Replies to This Discussion

Permalink Reply by claudette paluch on November 21, 2009 at 10:32pm

that is interesting and may be the situation i am facing because someone did say something similar to what you said when i was talking to the people i am dealing with re a new machine. thanks

99 said:

usually the auto is for setting up your pressures in the future as it is a kinda titration with the intention of giving you a cheaper machine latter with the pressures set

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Permalink Reply by claudette paluch on November 21, 2009 at 10:36pm

i agree Rock...the problem is that now i have a need to understand what machine possibilities exist for
my situation. I cant set the pressures but i feel that i would like a machine that would adjust for any
apneas or hypopneas that occur cause i still had some at the setting selected for me which was a fixed number.thanks

Rock Hinkle said:

An APAP is a CPAP with a floating pressure range based on a preset scale or range. The Auto VPAP 25 is a BiPAP unit. It has 2 different pressure settings. One for Inspiration (IPAP) and one for exhalation. I believe that it should be between you and your doc as to what machine or setting you use.

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Permalink Reply by RockRpsgt on November 22, 2009 at 4:19pm

It may be that your fixed pressure needs to be adjusted. Your pressure may need to be raised. You may want to go with an auto machine, but I would test all possibilities with your current one. What is your current AHI? Current pressure setting? The goal is to get your AHI<5. If you have already done this then your therapy is going well.
claudette paluch said:

i agree Rock...the problem is that now i have a need to understand what machine possibilities exist for
my situation. I cant set the pressures but i feel that i would like a machine that would adjust for any
apneas or hypopneas that occur cause i still had some at the setting selected for me which was a fixed number.thanks

Rock Hinkle said:

An APAP is a CPAP with a floating pressure range based on a preset scale or range. The Auto VPAP 25 is a BiPAP unit. It has 2 different pressure settings. One for Inspiration (IPAP) and one for exhalation. I believe that it should be between you and your doc as to what machine or setting you use.

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Permalink Reply by Judy on November 22, 2009 at 5:04pm

How long have you had your BiPAP Pro? Did insurance pay for it? Did Medicare pay for it? Who will be paying for a new bi-level for you, insurance or Medicare? And MOST IMPORTANT - WHO said "but then the question of insurance reimbursement raised its ugly head and i was told that i would not qualify for the new machine"???? The local DME provider? Did YOUR insurance tell YOU that? Beware local DME providers, some of them tend to be "less than truthful" - or blissfully and conveniently "ignorant".

In your case it could well be that your insurance reimbursement for a bi-level is low enough that your local DME provider stands to make more profit off of just continuing to provide your supplies than they will from providing you w/the Resmed VPAP Auto 25.

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Permalink Reply by claudette paluch on November 22, 2009 at 5:12pm

i think you are right Rock. i think i need further pressure adjustment. my last sleep study at the end of october showed that my respiratory disturbance index was 9.9 at a setting of 16/12....which is what my respironics is set at now.
so altho i have improvement its not at 5 or below....so i was wondering if the vpap 25 auto which i am using for a few weeks would give sufficient data to be able adjust the ipap on my respironics without having to repeat the sleep study....thanks.....

Rock Hinkle said:

It may be that your fixed pressure needs to be adjusted. Your pressure may need to be raised. You may want to go with an auto machine, but I would test all possibilities with your current one. What is your current AHI? Current pressure setting? The goal is to get your AHI<5. If you have already done this then your therapy is going well.
claudette paluch said:

i agree Rock...the problem is that now i have a need to understand what machine possibilities exist for
my situation. I cant set the pressures but i feel that i would like a machine that would adjust for any
apneas or hypopneas that occur cause i still had some at the setting selected for me which was a fixed number.thanks

Rock Hinkle said:

An APAP is a CPAP with a floating pressure range based on a preset scale or range. The Auto VPAP 25 is a BiPAP unit. It has 2 different pressure settings. One for Inspiration (IPAP) and one for exhalation. I believe that it should be between you and your doc as to what machine or setting you use.

