What do I say to get an Auto???

[biggziff]

I have the RemStar Pro II, but would like the funcitonality of the auto machine. What would you say to your doc to get them to switch you to the auto machine? I like the idea of the auto and using only as much presure as needed.

Thanks

[neversleeps]

Just get the prescription for the cpap from your doc. It does not need to specify APAP in order for you to get an auto machine. The billing codes for insurance are exactly the same whether you buy a straight CPAP machine or an APAP machine.

If you want to discuss auto machines with your doc, tell him exactly what you wrote here:

I like the idea of the auto and using only as much presure as needed.

If he is not familiar with APAPs, here's my personal spiel:

If you have an auto machine and use it in the auto mode, it can be set for a pressure range. If you use it for the full range, it can go anywhere from 4-20cm. If you choose to narrow the range (which seems to give better results based on what users have been reporting), you can set it to whatever gives you the best treatment. For example, if you were titrated at 10cm then maybe you'd want to try a range of 8-12. The auto machine will then adjust the pressure required as you are sleeping based upon your breathing patterns. It may use a pressure of 8 for just a few minutes, then maybe will go to 10 for 3 hours, then may go to 9 for 30 minutes, then may go to 11.... etc. Provided you have the software, you would examine your data on a nightly basis, experiment with a different set of ranges, and quickly discern the pressure range that results in the least apnea events.

One of the great things about the auto (APAP) is you aren't receiving more pressure than you need (as you may be with straight CPAP). When you think about it, your titrated pressure was based on a few hours in a weird (to say the least) sleep environment. Maybe you will discover through using the auto and evaluating your data, you consistently use 7 and never go above 9. That's the beauty of it! You use only what is needed and its all done for you while you sleep!

It is ideal for your doc to write a prescription for your CPAP machine with no expiration date. If you are doing this through insurance, be sure your doc includes a heated humidifier in the prescription. (While the humidifier itself doesn't require a prescription, it helps push through the cost to your insurance company). It is not necessary for the doctor to specify CPAP or APAP on the prescription. If you are only going to be ordering APAP machines, a pressure setting is not required on the prescription. It will come to you at 4-20. HOWEVER, the prescription must state the pressure level if you order a straight CPAP machine.

If you're doing this through your insurance (many don't; either they don't have insurance or they find it too big a hassle and not worth it because of the deductible), the billing code for the machine is the same regardless of APAP or CPAP (E0601 NU) and the billing code for the heated humidifier is E0562 NU.

You'll find cpap.com usually has the best prices and they always include the clinicians manual which has instructions for how to change the settings. If you're buying the software so you can conduct self-titration experiments with your new APAP, you will quickly learn the most appropriate range for the most effective treatment. There are some users who conduct these experiments and discover they receive the best treatment from straight CPAP set pressure. Since this is a possibility, some have queried, "Then why bother getting an APAP in the first place?" The answer is that you can revisit your decision as time passes and things change: i.e. weight gain/loss, different mask, change in altitude, etc. Maybe once every couple months the straight CPAP user will reset to auto mode to check to see if they do better at a different pressure.

Some say, "If the treatment is better at a very narrow range, then why bother getting an APAP in the first place?" The answer is that even within a narrow range, you are still getting only the pressure you NEED. If my range is set for 10-14 and I spend more of my night in the 10-12 range but occasionally go up to 13 or 14, I have never received more pressure than I required. This would not be true at a single set pressure, as there are times when it may be more than necessary, and times it may not be enough. So even a tight range is helpful.

Perhaps the best feature is the software that goes with it so you can see how you're doing. You no longer have to wonder if you're getting the best treatment possible, you no longer have to schedule a full PSG to check your results, you no longer have to make a drs. appt. every time you want to change your pressure, and you no longer have to pay exorbitant prices by making every move through a DME.

You will also no longer have to go back to your doctor for a new prescription if you'd like to try a different machine because cpap.com will keep the original (non-expiring) one on file.

[snork1]

And if all of the above excellent advice doesn't work and you NEED to get your doc to prescribe an "auto-titrating device" to get insurance to pay, you can try what I did.

I got a straight CPAP. Doc seems to like straight CPAP. Of course I notice DOC doesn't USE any CPAP himself.
So I told him the only way I could sleep was to keep hitting the ramp button all night, sort of a do-it-yourself Auto effect. So its obvious that the straight CPAP isn't working and I NEED and auto, since that technique helped at least a bit.

Some insurance companies REQUIRE you to TRY a straight CPAP machine, "prove incompatibility", THEN you can get an auto. The above method worked for me to work around this catch-22.

Your mileage may vary

[Guest]

After just one week, my doctor switched me from cpap to apap after listening to my complaints. (morning bloat, waking up in the night feeling like I was not getting enough air coming through the mask, not being able to sleep beyond 1-2 hours at a time.) When I started apap, there was a night and day difference for me! Just remember, results can vary greatly from person to person. Good Luck!

[WillSucceed]

My tactic to get an auto was to complain bitterly about the chest pain that I was feeling from the pressure delivered by vanilla CPAP. I was titrated at 15 and had so much pain that I thought I was having an infarct. It took about 6 faxes of compaint to the Dr. (ALWAYS put it in writing, creates a paper trail that they can't ignore) about the pain and an equal number of calls to the equipment supplier. They both suggested pressure reductions, you will get used to it, blah, blah, blah, etc., then, I suggested to the Dr.'s secretary (I think she is his wife) that I was contemplating a complaint to the College of Physcians & Surgeons regarding my feeling that the Dr. was not concerned enough about his patient (me).
Well, slam bam, thank-you ma'am... a script for the auto was faxed to me right away. Then I had to start fighting with the insurance company to get them to pay for it. Enough complaints to them and I get them to pony up for the auto based on the arguement that I was not able to tolerate CPAP.

