Question about Lincare and doctor's orders

I took my prescription for a new cpap machine to Lincare. I had decided that would be the cheapest way to go.......but not the easiest.

Here's my question.........Do they ever "fix" the machine so you can't accessess the clinical stuff? My doc wrote for a Resmed 9 Autoset, and then wrote an arbitrary 8-12cm pressure setting, knowing that I was on straight cpap. But he said he had to do it that way, since it was an apap.

So........if I call the doc's office and ask them to tell Lincare that I'm on a straight setting of 9, will they say I can't have an apap machine then?
If I go ahead and don't call the doc's office and then just let them set it for apap settings, can I easily change it when I get home?
Of course, the Lincare person told me I couldn't change things like that........but I can, if they don't remove that ability, right?
Which course should I take, to cover my arse? They'll be upset if they later see that I'm on straight cpap............and they never received an order from the doc.

Damn..........I get so irritated at these people treating me like I haven't got a brain.
Thanks for your input.

Be quiet and pickup the machine. Someone here will tell you how to change the pressure. It's easy.

Most DMEs never even notice you changed the pressure..all they care about is that you use it so they get paid.
All they can do is verbally slap your hands if they do notice and you can tell them the doctor changed his mind or whatever.

No, they cannot "fix" it so you can't change the mode. All the machines use the same little secret code for getting to the clinical menu to make changes or just look or whatever.

http://www.apneaboard.com/resmed-s9-cpap-setup

Just smile sweetly and pickup the machine and don't let on to them that you know how to do anything...and go home and do what your want.
Or you can do like I did...I just smiled sweetly and said "it's amazing what you can find on the internet" and left it at that.

Thanks ChicagoGranny and Pugsy!

Had to post this one more time :

Love it...

Really people shouldn't be changing the pressure without guidance from a respirologist, however, it's your body and if you want to take your therapy into your own hands there are plenty of online resources to help you do that. The APAP machines usually won't set at a specific pressure (S9 Escape Auto might be able to do CPAP only) so a range must be set. Also, government guidelines for funding your APAP may specify that the range must be +/- a certain pressure for APAP. A DME will get paid for the machine but they might be trying to help you out with qualifying for funding - not necessarily being greedy. My question would be the same as a previous post - why give an APAP when a CPAP would suffice? If the DME offers compliance downloads and the respirologist is worth his/her pay they should see if the pressure setting is effective and change it for the customer.

Guest wrote:If the DME offers compliance downloads and the respirologist is worth his/her pay they should see if the pressure setting is effective and change it for the customer.

True--but only in a perfect world. Too many of us have had to deal with arrogant, incompetent, or unresponsive doctors or DME staff, billing or insurance problems, delays of weeks or months for appointments, having equipment or supplies break while traveling, or myriad other problems.

In this imperfect world, it's best to keep your doctor involved whenever possible, but learn enough to fend for yourself when the system lets you down. That requires a machine with full efficacy data capability, such as an Autoset.

We all know how to change our own pressures. Pick up the machine and tune back in here. Someone will help

Guest wrote:Really people shouldn't be changing the pressure without guidance from a respirologist, however, it's your body and if you want to take your therapy into your own hands there are plenty of online resources to help you do that. The APAP machines usually won't set at a specific pressure (S9 Escape Auto might be able to do CPAP only) so a range must be set. Also, government guidelines for funding your APAP may specify that the range must be +/- a certain pressure for APAP. A DME will get paid for the machine but they might be trying to help you out with qualifying for funding - not necessarily being greedy. My question would be the same as a previous post - why give an APAP when a CPAP would suffice? If the DME offers compliance downloads and the respirologist is worth his/her pay they should see if the pressure setting is effective and change it for the customer.

Any APAP can be set for a fixed pressure to be used as a CPAP, but having an APAP allows you to titrate when needed, and some people do better with an APAP even if that wasn't picked up during the titration study.

The "government" and your insurer don't care if you get an APAP or a CPAP. Same billing code, same reimbursement rate. Your DME makes more money on CPAPs, so they care because of that. DMEs are not trying to be helpful to anyone but their own bottom line by choosing CPAP over APAP for you without giving you the option.

