Need to convince GP to include range in Rx

[phopap]

Hi all,
I’m new to the world of PAP, and I’m having trouble getting an APAP unit. Insurance declined to pay for any machine, so I’m paying for this on my own. I've got an APAP prescription from my doctor, but he's not a sleep specialist, which I think is why he won't write a pressure range on the prescription. But I can't get an APAP without a pressure range on the Rx, right?
Is there some source I could point him to that would both indicate an appropriate pressure range and also give him confidence that he's providing justifiable medical care?
My sleep study was back in April, the results being 6cm pressure. But this was before I started having extreme exhaustion, so it seems possible that now my apnea may be much worse, and therefore my pressure needs would be a lot different. I want to get APAP because it seems it would possibly help me avoid future sleep studies and future expense, as well as having the advantages of auto adjustment.
Do some sleep studies give pressure ranges? Are pressure ranges only for people with higher minimum pressures? Are APAP ranges usually small? Why have a range at all if the pressure needs are sensed and adjusted automatically? Does the fact that I was only given one pressure mean that, back in April, APAP was not indicated? Do I have to try to get the insurance company to send me to a sleep specialist (unlikely to happen) in order to get an APAP Rx with a pressure range? (or take my sleep study results to a sleep specialist on my own dime?) I called the company that did the sleep study, and they said it's up to my doctor to recommend APAP or not, not up to them. But my doctor is a GP, not a specialist, so I think he doesn’t want to risk writing the wrong range. How can I get him to write a range? Is there some authoritative site (in his eyes) that points out that an APAP can take the place of a sleep lab study, and/or it’s okay to just write for a large range?
It’s been about a year of frustration since I started this process. Any clarification or advice is greatly appreciated.

[palerider]

I've heard that cpap.com, possibly other online places don't care about whether it's got a range or not, as long as you've got a RX. give 'em a call, they do have a form you can download and give to your doctor and say "here, fill this out please".

[Julie]

Very many doctors (who don't necessarily know any better) routinely write "4 and 20" as a range... those are the machine's default low and high settings, so he won't go wrong by using them. You will very likely end up raising the low pressure (the one that counts) closer to 10 over time once you've 'titrated' yourself using Sleepyhead software with our help, but certainly can go with the above to get the machine in your hands. The high pressure won't in fact go any higher than it needs to, and few ever reach 20 even in odd spikes, so leaving it high is harmless. The low of 4 is actually almost impossible for most to inhale at decently and can feel suffocating, so raising it by at least a couple of cms even starting out is normal, but your doc doesn't need to know you plan to do anything yourself (the part that worries them) as doctors think Apaps auto. intercept apneas no matter how high from 4, but in fact machines can't do it in time if it's high-ish), so prescribe defaults and we ourselves then change those. The games we have to play!

[Pugsy]

CPAP is continuous positive airway pressure and it's a single pressure. Doesn't matter if the pressure is fixed or not...it's continuous single as opposed to bilevel where there are 2 pressures.

An APAP machine is nothing more than a cpap machine with the ability to have a mode (apap) where the pressures auto adjust...it also will have a fixed pressure mode (cpap)....

The billing codes for either a machine with or without auto adjusting modes are the same ....and apap machine is a cpap machine and they can legally be dispensed without a range of pressures being documented on the RX.
All a DME would have to do is set it in cpap mode if no range of pressures is stated.
Now they will blame insurance because they don't want to supply a more expensive machine but legally...they could supply an apap if they wanted to do it.

Since you are buying privately...you don't need a range of pressures to get the machine you want...a RX for "CPAP" is sufficient. CPAP.com specifically mentions this in their FAQ section. All the range of pressures might do is give them something to preset it at for you but that's not needed. It's super easy for you to set things yourself...you don't need it preset to anything.

I don't know of any place online that won't supply an apap capable machine with cpap on the RX and no range of pressures because and apap capable machine is legally a cpap machine first.

Do some sleep studies give pressure ranges?