[neversleeps]

I suggested to the Dr.'s secretary (I think she is his wife) that I was contemplating a complaint to the College of Physcians & Surgeons regarding my feeling that the Dr. was not concerned enough about his patient (me).
Well, slam bam, thank-you ma'am... a script for the auto was faxed to me right away.

Brilliant!!!!

[WillSucceed]

Thanks!
In grad school, I took 'bitch & complain' 101... my best class!

[biggziff]

Just get the prescription for the cpap from your doc. It does not need to specify APAP in order for you to get an auto machine. The billing codes for insurance are exactly the same whether you buy a straight CPAP machine or an APAP machine.

Here's the deal. According to my study, I did really well at between 7-9. Out of the entire study, I spent 9.4 minutes at 11cm (at the very end of the study) and for some reason, my machine is set to 11cm.

My study is here:

http://www.av8r.org/albums/cpap/index.htm

I have a RemStar Pro II now. Does the DME take the current machine back? I bought the Encore Pro software and card reader so that I could monitor and self treat when the time comes.

[biggziff]

I suggested to the Dr.'s secretary (I think she is his wife) that I was contemplating a complaint to the College of Physcians & Surgeons regarding my feeling that the Dr. was not concerned enough about his patient (me).
Well, slam bam, thank-you ma'am... a script for the auto was faxed to me right away.

Brilliant!!!!

I'm not so sure. This is on par to me demanding an antibiotic for my kids when they complain that their ear hurts. I'm not the expert...I am at the mercy of the experts and I'd like to have a civil relationship with this person. I understand that your experience may have been less than civil and I obviously can't comment on that. So far, my doc has been willing to listen to me, but hasn't really changed his mind. I'm attempting to gather enough information to make a logical arguement that has only one possible outcome. Basically, back him into a corner using the very data he has to rely on. That way, he saves face and I get what I want. However...should he decide to turn on me....I'll resort to whatever means (within reason) to get what I'd like to have. I'm sure that it won't come to me threatening him with reporting him...but ya never know!!

Thanks

[Severeena]

biggziff and others.

The insurance companies are nixing the APAP because the DME's are ruling it an in home titration study machine and therefore is not suppose to be available to us. Yes you are reading right. The APAP is nothing but an inhome Titration study machine we are not suppose to own.

The DME's have brain washed the insurance compaines to thinking this.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, DME, APAP

[wading thru the muck!]

biggzif,

Your insurance company already paid for a machine that is working for you just fine. To indicate otherwise just to get them to pay for a new machine would be insurance fraud. Why don't you just pony up the $500 +/- that the REMstar auto costs at cpap.com and buy it yourself. You can always offset the cost by selling the old machine. If it were me, I would just keep the Pro II as a back-up.

[biggziff]

Did they already pay for it? I've had it one week today. From what I've read, most companies are renting these until they receive compliance data proving that the insured is actually using the machine. I'll ask tomorrow.

Insurance fraud is generally defined as the intentional misrepresentation of material facts and circumstances to an insurance company to obtain payment that would not otherwise be made. Not sure where I'm intentionally misrepresenting material facts, but I guess that might be subjective. I'm using my study data and the opinions of professionals.

Based on my study and what I have been told by professionals in this industry after looking at my study data, I *am* a candidate for an auto machine. I'm still reserving judgement on my doc, but he seems to be the only one that feels I need to be at 11cm. Everyone else has suggested a range of 7-10, thus showing a need for a machine that has the ability to treat at a range of pressures.

If I have to, I will buy an auto machine out of pocket. Not a big deal, really. Selling the old machine isn't really an option as then you *are* venturing into the grey area of insurance fraud. If I buy a new machine, I'd have to call the Ins co. and offer them the option of taking the old machine back and then reimbursing me for the new machine, thus making them whole and executing their fiduciary obligation to me as the insured. Just like the guy that has an auto accident, gets the quote bumped up by $250 to cover his deductible and then takes the car to a neighbor who fixes the damage for a lot less. Cash that check and you have just committed insurance fraud.

Thanks for your opinion. I don't agree, but thats what makes the world go around.

[biggziff]

[quote="Severeena"]biggziff and others.

The insurance companies are nixing the APAP because the DME's are ruling it an in home titration study machine and therefore is not suppose to be available to us. Yes you are reading right. The APAP is nothing but an inhome Titration sutdy machine we are not suppose to own.

The DME's have brain washed the insurance compaines to thinking this.

[Jere]

I would think the DME's would only care about the $$$$$ and not about whether it is a CPAP or an APAP. But then again some of my friends thinks me a bit cynical.

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME, APAP

[wading thru the muck!]

Biggziff,

Not to suggest you were trying to commit fraud. I would be interested in your rationale suggesting an auto. You have a similar range to what I have, in fact I was titrated at 7cm and with my auto 90% of my events are prevented at a pressure of 9cm or below. I am fully in favor of everyone getting an auto, but the way the insurance reimbursement system is currently set up, there is no reason for a DME to provide apaps when a cpap will work. Interestingly Respironics (the makers of the REMstar machines) would recomend switching to a Bi-pap if cpap is not tolerated. Their position regarding autopaps is that they are to be used for a limited term to verify and/or adjust lab titrated pressure settings. I suspect this position is politically motivated to please the DMEs.