Insurance denied c-flex type machine - what to try now?

[mfbower]

Hi, folks.

I've had a ResMed M-series basic machine for just over a year. I also have three masks (pillow, nose and full face mask).

I have never been able to get used to the machine (max about 2 hours per night) so I asked my Dr for an Rx to upgrade my machine. But since my insurance bought my machine in July 2008, they won't authorize a new one for another couple of years (3 years total).

The problem I have is that I feel like I'm suffocating and can't exhale fast enough to inhale the next breath. So I had asked to get a AUTO CPAP (like c-flex or EPR).

Since they turned it down, does anybody have any other suggestions for trying to get used to my old machine. I don't have the money buy a new machine on my own dime.

TIA

Michael

[boston]

what about selling yours on cpapauction.com then using that money to buy what you want, may have to put more money with it, but it would be better than buying out of pocket.

[rested gal]

I have never been able to get used to the machine (max about 2 hours per night)
------
The problem I have is that I feel like I'm suffocating and can't exhale fast enough to inhale the next breath.

See if your doctor is willing to prescribe a "bilevel" (BiPAP) machine and will write a letter of medical necessity to the insurance company for "bilevel cpap."

What you've described sounds like exactly the kind of scenario that most insurance companies consider "patient failed CPAP" and warrants trying a different kind of machine -- a Bilevel machine instead of CPAP. Medicare (whose guidelines many insurance companies seem to follow) considers autopaps to be just a "cpap" machine and reimburses exactly the same for "autotitrating cpap" (autopap) as they do for plain "cpap."

But Medicare considers "bilevel" to be a different kind of cpap machine and reimburse differently. You might stand a better chance of the insurance company accepting that the doctor wants to switch you to a machine that gives a different kind of treatment...bilevel treatment... since you've "failed" CPAP treatment.

A bilevel machine can give much more pressure relief for breathing out than any of the exhalation relief features on "cpap" and "autopap" machines.

In the meantime, turning down the pressure to a point you can actually exhale against on your current machine is an option, but of course that might be a very sub-therapeutic level. Personally, I'd opt to do that... on the premise that "some treatment is better than none." Not being able to use the machine being "none." I'm not a doctor though, so you might want to discuss turning down the pressure with your doctor.

What pressure are you using?

[Goofproof]

Hi, folks.

I've had a ResMed M-series basic machine for just over a year. I also have three masks (pillow, nose and full face mask).
Your machine might be a Remstar, not Resmed.

I have never been able to get used to the machine (max about 2 hours per night) so I asked my Dr for an Rx to upgrade my machine. But since my insurance bought my machine in July 2008, they won't authorize a new one for another couple of years (3 years total).

The problem I have is that I feel like I'm suffocating and can't exhale fast enough to inhale the next breath. So I had asked to get a AUTO CPAP (like c-flex or EPR).

A Auto CPAP has little to do with C-Flex or EPR, they are comfort features. AUTO machines if set correctly adjust pressure according to your pressure needs. Most of them do have exhale relief.

The machine shown in you profile (ICON) doesn't match your (ICON) HH, When things are listed correctly in (Text), people will be better able to help you.

Since they turned it down, does anybody have any other suggestions for trying to get used to my old machine. I don't have the money buy a new machine on my own dime.

TIA

Michael

We need to know the machine and mask you use and the pressure it's set for. Unless you have a breathing problem the machine should be usable is set up correctly.

[mfbower]

My equipment is:

Remstar M-Series CPAP machine (basic machine without c-flex)
Optilife Pillow Mask, ComfortGel Nose Mask, FlexFix Face Mask (use the face mask mostly)
Remstart humidifier

Setting is 10. I have Ramp set to start at 6 (I think).

The problem is that I can usually get to sleep but I wake up after about 1.5 hours (for other reasons) and then can't get back to sleep with it on so I take it off.

[congahands]

Michael, you said....

The problem is that I can usually get to sleep but I wake up after about 1.5 hours (for other reasons) and then can't get back to sleep with it on so I take it off.

If you are waking up "for other reasons", then if you can get back to sleep, that might help?

When I first started CPAP with c-flex, I was determined to make it work "NO MATTER WHAT". I decided that even if I had to hit RAMP 15 times, I was going to keep the mask on my face for as long as I was in bed.