Sometimes they do and sometimes they don't.

Are pressure ranges only for people with higher minimum pressures?

Not necessarily...they are used mainly because someone wants to use a lower pressure for the periods of the night when less pressure gets the job done and only use the higher pressure when/if it is need...couple of reasons why someone might need higher...sleeping on your back or REM stage sleep. You might not always be on your back and you for sure won't always be in REM stage sleep...REM normally is only 20% of the night.

Are APAP ranges usually small?

They can be but not always..it depends on where you need to go. When I was using APAP I discovered that I sometimes would need 6 to 8 cm more during REM. I had to have a fairly wide range to cover the possible needs.
But it hurts nothing to have a smaller/tighter range if you don't need much variation.

Does the fact that I was only given one pressure mean that, back in April, APAP was not indicated?

No...means nothing other than a recommended setting for that one night.

I was also given a straight 8 cm RX...I ended up needing 16 to 18 in REM. I didn't get much REM during the titration sleep study so they didn't really get a chance to figure out what I might need in REM.

[chunkyfrog]

Are you planning to buy from a local DME, even though you are paying out of pocket?
If this is the case, do be sure to compare prices with cpap.com.
Local outfits like to bend you over and empty your bank account.

[phopap]

Very helpful replies, thanks much! So to confirm, any APAP I get I can change the range myself?

...an apap machine is a cpap machine and they can legally be dispensed without a range of pressures being documented on the RX.

Is there an authoritative source I can quote to that effect, in order to convince the seller from which I want to order that the pressure range they ask for isn’t necessary?

If I can get that seller to ship an APAP without a range, then I don’t have to try to convince the doctor to add a range. If I can’t, I need to convince my doctor. I feel comfortable with the knowledge from experienced users here, but I really doubt that my non-specialist doctor will accept a forum as a source on which to base writing a pressure range on a medical prescription.

I can say to him “Hey doc, could you just a nice small conservative range?” But even then I can easily imagine him saying “I’m not qualified in this area and don’t know how to determine your range, so I can’t write any range for you”. So I need some kind of professional info to show him, like some big league medical site, say, Harvard Med or Mayo Clinic. I need to show my doc some source that will make him feel safe writing a range, any range.

Insurance is not paying for this, so I won't be buying from a DME.

So to sum up, I'm looking for authoritative sources to convince either my doctor or the seller I'm looking at.

[Pugsy]

I don't know who you are looking to buy from but here's what cpap.com says

CPAP prescriptions are accepted for Auto Adjusting (APAP) machines.

https://www.cpap.com/cpap-faq/Prescriptions.html

also I know that secondwindcpap.com will sell you an apap with a cpap RX

If the seller you are looking at won't do it...find someone that will. They are being unreasonable.

[palerider]

Insurance is not paying for this, so I won't be buying from a DME.

So to sum up, I'm looking for authoritative sources to convince either my doctor or the seller I'm looking at.

just PM grayghost4, he'll make you a better offer.

[Janknitz]

Are you "paying out of pocket" because you have not met your insurance deductible for the year, or paying out of pocket because you have no DME coverage for CPAP?

If you are still working to get the insurance price for an E0601 machine (CPAP or APAP) then the DME can pretend you need a range on your prescription to get an APAP because they don't want to supply you with a more expensive machine for the amount you are going to pay based on your insurance company's negotiated price, even if every penny comes out of your pocket. In that case they play stupid games like insisting on a range to prevent you from getting the more expensive machine at the contracted price.

OTOH, if you have no insurance coverage, then they should be bending over backwards to give you a more Expensive APAP machine because you will pay for every penny of the added expense. The only reason a particular DME wouldn't want to sell you a high end APAP is because they don't stock them since they don't want to provide them to anybody at an insurance price.

Understand that any DME will gladly charge you 1/3 to 2/3 more than you will pay if you shop around on your own for a machine. Buyer beware. Shop around as previous posters have suggested unless you like paying more when you don't have to.