Sleep Study Results

[CrazyLife]

Hi all. New to the forum.

I just received the results back from my first sleep study. It shows 34 Obstructive Apneas and 164 Hypopneas for an AHI of 33.3 (Severe). So it looks like I will be on CPAP in a few weeks. Lowest Sp02 recorded was 84% with an Sp02 < 90% of 27.6 minutes.

I have already done a lot of research on the forum regarding equipment and dealing with the DME provider. I talked to my sleep specialist today and asked him about writing a prescription explicitly for the Resmed S9 Autoset with H5i humidifer and heated hose and he said he could not write a prescription directly for an APAP machine unless the Sleep lab determines that it is truly necessary during my titration study (scheduled for next week). He mentioned that the APAP was harder to get approved thru insurance (it's not) unless there was evidence to support its use during the sleep study. I would prefer an Autoset due to its versatility which would really help as the number of desaturation events (have a AH-50D) on a day to day basis fluctuate from Severe to Non-existent.


So my question to you is how can I get the sleep lab to recommend an APAP over a CPAP? Do they normally try both machines during a titration study? Anything I can say to nudge them in the right direction?


Thanks in advance

[Pugsy]

I got the same song and dance about APAP when I first got diagnosed. As you know insurance doesn't care so that excuse doesn't hold water at all.
Assuming you are in the US...

They won't use cpap vs apap during your titration study. Instead they will manually titrate and do manually what the apap might do only they do it faster and in direct response to what they see on their reporting instruments.

You won't be able to nudge them to recommend apap unless you have significant differences in pressure needs like for REM sleep vs non REM sleep or supine sleeping pressure needs vs side sleeping or if maybe they can't get your OSA well controlled for some reason.

Now..that said...DMEs often can and will supply the APAP model machines and just set them to cpap mode pressures per the RX.
An auto adjusting pressure mode machine is still a cpap machine and that's why the same HCPCS billing code.
So you might have better luck searching for a DME that routinely supplies APAPs...and yes, there are some that do but they aren't always easy to find and having your insurance be okay with them might be another thing if they only want you to go to one DME supplier.

If you are going to a one stop shopping center for sleep study and machine and equipment...unless your insurance company has no one else that they work with you don't have to get your machine from a facility that wants to dig in their heels about your getting an APAP machine. You are free to shop for someone who wants your business. There's no reason that a S9 AutoSet can't be supplied in cpap mode with a single fixed pressure RX except that the DME makes more money on the Elite over the AutoSet or god forbid the Escape models.

Start by checking to see who your insurance company has as in network providers if you have that limitation on your coverage...then start calling DMEs and tell them..."I am going to be purchasing a cpap machine shortly...what machines/models do you typically offer...I want the S9 AutoSet (make sure not to let Auto Escape get into the conversation) because that's what I want"
and if they say "no, we don't/won't/can't" move on to the next supplier on the list.
Unless you are part of an HMO with really restrictive supplier lists...you can shop for whatever you want.

[CrazyLife]

Thanks for the advice!

I have 4 DME's to choose from just need to get a copy of my prescription once it is written. Not sure who I will need to ask to get a copy because the doctor mentioned he only makes a recommendation to the sleep lab and they write the actual prescription and send it off to a DME provider (they have a list of ones my insurance works with?). Seems a little shady to me but I won't sign for a machine unless its the one I specifically requested.

[poppi2]

My first machine was a brick. After discovering this forum, I bought an apap out of pocket.

I printed the blank prescription form on cpap.com, and my family doctor signed it.

Earl

[bwexler]

ANY DOCTOR OR DENTIST can write your prescription.
If you have a good relationship with your primary care doctor or dentist or psychiatrist or neighbor who is a doctor, any of the above may be willing to look at your sleep study report and write the prescription for what you want.
When I did my sleepsudy I took it to a friend wha had cared for my inlaws and he wrote the prescription for what I wanted.
He also happened to be a hose head and used an S9 Autoset as did his office manager. They sent me to their DME who happily filled the prescription. That DME did not even want to stop providing my supplies after the insurance company changed their policy to only allow one DME (not mine). They never tried to collect a dime from me even after the insurance stopped paying them and I had to convince them to stop sending supplies without getting paid.

Now my PCP writes all my prescriptions as required by his medical group. They have to pre aprove prior to submiting to the only DME they will pay (Apria).
Luckily my PCP is very cooperative when it comes to DME and writes exactly what I ask him to.

[CrazyLife]

Did some more research and it turns out that the Sleep specialist I am currently seeing works directly for the sleep lab and interprets all of their results for them. Prescribing an APAP machine would be a conflict of interest for him as he has a financial incentive to send patients to the sleep lab for titration studies. Looks like I will be scheduling an appointment with my Primary care physician to obtain my prescription.