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Permalink Reply by claudette paluch on November 22, 2009 at 5:20pm

hi judy...i have had the bipap pro over 7 1/2 years....i have to check.. i think medicare paid for it...but i have to check my paperwork to see if i rented the machine in which case i think the dme owns the machine or whether i purchased it in which case i own it....i checked the paperwork box back then stating that i wanted to purchase it but i think i submitted it too late so it may belong to the dme....and that question seems to be relevant somehow to medicare replacing it. the dme told me that i dont qualify for a new machine...i need to talk to the sleep md at my next appt about it....i am not sure who has the last word...the dme or the md re submitting a claim for me....thanks

Judy said:

How long have you had your BiPAP Pro? Did insurance pay for it? Did Medicare pay for it? Who will be paying for a new bi-level for you, insurance or Medicare? And MOST IMPORTANT - WHO said "but then the question of insurance reimbursement raised its ugly head and i was told that i would not qualify for the new machine"???? The local DME provider? Did YOUR insurance tell YOU that? Beware local DME providers, some of them tend to be "less than truthful" - or blissfully and conveniently "ignorant".

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Permalink Reply by Judy on November 22, 2009 at 5:35pm

I would be talking to Medicare. I'm telling you, never put your complete trust in any local DME provider regardless how good or not they have been to you in the past. A LOT has transpired in xPAP capabilities in the last 7 1/2 years. And there have been changes in Medicare regulations and practices as well. Do your best to pinpoint WHO paid for your BiPAP Pro and when. Then I'd be inclined to talk directly to Medicare. Do you have secondary insurance coverage for DME benefits as well? Do you check out your benefits at mymedicare.gov?? You really should keep track of them if you don't.

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Permalink Reply by claudette paluch on November 22, 2009 at 6:20pm

THANKS JUDY....I HAVE SPOKEN WITH MEDICARE A NUMBER OF TIMES...THE INFORMATION I GET IS CONFLICTING....I HAVE STARTED TO LOOK AT THE ACTUAL REGS GOVERNING MEDICARE CAUSE I DONT THINK THEY ARE ON THE MEDICARE WEBSITES BUT I WILL DOUBLE CHECK THAT.. THANKS FOR THE HEADS UP ABOUT THE DME. I HAVE PRETTY MUCH DECIDED THAT A CLAIM FOR A NEW MACHINE WILL NEED TO BE SUBMITTED TO MEDICARE BY ?? FOR ME AND THAT I MAY NEED SOME SUPPORTIVE WORDS FROM THE MD RE NEED... IF POSSIBLE... TO ACCOMPANY THE CLAIM AND THEN WAIT AND SEE WHAT HAPPENS....AND GO FROM THERE....I DONT BELIEVE NOW THAT THERE IS A CLEAR CUT ANSWER WITHOUT GOING THRU THE PROCESS....RESPONSES ARE NOT CONSISTENT....EVEN WHEN READING THE REGS ROOM FOR INTERPRETATION EXISTS. COULD BE THAT THE RESPIRONICS WILL BE SITTING AT MY BEDSIDE ALOT LONGER THAN I THOUGHT.

Judy said:

I would be talking to Medicare. I'm telling you, never put your complete trust in any local DME provider regardless how good or not they have been to you in the past. A LOT has transpired in xPAP capabilities in the last 7 1/2 years. And there have been changes in Medicare regulations and practices as well. Do your best to pinpoint WHO paid for your BiPAP Pro and when. Then I'd be inclined to talk directly to Medicare. Do you have secondary insurance coverage for DME benefits as well? Do you check out your benefits at mymedicare.gov?? You really should keep track of them if you don't.

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Permalink Reply by Judy on November 22, 2009 at 6:35pm

Sounds to me like you are right on top of things, Claudette. Yep, I'd go ahead and try to get the sleep doctor to write the script and then run it by a couple of different local DME suppliers and see what kind of response to the claim you get. Good luck!!!

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Permalink Reply by claudette paluch on November 22, 2009 at 11:40pm

thanks judy....when there is a resolution to all this if ever...i will let you know...its amazing how much time one can spend trying to learn this stuff and get the appropriate help....i have to start doing other things now and get back to the apnea issues later...its all incredible to me...it should be easier to deal with.....take care....and good luck to you too.....

Judy said:

Sounds to me like you are right on top of things, Claudette. Yep, I'd go ahead and try to get the sleep doctor to write the script and then run it by a couple of different local DME suppliers and see what kind of response to the claim you get. Good luck!!!

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