(12-24-2015, 12:43 AM)jeryray Wrote: About 6 weeks ago my system 1 bipap had a power problem inside. This machine came from Cigna through Apria Health. I have been using a Bipap for 10 years.
I am on Medicare now. My doctor wrote a prescription for a new machine and medicare had me do another sleep study (no mask or machine). After the study my throat was sore for 2 days, felt like strep. Guess I was choking on my tongue. Now Medicare wants another sleep study so they go cheap and give a cpap.
After 7 weeks with no machine I purchased my own Respironics DreamStation BiPAP Auto with Heated Humidifier. This set to auto and my avg ahi is 1.9. So it does work for me.
I don't know if I should do another study if they are going to force a cpap instead of a bipap.
PS I will have to pay for my own supplies since I bought my own machine.
I suggest you should have the titration. I assume you have already asked for your doctor to appeal for the titration to be changed to a bilevel titration, without success. No matter.
If you are given an APAP or a fixed-pressure CPAP machine as result of the titration, try it out. You could try it for at least an hour or so each night for a week. If you find you cannot tolerate it, just return it to the DME and let them and your doctor know you were unable to tolerate it. And ask the doctor to apply for preauthorization for a bilevel titration. I'm pretty sure it will be granted.
Or, if you find you can tolerate it but are still having the same issues which caused you to need the bilevel machine earlier, then work with the doctor to have the machine upgraded to a bilevel.
Maybe U.S. Medicare needs to hold the lid on expenses by seeing if patients can achieve compliance and an RDI less than 5 while using a standard CPAP or APAP machine. (Medicare pays the DME the same amount for a fixed-pressure CPAP as for an APAP machine, and I think it is up to the patient to request the doctor to write the prescription for the APAP machine they want. I think patents would have most chance of success with an APAP.)
But when patients are unable to be compliant because of the exhale pressure or whatever, or unable to achieve an adequate RDI, Medicare will want to provide a bilevel if needed.
In addition to getting another bilevel machine if needed, this will likely save you a ton of money over the long haul, as otherwise large out-of-pocket costs for masks and supplies would add up over time.