Two week Christmas present.

[tgzlavistane]

I have the luxury of using a Phillips Respironics A-flex machine for two weeks for a CPAP titration study my doctor requested do to high morning blood pressure and feeling unrested. This machine is AWSOME! I feel more rested after only two days use. The machine is so quite I do not even hear it running. The sleep center is not charging me either for the use and information they will use to adjust the pressure on my CPAP. I already know what I want for Christmas next year, a Respironics A-flex machine. Merry Christmas to all and to all a good night.

[M.D.Hosehead]

Merry Christmas to you, too. Here's hoping you won't have to wait that long.

[rested gal]

You might want to try this... since you report feeling so much better using the autopap, tell the doctor you're doing so well, you'd like to stay on autopap as your therapy from now on. Ask your doctor to write a new prescription -- specifically for the Philips Respironics System One Auto with A-Flex set at the range of pressures he already has you using for this trial. Tell him you really would like to continue with this machine that is helping you so much, rather than go back to your old machine.

The doctor may say that what's making your feel better is a new pressure the autopap has found for you, and that the DME will set your old CPAP to that pressure so you'll continue to feel fine on your "CPAP." If he says that, tell him you'd really like to not take a chance ... that you'd really like to keep THIS machine (the autopap) since you know it is treating you superbly. And that if your pressure needs were to change again, you'll already be using a machine that can handle that.

Also mention that the A-Flex feature is different from C-Flex since A-Flex affects the transitions both ways -- for inhaling and for exhaling -- but C-Flex affects only the start of each exhalation. Your CPAP has only C-Flex. The autopap has A-Flex. And that you can feel the difference in the smoother transitions A-Flex in the autopap gives throughout both inhale/exhale as opposed to how C-Flex in the CPAP felt. In case the A-Flex feature is as much a part of helping you sleep better as the new pressure is, you'd like to not take a chance... you'd like to keep the Auto with A-Flex.

If the doctor won't order the swap, or if the DME won't make the swap at no additional charge to you if the doctor tells them to leave the autopap with you permanently, neither have your best interests at heart.

[LinkC]

RG-- As I read your post I was thinking "It all depends on if they are in the healing or the selling business!" As you said in your last sentence.

The doc has NO reason to balk (considering the results so far!) and the DME can charge off the swap. They will likely MAKE a few months worth of rental from the Ins co. It's either that or have a used loaner APAP in their stock.

[sister]

You might want to try this... since you report feeling so much better using the autopap, tell the doctor you're doing so well, you'd like to stay on autopap as your therapy from now on. Ask your doctor to write a new prescription -- specifically for the Philips Respironics System One Auto with A-Flex set at the range of pressures he already has you using for this trial. Tell him you really would like to continue with this machine that is helping you so much, rather than go back to your old machine.

The doctor may say that what's making your feel better is a new pressure the autopap has found for you, and that the DME will set your old CPAP to that pressure so you'll continue to feel fine on your "CPAP." If he says that, tell him you'd really like to not take a chance ... that you'd really like to keep THIS machine (the autopap) since you know it is treating you superbly. And that if your pressure needs were to change again, you'll already be using a machine that can handle that.

Also mention that the A-Flex feature is different from C-Flex since A-Flex affects the transitions both ways -- for inhaling and for exha




ling -- but C-Flex affects only the start of each exhalation. Your CPAP has only C-Flex. The autopap has A-Flex. And that you can feel the difference in the smoother transitions A-Flex in the autopap gives throughout both inhale/exhale as opposed to how C-Flex in the CPAP felt. In case the A-Flex feature is as much a part of helping you sleep better as the new pressure is, you'd like to not take a chance... you'd like to keep the Auto with A-Flex.

If the doctor won't order the swap, or if the DME won't make the swap at no additional charge to you if the doctor tells them to leave the autopap with you permanently, neither have your best interests at heart.

\


Hi Rested Gal,
I was recently put on a 30 day trial of autopap because my dr. felt, in his words,That I had failed c-pap.
I did great on the autopap for that 30 days and felt much better with a low ahi. My dr. was pleased and said he wanted me to have an autopap.I told him that medicare would not pay for it because I haven't had my machine 5 years until november 2011.
Well, I was right, medicare wouldn't pay for it because it has the same filing code as a c-pap.
The nurse finally called me back and told me,'sorry you'll have to wait until november.
I am left to use the c-pap even though I am having a really hard time with it.
Is there a loophole that I could check out to try and get a new machine?

[cflame1]

sister,
try for a bipap (you can get an auto on that)... it's a different medicare code

[rested gal]

cflame is right. She makes a very good suggestion about how to possibly get a machine that can autotitrate without having to wait until Nov 2011.

Respironics' name for their bilevel machines is "BiPAP."

ResMed's name for their bilevel machines is "VPAP."

For billing purposes, bilevel machines are considered a completely different type of machine from "CPAP" and "autotitrating CPAP."

Bilevel Auto machines have an autotitrating mode which can be turned on. If autotitrating is not turned on, they can be used in just bilevel mode. Either way, with "auto" turned on or turned off, the bilevel auto machines are considered to be "bilevel" machines first and foremost -- not "cpap" machines. So, a bilevel auto falls under the billing code for "bilevel" even though it can autotitrate if auto is turned on.