Once you are awake, there's nothing wrong with hitting RAMP again. If you need to, hit RAMP, again, and again, and again.

This is not to say that you don't need a better machine, but until you can convince your doctor that you need some exhalation relief, this may help.

Good sleep hygiene is also a big help. No caffiene after noon or 2 p.m. Cut back on all liquids for a couple of hours before bedtime. A cool room to sleep in. No political shows or exciting TV right before bed......

Hope this helps, at least a little.

[Goofproof]

Also by using the {Ramp}, at 6 cm, you may not be comfy with that low a pressure, I couldn't handle a ramp at all, I started at 14.5 cm with C-Flex, that means I was well over your top pressure even with C-Flex, and I had just had my chest cut open.

You might try using the machine at full pressure in the evening while awake watching t.v., to get more used to it and build up your breathing. You will notice some strain but you body will get use to it, in time it will even like it.

Every one should have a APAP, not because they work great for everyone, (they don't) but they offer more treatment options and data recording, the more the better. That makes life easier, but even the lowest CPAP can do the job for 95% of the patients.

One other thing to watch out for, by using a nasal mask, mouthbreathing can be a problem that needs to be addressed, many posts on that. Welcome to the group. Jim

[Snoredog]

yeah Insurance doesn't TELL you that little stipulation when you are FIRST getting your equipment. They give you the cheapest crap on the planet when it comes to CPAP equipment then tell you later you have to keep it for 3-5 years before they will buy you anything else.

If you got this machine on the Rent-to-own program, take it back to the DME and set it on the counter, tell them to stick it where the sun don't shine.

If you truly want to continue with therapy, go back to your doctor, ask for a copy of the PSG report and findings. Ask for a copy of the CPAP prescription. If he cannot give you that, go back to the Sleep Lab for the copy, if he cannot give you the prescription have him write you another with DX=OSA RX=CPAP therapy at what ever pressure. Order a Sandman Auto online, fax over the script. What you spend in deductibles for insurance co-pays you can probably buy your equipment outright and have money left over.

By returning the machine to the DME you basically "fail" CPAP, using it only 2 hrs a night is also non-compliance. All that means is therapy is NOT working for you. Insurance will have to eat the cheapo machine rental to date. TELL your doctor if he can't write you a script for an Autopap that you will take your business elsewhere and seek out alternative therapies. IF your GP is on your side they should back you up.

With your pressure only being 10cm I think a bipap machine will be a hard sell, waking up during the night is a sign the current therapy pressure is NOT working. With an autopap there is no guessing. You can have the pressure low so it is easy to fall asleep then during the night the pressure will increase to prevent the event that wakes you up. 1.5 hours into sleep means you are in REM as you will go through a REM cycle about every 90 minutes. You can have 3-5 of those cycles per night.

EPR is NOT an answer to that especially if you are already at 10 cm pressure, that machine won't respond to the event that obviously is waking you up. CFLEX/AFLEX while very comfortable therapy relief options, they do NOTHING once you are asleep, they don't start working until you get over 6.0 cm pressure. I don't think you have any problems at your starting pressure of 6.0 now, it is when that Ramp timer expires and the pressure goes to 10 cm event or NO event. With an Auto you can have that same starting pressure and it will only increase when you have an obstructive event, but by the time that happens you are asleep and know no differently. What you need is an auto that responds and eliminates those events when you land in REM. Current machine is unable to do that.

Time to get behind the wheel and in the drivers seat and get what you want. The last thing you want to do is go back to your doctors demanding a Bilevel when your pressure requirement is 10. Some people actually do worse on Bilevel than CPAP.

My recommendation:

1. Get the Sandman Auto w/software.
2. Get copies of your PSG results and prescription for CPAP, keep both, give others only copies.
3. Return the plain jane D100 CPAP to DME and cancel the Rental.
4. In 2009 start a medical savings account and put your annual deductibles there, you can buy a new top of the line machine every year
and still have money left in your wallet. You can also use that account to purchase consumable supplies, get an invoice from CPAP.com send to them for reimbursement, it will have the medical billcode you need.

Should you ever decide to sell that Sandman machine it will sell a whole lot faster and for a higher price than the D100. The last thing you want at your pressure is a machine with EPR, no one uses that for any amount of time once they wise up and understand how it works.