Sleep doctors (often a pulmonogist but not always) prescribes the pressure for a patient. A DME tech cannot change the pressure setting without a doctor's order. You seem to be using the term "respirologist" to refer to a DME sleep
Tech. Many of us are educated sufficiently to adjust our pressure according to our needs, but you should not change your pressure without a good understanding of what you are doing.

Guest wrote:Really people shouldn't be changing the pressure without guidance from a respirologist, however, it's your body and if you want to take your therapy into your own hands there are plenty of online resources to help you do that. The APAP machines usually won't set at a specific pressure (S9 Escape Auto might be able to do CPAP only) so a range must be set. Also, government guidelines for funding your APAP may specify that the range must be +/- a certain pressure for APAP. A DME will get paid for the machine but they might be trying to help you out with qualifying for funding - not necessarily being greedy. My question would be the same as a previous post - why give an APAP when a CPAP would suffice? If the DME offers compliance downloads and the respirologist is worth his/her pay they should see if the pressure setting is effective and change it for the customer.

If you set the minimum to say 9 and the maximum to 9 it would be in "APAP" mode and yet stay at 9 cmH2O. For me though if that was what the was I'd want to go with a pressure range of 7 to 11 or thereabout. Using the range of pressure and software I can tell where I need to be, not where the doctor is thinking I need to be. Doctors and Respiratory Therapists are using educated 'guesses' (It's called practicing medicine because they've not perfected it yet) by looking at 1 or 2 nights of data on someone who is just starting to learn to sleep with a snake in their bed, not to mention an octupus on their face. This is probably not the best nights sleep to determine the 'best' pressure

When I first started I was started at a pressure of 15, and used a S8 autoset I believe for a week and returned it to the doctor. They looked at the data and dropped it to 13. From there I got a S8 escape (brick) and used it for a year or so, using 13 cmH2O. I went ahead and purchased a S9 autoset so I could start monitoring my therapy. The doctor prescribed a pressure of 10-20 cmh2O with EPRx3. For the past year, my 95% pressure has been 11.04 So the Dr ordered 15, modified it to 13 and yet for the majority of the time my pressure is 11 or below. No straight CPAP device could have determined the optimum pressure as quickly and accurately as a APAP machine.

-Bill

wm_hess wrote:

Guest wrote: The APAP machines usually won't set at a specific pressure (S9 Escape Auto might be able to do CPAP only) so a range must be set.

If you set the minimum to say 9 and the maximum to 9 it would be in "APAP" mode and yet stay at 9 cmH2O.

one thing I've learned here is to pretty much ignore anything posted by 'guest'.

every apap that I've gotten my grubby little paws on has had the option of setting into straight cpap mode.

palerider wrote:

wm_hess wrote:

Guest wrote: The APAP machines usually won't set at a specific pressure (S9 Escape Auto might be able to do CPAP only) so a range must be set.

If you set the minimum to say 9 and the maximum to 9 it would be in "APAP" mode and yet stay at 9 cmH2O.

one thing I've learned here is to pretty much ignore anything posted by 'guest'.

every apap that I've gotten my grubby little paws on has had the option of setting into straight cpap mode.

While I understand the (sometimes) futility of a drive by guest, if someone else some day down the road looks at this thread the last word won't be one that is unhelpful.

-Bill

Guest wrote:Really people shouldn't be changing the pressure without guidance from a respirologist, however, it's your body and if you want to take your therapy into your own hands there are plenty of online resources to help you do that. The APAP machines usually won't set at a specific pressure (S9 Escape Auto might be able to do CPAP only) so a range must be set. Also, government guidelines for funding your APAP may specify that the range must be +/- a certain pressure for APAP. A DME will get paid for the machine but they might be trying to help you out with qualifying for funding - not necessarily being greedy. My question would be the same as a previous post - why give an APAP when a CPAP would suffice? If the DME offers compliance downloads and the respirologist is worth his/her pay they should see if the pressure setting is effective and change it for the customer.

Let me answer two of things you mentioned. Yes an APAP can run as a straight CPAP. I am running my S9 Autoset in CPAP mode.
The reason to get an APAP when just a CPAP will work is that my insurance will only allow me to get a new machine every 5 years. If at some point in the next 5 years the CPAP doesn't work for me then I have to try to convince my insurance that I need an APAP before the 5 year period.