Help needed for convincing them to rx a BI PAP

[gadaisy]

I am going to the sleep center on Tuesday and will be trying to convince them that I need a bipap rather than the basic M series DS100 they gave me on the 16th. My pressure is 19 and the machine makes too much noise upon exhale and it feels like I'm fighting to exhale. Jules has told me that the machine I have will only go up to 20, so I am going to bring up the fact that if I need adjustment I'd have to buy anew machine. I have a used bipap and I do not have the same problems when I use it. It however will not record anything other than basic data of hourly usage. Please help me to go in there informed and prepared. I should mention that I have an HMO and the doc, sleep center and DME are all one in the same.

[Wulfman]

Whatever you get, make sure it is fully data-capable. (there are some Bi-Level machines that are not)

I was also prescribed a high pressure - 18 cm. But, with the help of my data-capable CPAP (Pro 2) and Encore Pro software, I was able to figure out that I didn't need nearly that much pressure......only 10 - 12 cm. Not saying that is comparable to your situation, just pointing out that with the availability of data and software, we can fine tune our therapy much better over time than one night in a sleep lab.

In any case, the pressure YOU'VE been prescribed should be enough to demand a Bi-Level machine.

Den

[jules]

read this thread - might help - especially the responses

viewtopic.php?p=332048#p332048

[Slinky]

Hoooo! Rots o ruck having an HMO that has

...doc, sleep center and DME are all one in the same. ...

You have your work cut out for you. That "basic M series DS100" they gave you initially gives you a good idea what you are up against. Most likely you are gonna be lucky to get a fully data capable straight CPAP w/C-Flex.

Keep in mnd most insurances require that you "fail" CPAP therapy before they will pay for a bi-level. So you may have to struggle along w/a CPAP for a while and just keep bugging them and complaining - and if you do manage to get a fully data capable - that the data supports your complaints. Sorry to be such a wet blanket. I sure do wish you GOOD LUCK!!!

[gadaisy]

You would be so proud! I walked in there today ready for an uphill battle. I laid it out and the first "technician" asked me what type of mask I was using. Like she didn't know, my chart was in front of her and she was the one who fitted it for me. She said a full face mask was my problem. I corrected her and said that it was not the case because when I use the used bipap with the mask they sold me it worked beautifully. When I told her that I had concerns that they would issue a cpap to begin with considering the high rate of pressure that was prescribed. She added that I did perfectly well with a cpap during the sleep study. I told her that I had that cpap on for a total of 2.5 hours and that is very different than trying to tolerate it for 8 hours and I didn't fell I coud survive on 2.5 hours of sleep if they felt that was adequate treatment for my severity. she said that the insurance will only pay for a cpap if that it what the study showed. I told her that I had researched it and that I was a candidate for a bipap purely on the idea that my pressure was over 15. I also told her that It would also cover it if it was proven that I couldn't tolerate a cpap. She gave up when I told her I would accept one of two options. I would purchase a bipap from the that was data capable and compatible with the humidifier they sold me. OR I would take the 150 dollar loss on the humidifier they sold me and get the rest of my money back and continue to use my old machine. Well one of the sleep therapists came in and talked to me and said that I was correct and that he would be speaking with my Dr. tomorrow ( It was after 5 pm) and he didn't see a problem with issuing a new bipap and having me pay the difference. He is supposed to be calling me back tomorrow. He also suggested that I continue to use the bipap until they can order the new machine. Now he could just be putting me off, but we will see. He did say that he "had concerns" that I wanted a data capable machine. I told him that want to be able to monitor my progress. He said that you can monitor it without a data capable machine. He looked surprised that I resonded with I wanted to be able to monitor more than my hourly usage and that I felt that if I were monitoring myself at home we would be able to have better control over my treatment than if I came into the center once every 90 days. I followed everyone's advice and even mentioned about farts, gassiness and stinky flatulence, heartburn. Well thank you to all of you for helping me to prepare for this. Hopefully I will have success, but I won't hold my breath! Not with the used bipap anyway LOL!!! What do you think; am I being overly hopeful? My apologies for the length of this post.

[GumbyCT]

I think they will still screw you.

Check the price at cpap.com to compare with what your co-pay will be. Also keep checking Craigslist and cpapauction.com. Knowledge is power.

Good Luck

[gadaisy]

My plan is to get my study and my new rx and then ask the price of the new bipap. When they tell me the cost, I will say that I feel it is overpriced and I will purchase elsewhere. I can be patient and wait out finding a good deal because I have a perfectly usable machine in the meantime. Believe me, this day and age I can certainly use every penny I can save. Oh and by the way, went to Ortho surgeon for carpal tunnel surgery follow up (I've been out six weeks) and I have to go back to work Thursday ! No more staying up till 3 am.

[Slinky]

Sounds to me like you must be the epitome of diplomacy and tact!!! Good luck!!!

[jules]

http://sleepapnea.respironics.com/clini ... 5B1%5D.pdf