HELP HELP HELP. CPAP prescription for Auto CPAP.

[Guest]

Hi,

I had a sleep study which reveals a CPAP setting of 8cm H2O. My ENT doctor at UCLA is very irresponsible and is impossible to reach. It's very expensive and long-waiting to get an appointment from them. I tried to reach them in vain (by phone, by FAX, by letters...multiple times) they just never responded to my phone/letterletters. Because it's a university clinic, the doctor is only there one half day per week. The last time I got my prescription was to walk to the counter and complained that I could never get a response and then I was able to get a duplicate written prescription. Prior to that during my medical visit, the doctor said he will send to prescription out to a DMS and didn't want to give me the prescription. It turned out the DMS that contacted me was not a BCBS contracted supplier and I couldn't buy it from them because I would have to pay 60% out of the one thousand something cost. That is much more than one can get from the https://www.cpap.com at 100% cost.

Part of the reason I am reluctant to return to UCLA is that they seem to be over billing my insurance (for the past 4 visits I had, they ALWAYS sent a bill of $300 to $500 to my insurance claiming some kind xxx-scopy (forgot the term) which is a costly procedure. This seems to be a routine charge by having the doctor sticking a thin viewing tube into my noses even for just a few seconds. It then became a xxx-scopy procedure.

So, armed with the original prescription (by getting it in person after finding out the prescription was sent to the out-of-network DMS) and the sleep study info, I went to my family doctor to ask him to change my prescription from CPAP 8cm to Auto-CFlex 8cm.

Now, the new in-network DMS supplier (APRIA healthcare) says they need two pressure rates, one for max and one for min in order to fill my order.

I remember seeing people here says that you can buy a APAP with a CPAP prescription. With the CPAP prescription of only one rating, how will the statement "buy APAP with a CPAP" work if it has only one pressure setting on the prescription?

I am buying the APAP with a local BCBS contracted DMS (price is much much more expensive than only https://www.cpap.com) and have no other choice. I believe that my family doctor is not familiar with the APAP settings. I also call https://www.cpap.com operator and they said they will suggest, in this case, to set it to wide open range from 4(min) 20(max).

Could someone please help!!!! Based on the 8cm CPAP diagnosis value, could someone please help recommend what's the best way to set the APAP machine to the best setup. I don't know how this machine work but would guess setting Max=8 and Min=4 is a lot better than having a wide open range like 4-20. That's assuming Max is equivalent to CPAP setting and Min is to help ease the exhale phase. But's that only pure guessing.

HELP HELP. I appreciate very much for any comments you will have. I should be able to take in multiple advices and draw the most suitable conclusion from that. So please feel free to offer any thought you might have. I will definitely appreciate your time and effort. For now, I need to know how to deal with the settings ASAP... I have not had a good sleep for who knows since when.... Without the prescribed settings, they will not send my the machine.

Again, please write some thing here. Any commnents.... Please help help.

BTW, the online https://www.cpap.com operator says that if I buys the APAP from them, they will set it to 4/20 and will ship the setup CODE with the machine to allow me to update and change the setting to my need. With the local DMS, will this CPAP pressure setup code be revealed to us? (i.e. non disclosured). In this case, how will one be able to change this machine backward/forward between APAP and CPAP without being able to set the CPAP (one setting) and the APAP (two settings). I can't think of having to bring the machine to the DMS every time and be told: "you can't do this, you can't do that, this must be on the prescription..."

I think the DMS assumes that we are too dump enough to screw around. (After all, the people who knows their computers well these days are actually the teenagers because they are not AFRAID to test and check them out) But as an engineer, I just feel very frustrated about this whole thing. For example, they told me, in order to get the confort lite mask, you must ask your doctor to prescribe it or we will just give you the default one....


Regards,

[GoofyUT]

You'll keep yourself up at night!!!

You can legally get an APAP with a CPAP script since an APAP IS an auto-titrating CPAP.

A starting point of titrated pressure +/- 3 cmH2O is usually standrad practice. So for you, you'd start at a min. of 5cm and a max of 11 cm

DON'T FRET!!!

Chuck

[GoofyUT]

BTW, many of us here believe that setting your xPAP should be left ONLY to professionals because they are the ONLY ones who know what's good for us, certainly better than we do!

