BiPap or Auto BiPap?

[ZeroDigger]

I’ve recently been prescribed a bi-pap machine. I’m not sure if I even have a choice, but I’ve been wondering if there’re preferences here among members for straight or auto bipap machines. My inspiration pressure has been suggested at 18 cm/h20.
I’m currently on an auto-cpap, and some nights the 90% rate varies as much as 3 cm/h20. I’m still a fairly new user, just approaching three months on the machine.
Any opinions?

[cflame1]

Just like with a Auto PAP... the Auto Bipap allows you to run in multiple modes (so gives you more flexibility). With your pressure... it wouldn't be an issue using an Auto Bipap.

[ZeroDigger]

It appears that I don't have a choice. I contacted my sleep doc to inquire whether the prescription could be modified to allow an auto-bipap. The answer was no. I was told that an auto-bipap was ten times more expensive than a regular bipap, and that it was not medically necessary.

[cflame1]

then at least make sure that they don't stick you with a Bipap Plus (I'm guessing that you're sticking with a PR machine). It's not data capable.

[jnk]

An autobilevel is NOT that much more expensive than a bilevel.

For example the two of one brand on one site are the exact same price:

http://www.cpapsupplyusa.com/CPAP-Depar ... esMed.aspx

(If you buy, though, buy from our sponsor, who gives a better price or price matches: https://www.cpap.com/cpap-machines/bipap-machine.php I only linked to the other site because I don't think our sponsor sells the S.)

Insurance doesn't even know the difference, as I understand it, since both bilevel and autobilevel are, to my knowledge, the exact same insurance code.

My sleep doc didn't want to write an Rx for autobilevel, either. But at my insistence, he eventually wrote on the Rx: "Patient may use BiPAP Auto." That allowed him to feel he didn't actually prescribe it, just allowed it, but those words then allowed me to tell the DME that I would not sign for anything but an autobilevel (another name for BiPAP Auto), since the word "auto" was on my Rx.

As has been said, though, it is much more important to fight for a machine that gives you data than it is to fight for an auto, although I believe it important to fight for an auto if you can.

[rested gal]

An autobilevel is NOT that much more expensive than a bilevel.

Right.

Insurance doesn't even know the difference, as I understand it, since both bilevel and autobilevel are, to my knowledge, the exact same insurance code.

Right again.

A bilevel auto machine is... (in Medicare and in most insurance companies' eyes) ... first and foremost a bilevel machine. It's a bilevel machine that happens to be able to autotitrate the two bilevel pressures if autotitrating is turned on, but even then it is still operating as a bilevel with separate exhale/inhale pressures. ResMed's VPAP Auto and Philips Respironics' System One Bipap Auto are bilevel machines. They are bilevel machines that have an autotitrating bilevel mode...but still ARE bilevel machines -- both for treatment purposes and for insurance and Medicare billing purposes.

My sleep doc didn't want to write an Rx for autobilevel, either. But at my insistence, he eventually wrote on the Rx: "Patient may use BiPAP Auto." That allowed him to feel he didn't actually prescribe it, just allowed it, but those words then allowed me to tell the DME that I would not sign for anything but an autobilevel (another name for BiPAP Auto), since the word "auto" was on my Rx.

Why am I not surprised that you persuaded your sleep doctor to add that magical phrase onto his Rx for you, Jeff? What a clever "work around" you came up with!! I like that!

As has been said, though, it is much more important to fight for a machine that gives you data than it is to fight for an auto, although I believe it important to fight for an auto if you can.

Excellent point.

For new readers -- "data" (sometimes called "full data" on the message board) is "AHI" and "Leak" info. The AHI would tell the number of apneas and hypopneas that are sneaking through despite treatment... an average number per hour of events that the machine was not able to prevent. If a "treated" AHI is above 5, that can be an indication the prescribed pressure of a CPAP (or the minimum pressure of a CPAP in autotitrating mode, or the EPAP pressure of a bilevel, or the "minimum EPAP" pressure of a bilevel in autotitrating mode) might need to be set a little higher.

Some machines can record and show that kind of data, but more basic ones can show only "hours of use."
Here's a link that might be helpful to you when the time comes to accept (or reject) whatever machine the DME tries to give you. You'll want a machine that can record leak and AHI info. The ones in blue do that; the ones in red do not:
viewtopic.php?p=307168#p307168

[robysue]

It appears that I don't have a choice. I contacted my sleep doc to inquire whether the prescription could be modified to allow an auto-bipap. The answer was no. I was told that an auto-bipap was ten times more expensive than a regular bipap, and that it was not medically necessary.

As others have told you there is little cost difference between a straight bilevel (with full data) and an auto bilevel.

There are, however, much more expensive and fancier bilevel machines with timed back up rates vs. spontaneous breaths (so called S/T models) and "bil-level" ASV machines which are much more expensive than the standard bi-level and are billed under a different code. Although your sleep doctor ought to know the difference between the following machines:

• PR System One REMstar BiPAP Auto with Bi-Flex
  PR System One REMstar BiPAP ST Machine
  PR System One REMstar BiPAP AVAPS Machine

there's still a good chance that either the doctor doesn't know the difference or the doctor thinks you think you are taking about the second or third machine on the list instead of the first. (I say this as someone who spent a good week and a half educating my usually good DME that the "V" in the Resmed VPAP Auto 25 stood for "variable" (i.e. "auto") instead of "ventilator.")

