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Looking for some advice (RE: my mother)
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Tachyon Offline

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Machine: Philips Respironics System One BiPAP with Humidifier
Mask Type: Full face mask
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CPAP Pressure: 16IPAP 8 EPAP
CPAP Software: Not using software

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Sex: Male
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Post: #1
Looking for some advice (RE: my mother)
Hello, first off let me apologize, I am completely new to the subject of sleep apnea. This question is actually in regards to my mother (apnea patient). I have been a care giver for her for nearly 14 years now. She has been in and out of the hospital lately and we are in the process of trying to get her a BIPAP as a DME. Her last sleep study was approximately 15 years ago, during that time she was diagnosed with sleep apnea, OSA and COPD, although she has never been a smoker. (apnea incidents 120+). She was started on CPAP, which she used for awhile. Since then she was hospitalized (about 2 years ago) as her c02 levels were elevated (68+). The Pulminologist there felt that the CPAP was just not effective at keeping her airways open. And has been using BIPAP therapy in the hospital since. We are unable to get her to a current sleep study due to her mobility (she only travels by ambulance on a gurney. As this is not considered "emergency transportation" medicare will not cover the cost. The ambulance company quoted us something in the range of $6,000 for the round trip, with no payment arrangement. Unfortunately we just do not have that kind of disposable income. I also arranged for a home sleep study, but they felt that due to the constant need for O2 (15LPM) that they could not complete the study due to their probe not working in conjuction with the oxygen. Sorry for the long narrative. Now the question that I have is with the sleep study and diagnoses that she has received as well all of the documentation from the hospital (doctors orders for the BIPAP, Pre and Post ABG tests.) She technically meets the criteria for a BIPAP through Medicare. Co2 levels elevated above 52, she desaturates below 88% on 2LPM and has diagnosis of Sleep Apnea and OSA with recent documentation showing that the CPAP did not provide enough pressure in order to be beneficial. Everything except a "Recent Study" now as we are not trying to have medicare pay for the unit, my goal being to purchase it as Durable Medical Equipment. Does she "Need" a current sleep study or could her doctor prescribe the unit based on all of the documentation, since we are not purchasing it through medicare? Any advice would be Incredible and Very Helpful, as I am stuck, she is terminal and I am just trying to help her out and hopefully keep her around a little longer. Thanks in advance guys. Oops almost forgot, I realize that she obviously needs an RX from a Physician, just not sure if the sleep study is necessary in order to receive the Rx. ;o)
(This post was last modified: 12-16-2014 09:09 AM by Tachyon.)
12-16-2014 09:08 AM
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Crimson Nape Offline

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Joined: Oct 2014

Machine: ResMed S9 Autoset
Mask Type: Other
Mask Make & Model: P-10 / F&P Simplus / DreamWear
Humidifier: H5i w/Climateline
CPAP Pressure: 8 - EPR 3
CPAP Software: SleepyHead

Other Comments: CMS-50F & 50IW

Sex: Male
Location: Georgia

Post: #2
RE: Looking for some advice.
Welcome to the board!

From what I understand any medical doctor or dentist can prescribe a CPAP/BIPAP/ASV and accessories. Ask your mother's PCP for one. If your mother is terminal, you might inquire at your local DME about renting a unit instead of buying one. Also, there is a website that deals in used/refurbished xPAPs. I beklieve its name is SecondWindCPAP, they are Supplier #2 on the supplier list..

Good Luck and I wish you and your mother the best!

Statistics prove that people who have more birthdays live longer.
(This post was last modified: 12-16-2014 10:09 AM by Crimson Nape.)
12-16-2014 09:49 AM
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me50 Offline

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Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Sex: Undisclosed
Location: USA

Post: #3
RE: Looking for some advice.
If you are paying for it out of your pocket, then it is doubtful that medicare will care about any details regarding the need for which type of machine and that you wouldn't need their approval, etc. for a sleep study IF medicare isn't going to be billed for the machine.

If medicare would pay for it, especially when someone has a fixed income, I would let them do it unless you can buy one for less than it would cost you through medicare.

That being said, I don't know what medicare would do about a sleep study requirement. Is there not a sleep study facility in the hospital where she is right now? It might be possible that with all the documentation that you have, if the doctor can write the letter to Medicare's satisfaction, that they may not require a sleep new sleep study.

