crazy during a titration study; I positively hated it because I was used to EPR instead of Flex. I asked the sleep technician to turn Flex pressure relief completely off, but she claimed she couldn't. She was a student and I think she simply did not know how. (Imagine, insurance paying thousands of dollars for a titration which is performed by an incompetent student!)

I think you can probably get used to Flex instead of EPR, but it may take a few days or weeks.

ONE OPTION IS to ask the doctor to prescribe a ResMed S9 AutoSet and heated hose and to ask him to write "Dispense as written" and ask him to specify a RANGE of pressure instead of one fixed pressure.

Take care,
-- Vaughn

Hi, Vaughn,
I do remember that my sleep doctor was interested in trying a "fixed pressure" during my titration study. I also heard her say something to the technician who was in the room with us that a "BiPap" might be in order, but she'd know more after my titration study. She mentioned that I seemed to be de-saturating the most during REM sleep. I use an oxygen concentrator at night to keep my O2 levels above 88% and she said if that was the case (de-saturating during REM sleep), then, maybe, a fixed pressure would eliminate the need for O2? I put a question mark there because I'm not certain if I made this part up. After half an hour with her, I'm starting to wonder what I thought I "heard" as opposed to what she actually said.

Anyway, just as I was waking up from the sleep study (after eight hours of sleep - interrupted only once when the technician came in to reposition my mask) I felt as though the machine was "forcing" air down my throat. I felt like I was gulping air and "choking". I tried (in my state of being partially awake/mostly asleep) to cough, but that made the "air pressure" seem worse, so I … woke up. Do you think this might be the "flex" instead of EPR (which is set at "2" on my ResMedS9)? That might be somewhat uncomfortable - just as you said.

I really want to understand what is being prescribed for me and the reasons why this will be better for me than what I already have (that Medicare won't pay for, so I need to give it back to the first totally incompetent DME). This was my first titration study and I can't wait to understand what they found and why I'm being given a different make/model of PAP machine.

Thanks for "waking me up"!
Margaret
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#16
(07-05-2014, 11:33 AM)APAAW Wrote: Does your new sleep doctor believe a PRS1 460 (a NON-auto machine) will work as well for you as your current ResMed S9 Auto? It isn't clear to me (which doesn't matter) but it needs to be crystal clear for you. As long as you and your new sleep doctor are on the same page, it sounds like you'll do fine - as long as the DME does right by you!

I wasn't nearly assertive enough in my first 4 years of apnea treatment - and am paying a price for it now - I don't want the same to happen to you.

P.S. I envy your night skies. Enjoy!

Hi, APAAW,

I'll find out next week (Monday, I hope) what my new sleep doctor has prescribed. I'll also find out why this will be more helpful than the ResMed S9. As you said, she and I have to be on the same page - totally.

I don't want to go through another 19 months battling with Medicare, a highly incompetent DME and dealing with a treatment plan based on a sleep study where I never slept …. I'm getting a new start and I plan to be a bit more ALERT and assertive this time around.

THANKS to YOU … and all the others who have opened my eyes!!

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#17
(07-05-2014, 05:48 PM)MAPnea Wrote:
(07-05-2014, 01:41 AM)vsheline Wrote: Flex drove me crazy during a titration study; I positively hated it because I was used to EPR instead of Flex.

... just as I was waking up from the sleep study (after eight hours of sleep - interrupted only once when the technician came in to reposition my mask) I felt as though the machine was "forcing" air down my throat. I felt like I was gulping air and "choking". I tried (in my state of being partially awake/mostly asleep) to cough, but that made the "air pressure" seem worse, so I … woke up. Do you think this might be the "flex" instead of EPR (which is set at "2" on my ResMedS9)? That might be somewhat uncomfortable - just as you said.

If you have become used to EPR of 2, if you are no longer able to use it because you change to a PRS1 machine, I think you will miss it a lot for the first days or weeks.

Hard to say why the pressure felt high and woke you up during your titration study. Perhaps it was merely that the mask started leaking after the pressure had been adjusted high, so the technician left the pressure on a high setting and came in to adjust the mask until it would no longer be leaking at that pressure. Maybe nothing to do with EPR or Flex.

Why does the doctor think it would matter at all to Medicare whether your new machine will be an S9 AutoSet versus a different brand or model?

I do not see why it would matter to Medicare whether the machine is same brand and model (ResMed S9 AutoSet) or a different band and model like the PRS1 460 Pro (fixed pressure only) or the PRS1 560 Auto (which, like the AutoSet, can be operated as either fixed-pressure or APAP). All three of these machines (and many others) have the exact same billing code for Medicare billing purposes and cost Medicare the exact same amount. So why not ask the doctor to prescribe an S9 AutoSet, which you are already comfortable using?

If the doctor wants you on a fixed-pressure prescription (for example 11.0), ask him to give you instead an APAP prescription with a very narrow range, (for example 10.6 to 11.0), because this will guarantee you will get an APAP machine like the AutoSet or PRS1 560 Auto, which will be two machines in one, and can be operated in fixed pressure mode or in APAP mode.

Plus, having an APAP machine would give your doctor (and you) more treatment options and greater data gathering abilities, since he would be able to change it to APAP mode for a week any time he (or you) might want to recheck your fixed-pressure prescription.

--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#18
(07-05-2014, 05:48 PM)MAPnea Wrote: I felt as though the machine was "forcing" air down my throat. I felt like I was gulping air and "choking".

Mention that to the doctor as it may be convincing evidence for a prescription for a bilevel machine. Ask for the Respironics BiPAP Auto (Model 760) or the the ResMed S9 VPAP Auto.

These machines will make it easier for you to tolerate the pressure and they will respond to flow limitations by increasing the pressure.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
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#19
(07-05-2014, 07:48 PM)Sleepster Wrote:
(07-05-2014, 05:48 PM)MAPnea Wrote: I felt as though the machine was "forcing" air down my throat. I felt like I was gulping air and "choking".

Mention that to the doctor as it may be convincing evidence for a prescription for a bilevel machine. Ask for the Respironics BiPAP Auto (Model 760) or the the ResMed S9 VPAP Auto.

These machines will make it easier for you to tolerate the pressure and they will respond to flow limitations by increasing the pressure.

Probably wouldn't hurt to try, but I think a new bi-level titration would be needed before a bi-level machine could be covered by Medicare.

And I think Medicare would not authorize a new bi-level titration unless MApnea had first tried the new CPAP/APAP class machine and was complaining about the pressure with the new machine.


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#20
Sleepster and vsheline,

I'm going to print out your comments - actually, everyone's comments - and highlight some areas to "study" before I talk with my new sleep doctor tomorrow or Tuesday … or whenever she gets back to the clinic after this long holiday weekend. You've been so supportive, helpful and encouraging.

I'll report back as soon as I hear from her.

Margaret
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