Your DME doesn't need anything beyond a prescription for "bi-level machine at IPAP=*cm and EPAP=**cm" to order the PR System One Bi-Pap Auto or the Resmed VPAP Auto 25. You might try talking to the DME as well as educating the doctor by printing out the Cpap.com descriptions of the Auto Bi-Paps that you would be willing to have.

[jnk]

My sleep doc didn't want to write an Rx for autobilevel, either. But at my insistence, he eventually wrote on the Rx: "Patient may use BiPAP Auto." That allowed him to feel he didn't actually prescribe it, just allowed it, but those words then allowed me to tell the DME that I would not sign for anything but an autobilevel (another name for BiPAP Auto), since the word "auto" was on my Rx.

Why am I not surprised that you persuaded your sleep doctor to add that magical phrase onto his Rx for you, Jeff? What a clever "work around" you came up with!! I like that!

Thanks, RG. But in that shortened version I gave, I may have given myself too much credit. This is the long version the way I remember it.

I asked him to prescribe autobilevel specifically. He said, "No, insurance doesn't like to pay for that." I said, "Let me worry about insurance. If I can benefit from auto, that's what I would like to have." He then said "OK."

So at first I was expecting "auto" to be prescibed outright. He didn't. The wording "patient may use BiPAP Auto" was wording he chose, not me.

The first machine that the DME brought was not an auto, although I thought it was. When I discovered it wasn't, I called my "insurance" people (they aren't really insurance in my case, because of the way my healthcare is paid for, but they use the same codes), and I told them that I had accidentally received the wrong machine. They spoke to the DME and the DME called me. That is when I told them to come get their machine, and then that was when I pulled the line about not signing for anything but an autobilevel, since the word "auto" was on the Rx and my "insurance" people didn't mind. Because of the education I got at this forum, I told them specifically which machine I wanted. At first they brought me a brand other than what I was expecting, so at that point I actually refused to sign for that machine. That is when I got my present machine.

Anyway, it was a fight.

I just wanted to clarify that I didn't come up with the wording the doc used. That was his wishy-washiness and was just his way of trying to appease me in what I was insisting on. And he must misunderstand the whole insurance issue, since he thought insurance cared whether I would get an auto or not.

I no longer deal with that DME. (I really don't think they miss me at all, either. ) My masks and supplies now come from cpap.com, as will my next machine, since my "insurance" people have agreed to reimburse me for what I buy according to their schedule if I forward to them the forms cpap.com sends me each time.

[rested gal]

Thanks, RG. But in that shortened version I gave, I may have given myself too much credit. This is the long version the way I remember it.

I asked him to prescribe autobilevel specifically. He said, "No, insurance doesn't like to pay for that." I said, "Let me worry about insurance. If I can benefit from auto, that's what I would like to have." He then said "OK."

(bold red emphasis, mine) -- For using that sentence, you still deserve 99% of the "credit."

And you got the other 1% back when you dealt with the DME...

So there.

Please don't change the version again. I want to continue admiring you!!

[jnk]

the "credit."

Thanks, RG.

But in my mind, that goes to those of you then participating in the online forums when I was trying to figure everything out. Without you folks, I wouldn't have had a clue.

I was so brain-dead back then, I'm surprised I remember much of those discussions with the doc at all.

[ZeroDigger]

I forgot to add that the doctor said "There is no advantage regarding compliance or effectiveness in using an auto-titrating BiPAP."

Has anyone seen anything that might be used to refute this?

[jnk]

I forgot to add that the doctor said "There is no advantage regarding compliance or effectiveness in using an auto-titrating BiPAP."

Has anyone seen anything that might be used to refute this?

I would ask my doc to produce proof that there is an advantage regarding compliance or effectiveness in using a NON-auto-titrating BiPAP.

Good doctors care about the comfort of their patients, whether the patient is willing to be uncomfortable or not.

There is no proof that dental work is more effective with pain-killers, either. But dentists who care about their patients are interested in it.

An auto-titrating machine has the ability to run in non-titrating mode. So with an auto, you will have the ability to run in the mode that is most effective and comfortable FOR YOU.

Bottom line is that your doc, your insurance, and your DME people will sleep just fine, whether you get an auto or not. So they have no reason to care whether or not you have one. You do have a reason to care. And you are the one who will, or will not, sign for the machine the DME tries to give you. And if that DME doesn't care what you want, hopefully you can find a DME who does. And you can make that demand whether your doc prescribes it or not, since the DME will be writing down the same insurance code either way.

You are the one who will be sleeping with the machine every night. It matters to you. And your comfort should matter to good medical people. And there is no proof that medical people's ignoring the comfort wishes of patients improves compliance or effectiveness.