So, there are LOTS of us who will be GLAD to tell you EXACTLY WHAT NOT TO DO, in clear and simple instructions, so that you WON'T BE TEMPTED to try to set your own machine.

There are folks here with TONS of experience with virtually every APAP in use, and setting machines ain't all that hard. There ARE NO DOUBLE SECRET CODES!!! Just a few key-strokes in the proper order, and we'll be glad to help you NOT make them!

Hang in there!

Chuck

[Guest]

The brick and mortar dme places have to work under different rules and regulations than the internet sites. Your local dme company is not legally able to provide you with an autopap that does not have a minimum and maximum pressure setting. The internet companies do not have to operate under the same restrictions and can therefore provide you with an autopap while only having a cpap prescription. That's the reason for the difference.
You could ask your familar doctor if he is comfortable writing an autopap prescription with a minimum and maximum pressure.
If he is not comfortable doing that than I would suggest finding a different sleep specialist.
a great list:
http://www.absm.org/diplomates/listing.htm
Without getting the specific autopap prescription your only other choice would be to pay out of pocket and buy it yourself online.
I have bcbs and at least with my plan going through an in network company was a lot cheaper than online. ymmv etc etc

[tomjax]

Goofy, You need to put a winking emoticon after your post.
Someone may think you are serious is saying a professional is the only one who knows what is good for us.

Include me out of the group that does not know how to take charge of my own health.

I would venture to say that a good percentage of users here know MUCH MORE than many doctors.

Thought for the day:
If a woman clones herself and then kills the baby, would it be considered suicide?

Big day in Fl tomorrow. Danny Rolling will get the big needle in his vein:
Why do they require a steriile IV set for lethal injections?

[Wulfman]

I've read where some of the BCBS members have been able to purchase out-of-pocket and then get reimbursed by them at the in-network rate. If you check with your group representatives, this may be an option for you.....if you're in a position to purchase your equipment that way. Tell tham how much you're going to save them.

If you purchase from CPAP.COM, you'll get the "Home Care Provider Setup Instructions" manual. If you purchase from a local DME, they won't give it to you.

If the purchasing out-of-pocket is not an option, you might check with billmyinsurance.com (another part of CPAP.COM) and see if they can work with your insurance provider. They DO have a couple of BCBS listings that they work with. BMI may need a copy of your sleep study.....which you should have (or be able to get) anyway.

As long as you have your CPAP prescription, you can buy an APAP.

Best wishes,

Den

[Snoredog]

UCLA Medical Center is a teaching institution, while it may have some of the best doctors in the country in certain specialties, nothing happens there very fast. They usually tell you that right up front from day one after you turn in your medical history form.

Only reason you would go there for routine service is to obtain either a 2nd opinion or if you are trying to help out a student doctor, in the case of the latter, it happens slower because every step taken during the process has to be approved by a Professor doctor before the student doctor can go on to the next step.

If you want things to happen faster and have them be at your beckoned call, get another ENT, the phone book is full of them.

But you don't need any special script for an autopap, use your old one, it will work fine and change the pressure when you get the machine. OSA is a life-long disorder, reason the script really never expires.

[snoregirl]

Yes you can buy an APAP with a CPAP prescription ONLINE, but generally not from a local DME. SO for the local DME you most likely need a prescription that says APAP with a range.

Do not set it for less than 6. +/- 2 or 3 from your titrated pressure is usually a pretty good place to start, but less than 6 is not tollerated by a good number of folks.

So I would do yours 6 - 10

Tell your doc this and see if he or she won't just write it on a new prescription. Tell him/her that you did some research and feel that this will work for you.

If you buy from a local DME you may not get all the manuals. Most likely will not get them. You can buy online Ebay for most machines (aprox $6), or get someone here to give you information. Most machines are not rocket science to change. Even if you get a DME to set it up make sure that they do it right. Get the info on how to check (which is just like changing except when you toggle through the settings you don't change anything). DME's make mistakes. Check.

Worst case if local DME will give you APAP set wide open 4 - 20, take it and change it yourself if there is any question of you doc putting a range on a prescription (like he/she doesn't want to if they don't think they have the expertise).

If you stick with a major brand that lots of folks have, info is easy to get.

Have you read what Resmed is doing with pricing? You might want to stay with Respironics. Especially if you may need to buy anything out of your own pocket in the future online. Lots of help here with Resprionics machines.

