Where do I even begin

[hairfallingout]

I really do want insurance to pay for it.

+1

I will be calling again this week for updates and what this waiting for clinical mean.

Ask to speak to a supervisor. Tell the supervisor the prescription calls for a bi-level (E0470).

I will say I live in Louisiana and this state is arse backwards it’s not funny.

When it comes to DMEs and insurance companies, you can multiply that by 50 states.

You mean E0471 ?? not E0470 ??

[Pugsy]

You mean E0471 ?? not E0470 ??

No. E0471 is for a different bilevel machine that will act like a ventilator and essentially breathe for you.
These are use for people who have central apnea and just stop breathing. They have what is called a back up rate available.
As opposed to obstructive apnea where people still try to breathe but they can't because airway tissues are obstructing the airway and no air can move.

E0470 bilevel machines don't have a back up rate available...they can't breathe for you.
Your RX doesn't mention back up rate at all.
E0470 is the correct HCPCS billing code per your RX.

machine codes.JPG

[hairfallingout]

Thank you, so for E0470 the respironics dreamstation DSX700T11 would work then?

[Pugsy]

Yes, that DreamStation model DSX700xxx will meet the requirement of the RX and the HCPCS billing code is E0470.

I don't know why your doctor specified PS range of 3 to 8 unless he was thinking it would help you get auto bilevel.
Sometimes the docs don't know the finer details available for each brand and model.
But the PS having a range means the Respironics bilevel auto.
ResMed has a similar bilevel auto but it doesn't offer a PS with a range...meaning the PS won't/can't change.
I have never been able to figure out why people might want or need a range of PS in this type of bilevel machine.
I understand the need for it with the ASV bilevels but never could find documentation for why someone might need to go with an auto adjusting PS with this type of model machine. I actually own an older big brother (prior discontinued model) to the DreamStation BiPap Auto...it has the PS range too but I never found it to do much even when it could.

Just because it can roam around between 3 and 8 doesn't necessarily mean that it will roam.

[hairfallingout]

Insurance and doctor basically wanting me to use the auto before the bi pap auto, This is the craziest BS I have ever seen. When I tried the family members auto machine for 4 hours i woke up like i was DRUNK and even more tired then ever. It scared the hell out of me, I didn't like that at ALL, I couldn't believe how tired it made me feel.

[ChicagoGranny]

When I tried the family members auto machine for 4 hours i woke up like i was DRUNK and even more tired then ever. It scared the hell out of me, I didn't like that at ALL, I couldn't believe how tired it made me feel.

But, you have zero idea whether the Auto's settings were correct for your condition. You also don't know if a more expensive bilevel would treat your condition better.

Get over your preconceived notions and start cooperating with your medical team. Download OSCAR software (see my signature) and get help from the forum to learn how to use it.

Many of us are here because the medical profession did not serve us well. But, you have yet to give them a chance.

[hairfallingout]

I don't trust my medical team thats why I'm here LOL After my second visit I lost trust.

[Okie bipap]

A lot of people are here for that same reason. My current settings are close to what I was prescribed. During the last four years, I have played around with my settings, and ended up where I am now. My pressure stays within a small range (less than two cm) on most nights.

[TropicalDiver]

Insurance and doctor basically wanting me to use the auto before the bi pap auto, This is the craziest BS I have ever seen. When I tried the family members auto machine for 4 hours i woke up like i was DRUNK and even more tired then ever. It scared the hell out of me, I didn't like that at ALL, I couldn't believe how tired it made me feel.

All due respect, it is not crazy. In medicine, some approaches (less expensive, less invasive, or a lesser risk profile) are often tried before others. This sort of thing plays out in imaging and pharmacy often.

You tried one night with a borrowed machine. We have no idea whether the settings were optimal for you nor whether the mask fit well. A bi-level machine would not address any of those concerns. You still have to get the settings dialed in. Yes, a bi-level does provide you with more options.

And, almost every first night, including mine, was awful. And, yes, that was with a bi-level.

People get frustrated with docs and insurers for lots of good reasons. But here they are trying to get you a machine to try...if you fail, they would go to the more expensive bi-level unit. I would also add the doc has done everything possible to get you a bi-level. Without demonstrated failure to tolerate CPAP, or the need for higher pressure support (which you are preventing), there is nothing more any doc can do for you.

[hairfallingout]

I get what you are saying but like others have said on this forum take control and do whats best for you, I see that now. I will spend my money where I want i will not let someone decide for me. My money my life.

[babydinosnoreless]

I get what you are saying but like others have said on this forum take control and do whats best for you, I see that now. I will spend my money where I want i will not let someone decide for me. My money my life.

Others are saying you do not know yet what is best for you. An auto pap might be sufficient. I am on a bilevel and it is no picnic if I could use a regular cpap I would be thrilled. Your money your choice. Insurance money, their choice.

[TropicalDiver]

Others are saying you do not know yet what is best for you. An auto pap might be sufficient. I am on a bilevel and it is no picnic if I could use a regular cpap I would be thrilled. Your money your choice. Insurance money, their choice.

Very well said.

[palerider]

Insurance and doctor basically wanting me to use the auto before the bi pap auto, This is the craziest BS I have ever seen. When I tried the family members auto machine for 4 hours i woke up like i was DRUNK and even more tired then ever. It scared the hell out of me, I didn't like that at ALL, I couldn't believe how tired it made me feel.

And an Auto Bilevel can be much much worse than an auto ever could, if set incorrectly.

[hairfallingout]

Time will tell, I didn't have a good experience with a week of the auto, four hours sleeping with a auto I felt more tired then not using it. Dammed if you do dammed if you don't I suppose.

[zoocrewphoto]

Time will tell, I didn't have a good experience with a week of the auto, four hours sleeping with a auto I felt more tired then not using it. Dammed if you do dammed if you don't I suppose.

A lot of people feel that way when they first start out. And then once they have better settings, the right mask (fitting well), they start to sleep better and then feel better. Without getting a new machine. Nobody starts out used to sleeping with a mask on their face. That alone causes people to toss and turn, wake up more, and not feel good. This is not an easy treatment to get used to, regardless of which machine we use.

Now, consider how many people quit using their machine. Insurance companies usually have a compliance period before they pay for the machine in full. This is because so many people quit. They would be downright stupid to go ahead with a more expensive machine if it isn't needed. For example, our sponsor has the Airsense 10 Autoset for $883. The Aircurve 10 VAuto Bilevel machine is $1726. That is almost double! They don't want to pay that kind of money when it isn't needed. And most people do NOT need anything nore than the regular auto machine.

If you want insurance to pay for the machine, you need to jump through the hoops. They have not singled you out. This is standard practice, and has been for many years. Make an honest effort to use your machine. Let us help you adjust your settings and make the most of the auto machine. Don't base your whole impression of cpap on one week of using a machine when you had no idea what settings to use. Even with a good titration, it can take much longer than that to get used to the machine, the sounds, the feel of the mask, etc. I had the right mask when I started, and the right settings. But it took me 6 weeks and a new, smaller headgear before I got the mask fitted well. Sis WEEKS of fighting with the mask, wanting to throw it across the room. Loud leaks. Hard to sleep. I got through it. I did not need a different machine of even a different mask. Just smaller headgear to make it fit better.

Give yourself a chance to succeed.