Sounds like you have a sympathetic doctor since he was willing to say you had "failed CPAP" and was willing to switch you to a CPAP that could autotitrate -- an autopap.

In order to get autotitrating capability without having to wait until you're eligible for a new "CPAP" machine, ask your doctor if he will prescribe a "bilevel auto" machine for you. Since a bilevel is a different type of machine with a different billing code, perhaps you (having "failed CPAP") will be eligible for that different type of machine right away.

Two bilevels which are capable of autotitrating are:

Philips Respironics System One BiPAP Auto

ResMed S8 VPAP Auto 25

Good luck, sister!

Good idea, cflame1 !

[sister]

Thanks so very much, I am waiting for a call back from his nurse,and sometimes that takes weeks.
I,m wondering if I should relay all this to her or just make an appointment to go in and talk to him.
I wanted also for him to understand that while i had the autopap on trial for 30 days I think my aerophagia was better. I really have a bad problem with that all the time,but it seemed to be better on the autopap.
Thanks so much for the reply,I am going to check into it,why should I have to suffer for 11 more months with a machine that i know is not working?
Wish me luck,I know it will take a long time at best.
I already tried one time and the nurse was a little short with me,she said,'you are not due a new machine until november 2011,so unless you want to pay for it out of pocket you will have to wait.
does anyone know the guidelines in getting a bilevel autopap? I am currently on a pressure of 10 but it went up more than that occasionly when i had the autopap.
Oh!, also, which one would you ask for if you had a choice?
Resmed VPAP Auto 25 or Phillips respironics system one.
Any help is appreciated!!!
GOD BLESS YOU!!!

[Janknitz]

Make sure you understand how much it's going to cost you before asking for an auto or a BiPAP.

Medicare (and most other insurers) will NOT pay for an upgrade within the same HCPC's code. So if your insurance paid for that CPAP Plus within the last 5 years, you won't be able to get insurance to cover an APAP no matter what the doctor says.

Upgrading to a BiPAP (a different HCPC code) is an option BUT before you commit, you should learn what your co-pay and deductibles will be. Remember that Medicare does these things on a capped rental basis for 13 months, and the co-pay for BiPAP is considerably HIGHER than for CPAP/APAP (~$40 per month to $125 per month depending on the type of BiPAP). So if you don't have a supplemental policy picking up the difference it might end up costing you a LOT more than buying your own machine online.

The nicest thing would be if the DME would simply upgrade you without charging extra (they would have gotten exactly the same reimbursement if they gave you the APAP in the first place), but it's unlikely they would agree to do so.

[sister]

Thanks Janknitz,
Actually, I have had my cpap since 2006. At that time medicare paid for it on a rental basis and my bcbs supplement picked up the rest.I didn't pay anything at all so I guess they would do the same again. At that time I was just given a machine,I had no idea even what a cpap was!
So realizing that medicare only allows for a new machine every 5 years I have tried really hard to use this one.
My dr. did not realize that cpap and autopap were under the same code for medicare. He is so sweet trying to help me in every way,he insisted on my doing a 30 day trial of autopap,I tried to tell him it would not be covered. Anyway, I did much better on the autopap but when the nurse checked with medicare she called and said I wasn't due a new machine,which I knew.
If I was able to get a bilevel autopap down the road,which one do you recommend?
I have read so many of your posts and I value your opinion.
I understand that the smart card comes with the respironics so that would be a plus,i think.
Thanks so much!!!

[sister]

Hi, it's pretty weird, I just noticed the name of this post{two week christmas present]. When my dr. was leaving the room I was trying to tell him that I didn't think that Medicare would cover an autopap, he replied,OH, I think it will,MERRY CHRISTMAS!!!! You'll have a new machine for christmas, he said.
I WISH!!!

[sleeplessinaz]

Hi SISTER---the Resmed 9 Auto comes with a smart card---it is an SD card and you can use Rescan to see your numbers on your computer. SO if you wanted to stay with the RESMED machines--that is the one machine that most of us are using and loving.

I recently got upgraded to RS9 Auto from a Rs8 CPAP and I did not have my machine for 5 years. I have private insurance though --CIGNA--not Medicare so maybe that is the difference why I got a new machine early.
My doctor ordered it to be upgraded due to my quality of sleep and not feeling refreshed anymore in the mornings-----
Hope this helps,
Carrie

[sister]

Hi Carrie,
Thanks, but I know that medicare won't pay for an s9 right now. It has the same HCPC code as my cpap.
Have a really good night!

[Janknitz]

I don't know BiPAP machines, but I understand that to get a ResMed BiPAP you'd need an S8 which has a proprietary card and reader. There is no BiPAP in the S9 series yet.

The Philips Respironics System One BiPAP machines use a standard SD card and reader you can get from anywhere they sell electronics for very little money.

CHECK with your BCBS plan before assuming they will pick up the 20% Medicare does not on the BiPAP. Plans may have changed over the years.

[sister]

Thanks so very much!
Have a great day and a restful night!