[krousseau]

On the Auto PAP the minimum is not the exhalation pressure. It is the baseline pressure when the machine is set to auto titrate. The machine will run at 4 unless it determines you need more pressure. If you have it set at a max of 8-the machine will titrate up to 8 if you have an event. If you get a Respironics auto with C-flex it gives 3 levels of expiratory relief with 3 being the greatest pressure drop on exhalation. The 1, 2 & 3 are just relative numbers-and do not correspond to cm of water.
There is an Auto bi-pap where the expiratory level really is set in cm of H2O but you would still do inspiratory pressures within a range.

[rested gal]

So, armed with the original prescription (by getting it in person after finding out the prescription was sent to the out-of-network DMS) and the sleep study info, I went to my family doctor to ask him to change my prescription from CPAP 8cm to Auto-CFlex 8cm.

Since you have a sensible family doctor who is willing to work with you, here's how I'd ask that the prescription be written IF it were me and if I were going to get the machine from a local DME (DME is message board shorthand for the local bricks and mortar stores that sell cpap equipment..."durable medical equipment"):

Respironics REMstar Auto with C-Flex
Pressure setting: 6 - 12 cmwp
C-Flex set at "2"
Integrated heated humidifier
Homecare Provider Setup Instruction manual and User Manual
Mask - patient's choice

The DME will probably go apoplectic at the doctor ordering them to turn over the setup instructions to a lowly patient; but hey, if the doctor's Rx orders them to give that to you, they should do what he says ... however reluctantly. They'll probably call the doctor to argue all kinds of reasons why a patient shouldn't be given the setup instructions, but there is no legal reason at all that you can't have that if your doctor wants you to have it. If the doctor doesn't want to listen to their arguments (if they object at all -- they might not) he could tell them to send the setup instructions booklet to him and let you pick up the booklet at his office.

The reason you should have the doctor specify the exact brand and model of autopap you want is because the DME might try to substitute another brand of autopap -- one that might not be as useful for monitoring your treatment via software as the one I mentioned or wouldn't have exhalation pressure relief (C-Flex) that can be used in auto mode. For example, resmed's "EPR" exhalation relief cannot be turned on in their Vantage autopap when the machine is being used in auto mode.

If your doctor caves in to the DME's urging that you not be given the setup instructions, no big deal. Many people are willing to help you if you get a machine and don't know which buttons to push at the same time to access the clinical menu or what plug to unplug/plug back in. There is not a separate code for each individual machine for getting into the "setup menu" on the machine itself. Nor do you have to open up the machine. It's quite simple to access the menu once you know the steps for a particular manufacturer's machines.

If I were going to purchase the machine from cpap.com and my prescribed pressure were 8, I'd ask the doctor to write the prescription any of these ways:

cpap
That one word is all that absolutely has to be on the Rx to buy an autopap from cpap.com. The machine would arrive set "wide open" 4 - 20. The setup instructions would be with the machine, so you could change it yourself to 6 - 12 or whatever.

or, if you want the online store to go ahead and set it for you before shipping, the Rx should read:

cpap 6 - 12 cmwp
C-flex 2

or

autopap 6 - 12 cmwp
C-flex 2

"cmwp" means "centimeters water pressure" -- the amount of air pressure it takes to raise a column of water that many centimeters. You'll also see it written just as commonly on Rx's as "cm H20".

You will definitely receive the Homecare Provider's setup instructions booklet or card in addition to the User manual with any machine you buy from cpap.com

You can order any mask your want online...no Rx is needed for mask, humidifier, etc. Rx is needed only for buying a machine.

Whether you get the Respironics REMstar Auto with C-flex from your local DME or from an online store, I'd definitely get the Encore Pro software and card reader. Very useful for monitoring your own treatment yourself. A "Smart Card" comes with the machine, whether the machine is bought from the local DME or from an online store.

Good luck!

[Patrick A]

I have BCBS FEHD and i got screwed by Apria

Guest wrote Now, the new in-network DMS supplier (APRIA healthcare) says they need two pressure rates, one for max and one for min in order to fill my order

.