I am a little confused about why the CPAP isn't working (other than it may be an older machine and the newer ones have been improved a lot) because the pressure of a cpap goes up to 20 and a bipap goes up to 25 I believe. But, hey, I am not a doc and there is a lot that I wouldn't understand or know to ask you, especially with COPD and other issues involved. INsurance, medicare, etc., can be pretty "heartless" in my opinion, when a patient is terminal. They could come back and say that CPAP, BIPAP, etc. isn't necessary for a terminal person. Sad but true.

I really don't know what to suggest other than to have the doc write a letter to medicare IF you want medicare to pay for the machine. Otherwise, if you plan on paying for it out of your pocket, then I don't think it matters what medicare would require. So, if the doc will prescribe the machine and the supplies to go with it, then you shouldn't have a problem getting it from a DME. Just remember, BIPAP's are more expensive than CPAP. Check out the supplier list on this forum to see what prices they are.

Much success in all of this.
12-16-2014 10:01 AM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
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CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

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Sex: Male
Location: Калифорния

Post: #4
RE: Looking for some advice.
Bilevel is used in COPD to permit a great expiratory relief. By lowering EPAP pressure, more CO2 can be expelled.
Get an Rx from any doctor. I got my bilevel from Supplier #2 as an open box special.
(See supplier list at top of page.)
You need the IPAP, and EPAP pressures found best for her at the hospital.

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.
12-16-2014 12:50 PM
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archangle Offline
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Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #5
RE: Looking for some advice.
Find out if any of the local hospitals have a sleep lab in the building. Then, if she goes into the hospital again, maybe you can get a sleep test at that time.

Not a good solution, but might work.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
12-16-2014 01:20 PM
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PaulaO2 Offline
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Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #6
RE: Looking for some advice.
It would be easy to have the doc write a new script for a new machine then see if Medicare would pay for it. They should since she is using one and has been forever. There will be a form called "medical necessity" that the doc would then have to fill out prior to them paying for it and that is where he/she would put the information.

I don't see why Medicare won't pay for it. But then, they like to demand an expensive test be done before they pay for something half the cost of the test.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
12-16-2014 02:08 PM
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trish6hundred Offline

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Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #7
RE: Looking for some advice.
Hi Tachyon,
WELCOME! to the forum.!
Your mother is very lucky to have you as her caregiver.
Hopefully, you can get her the machine she needs.
Hang in there for more suggestions and best of luck to both of you.

trish6hundred
12-16-2014 03:55 PM
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3porpoise Offline

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Machine: S9 VPAP Adapt ASV
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CPAP Software: ResScan

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Post: #8
RE: Looking for some advice.
Hi Tachyon,

Resmed appears to have a Vpap Copd for this condition , you can read about it on their website.
All the best.
3
12-16-2014 09:32 PM
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Ghost1958 Offline

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Machine: PRS1 Series Sixty Auto Aflex
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CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #9
RE: Looking for some advice.
As several of the folks I have spoken to at my Medicare health care plan have repeatedly stated. " A DOCTOR can get Medicare to pay for anything IF they will go to the mat and show a medical necessity, regardless of Medicares one size fits all guidelines."

The trouble is finding a Doctor willing to "go to the mat" document, appeal and fight for a patient beyond writing a script and a couple emails.

IF you can find a Doc willing to do that he CAN get her a Bipap covered. And her rides in an ambulance also if he will again go to the mat and prove that is the only medically safe way for her to travel. Finding that Doc is tall order these days.
12-16-2014 10:01 PM
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Peter_C Offline

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Machine: System One DS960HS
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CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #10
RE: Looking for some advice.
I do not know what country you are in, but in the US, *any* doctor can write a script for a CPAP, or bi-PAP/bi-level machine.

I do wish to clear up one point in your post? Are you talking about buying it out-of-pocket, or getting Medicare to pay for it? The reason why I am asking, if Medicare is to pay for it, a script is not enough, as they will demand a 'titration' done to prove that a bi-level will be effective, and I simply do not know if the hospital info will be good enough?

When I got on Medicare, they would not buy my bi-level even though my last machine was a bi-level and I had a script from my sleep doc - they demanded a *new* titration first.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
12-17-2014 07:36 AM
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