Not only did they gave the cheapest piece of equipment, They never returned phone calls, they even tried to bill Medicare (after I went on Medicare) for the equipment after my ins. paid the 10 months rental. and I can tell you from experience they will charge you a deductable when you get the equipment and then again after Jan 1
Your best bet is to by the unbit out right from Cpap.com for less than $500.00 bucks, buy your masks also.
By the time you pay for your equipment and then send the bill to BCBS they will pay 90% you pay 10% In the long run you will pay far less that way than renting it to own it.
Good luck Welcome to Cpatalk




_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com, medicare

[Krelvin]

Mask - patient's choice

I would have the Dr. write for Mask - Patient Choice (Full Face or Partial) and not use just Patient's Choice.

I've seen an RX written like this cause problems if the Patient wants/needs a Full Face mask.

I know of two people who ran into problems with the DME refusing to give them a FF mask because it was not specified.

You would think that Patient's choice would be selfexplaintory... but. apparently not.

I got away with it because I brought my Sleep Study.

In fact, I ALWAYS bring my sleep study to any Dr. Visit because I've found they seem to always have misplaced it or have not received from the other Dr's office.

I also like to bring a Tape recorder (actually its totally digital). Its amazing how they choose their wording when they know the conversation is being recorded.

It helps my memory to know exactly what they said. Helps them too!

[rested gal]

Mask - patient's choice

I would have the Dr. write for Mask - Patient Choice (Full Face or Partial) and not use just Patient's Choice.

I've seen an RX written like this cause problems if the Patient wants/needs a Full Face mask.

I know of two people who ran into problems with the DME refusing to give them a FF mask because it was not specified.

You would think that Patient's choice would be selfexplaintory... but. apparently not.

Excellent point, Krelvin. Thanks for the good suggestion!

[pcisuser]

Wow, I would like to express my sincere appreciation to everyone who has written a response here up to this hour (about 4 hours after my request). I would like to take the time to thank you all: Guest, goofyUT, tomjax, Wulfman, Snoredog, Snoregirl, Grousseau, Rested Gal, Patrick A, Krevlvin… (people who have posted so far).

In my original post, I forgot to mention that I had my family doctor prescribed exactly the name of the machine as I have seen at https://www.cpap.com which is:
“Remstar Auto C-flex CPAP with heated humidifier with SW and card reader”
I forgot (or did not feel necessary to spell out the Remstar software package name and the M series). When I talked to APRIA’s respiratory staff on the phone, the lady asked me the max and min settings and asked me what does “SW” mean? (um… I am wondering if I have to specify ENCORE PRO as the exact software name just to prevent them to find an excuse to not give me that) She then asked why do I need the APAP while CPAP appears to be what I need. I told her so that I can adapt to it easier and less chance to reject the machine…. So much for the resistance I can feel…

Follow up question for Snoregirl and Rested Gal: I appreciate so much that you went through the full length to address my issue which is “what should the prescription say?”

----------------------------------------------------------------
Rested Gal wrote (thanks a lot for this kind of details)
Respironics REMstar Auto with C-Flex
Pressure setting: 6 - 12 cmwp
C-Flex set at "2"
Integrated heated humidifier
Homecare Provider Setup Instruction manual and User Manual
Mask - patient's choice.
-------------------------------
Question:
What does “2” mean in the C-Flex set at “2”
Do you mean in step of 2 cm of water pressure?
Could you help explain why the max margin is far larger than the min margin (i.e. Min=8-2 while Max=8+4) ? I hope by asking this question I will be able to understand more about the APAP machine.
----------------------------------------------------------------
Snoregirl wrote (thanks also to the detailed info in your response)
So I would do yours 6 – 10 (cm of water)
Krousseau wrote
If you get a Respironics auto with C-flex it gives 3 levels of expiratory relief with 3 being the greatest pressure drop on exhalation. The 1, 2 & 3 are just relative numbers-and do not correspond to cm of water.
------------------------------
Question: I am not sure what “auto-titrate” means. Allow me to re word it to see if I understand it correctly. With example of 6-10 pressure setting, does that mean the machine will start at the INHALE base-line pressure at 6 cm. If this pressure does not improve the sleep numbers, it will gradually adjust the pressure from 6 all the way to max 10 and will try to find the pressure setting that will yield the lowest number of events of the optimal condition? In this case, what is the incremental pressure step that the machine will take?
On the other hand, the “EXPIRATORY RELIEF” will NOT be adjustable by the user but the Remstar Auto will lower the pressure in 3 pre-defined pressure drop that is based on the current optimal inhale pressure. The Auto Cflex will pick the best one out of the 3 pre-defined expiratory pressure drop which is not controllable by the DME or the user.
Is my understanding as written above correct? Thanks a lot again for your help here.

Thanks a lot for everyone’s help. I still need to know the following questions:

(1) with CPAP rated at 8cm, what is the pro and con of using Max=12 Vs Max=10 cm?
(2) It may be a hassle to have the DME turn over the setup manual and setup code. However, it seems that most members here are suggesting that this is nothing really secret. I assume that the so called setup code is NOT some kind of password and serial code that is unique to each machine but is some kind of key entry sequence that is the SAME and COMMON for units of the same model. Am I correct? If this is the case, as long as I have the model number (I am buying the Remstart Auto Cflex CPAP with software capability) then someone here will be able to help me on how to change the Min/Max settings in case the reports shows that I need a different setting that is outside the Min-Max range. Correct?
(3) I will call BCBS tomorrow to find out if I can purchase the machine from CPAP.com. The only issue I have is because I am a NEW NEW user and the BCBS’s 10 month rent-to-own policy may helpful in allowing me to have a low risk try-out period. On the other hand, judging from the red-tape procedure (not allow me to understand the setup. Not all patients are incompetent and most of us here are far far from that, need a prescription even for a mask. My prior prescription didn’t have the word “heated humidifier” and they didn’t want to give me that feature….), I am not sure how good is this 10 month period. Comparing the rental price (from my old prescription) with CPAP , the price difference is like $500 at cpap.com vs $1200 at DME. This is too big a difference and I am not sure why BCBS would have us stick to the contracted DME. I think this is a fairly new science (not exactly the science but the ever-more-popular use of the CPAP machines)

Finally, I sincerely thank everyone again for helping me out. I still have quite a few questions in this post and I hope you could help.

Regards,

[bdp522]

As I understand it, the auto set at 6-10 will run at 6 until there is an event. Then it will increase the pressure in .5 increments until it stops the event or hits 10. After the event the auto will drop the pressure in .5 increments until it hits 6 or senses another event.
The c-flex gets set by the DME (or user ) to either 1, 2, or 3. The only way that changes is to actually go into the provider menu and change it.

REMstar Auto w/C-Flex Setup

When in the Setup Menu, the humidifier ^ and ramp v buttons operate as up and down keys to change the settings, the left/right user buttons < > allow you to go to the previous/next question or setting, and the pressure start/stop button is used to exit the Setup Menu. Holding the humidifier or ramp buttons down will cause the values to change more quickly.

To enter the Therapy Setup Menu, hold the two top user buttons < > down while plugging in the power cord.
Continue holding the buttons down until the REMstar Auto w/C-Flex beeps twice.

Note: The word "setup" will appear on all of the screens indicating that you are in the Therapy Setup Menu.
(If you press the Pressure start/stop button, you will exit the Setup Menu.)

A. Compliance hours/nights: (recommend leaving alone, but CAN be cleared at this point)
Select next setting with >

B. Therapy mode: (CPAP/CFLE/APAP/AFLE) select with ^ or v
Select next setting with >

B1. If CPAP or CFLE select pressure setting: Select with ^ or v
Select next setting with >

B1a. C-Flex mode (if you chose CFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

B2. If APAP or AFLE, select minimum pressure setting: Select with ^ or v
Select next setting with >

B2a. If APAP or AFLE, select maximum pressure setting: Select with ^ or v
Select next setting with >

B2b. C-Flex mode (if you chose AFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

C: Ramp time setting: Select with ^ or v
(ramp time will be turned off with a setting of 0)
(if using APAP or AFLE mode, Ramp setting MUST be set to 00:00)
Select next setting with >

D. Ramp pressure setting: Select with ^ or v (use only in CPAP or CFLE mode)
Select next setting with >

E. Patient disconnect setting: 1 = on 0 = off Select with ^ or v
Select next setting with >

F. Buttons lights setting: 1 = on 0 = off Select with ^ or v

(Last setting. Use On/Off button to exit Setup)

I think most insurances like the rent to own because you have to show compliance to keep the machine. If you don't use it enough they take it back.

I'm not sure about the pro and con of max pressures, but someone will be by shortly to let you know.

Brenda