Help with prescription

[_details_]

I need some help getting my prescription correct so my family doctor can help me get a new BiPAP machine.

Short version: My ResMed S9 has been displaying an "End of life" message for quite some time. I tried contacting the sleep clinic that originally prescribed it, but they won't talk to me because I'm "no longer a patient." My family doctor was willing to write a prescription using the settings from the setup screens of my machine. When I attempted to buy a machine, I was told the only machines that qualified for those settings were very expensive. I just need a BiPAP capable machine. How can I modify the prescription to remove the "complex" requirements?

Prescription: New Bipap. Max ramp 45 min epap 4.0 ipap 8.0 epap 5.8 TI max 3.0 min 0.3 Risetime 300

Long version: When my ResMed S9 hit 10 years old it began displaying an "end of life" message. I contacted the sleep center where I originally got the prescription and didn't hear back. After leaving four or five messages with no reply, I finally got lucky and someone answered. I spoke to an unhelpful person who told me that I wasn't a patient since I hadn't been there since about 2021. After COVID they didn't call me to set up any appointments and I just forgot about it.

After that interaction, I explained to my family doctor the issue I was having and he volunteered to write a prescription. He used all the settings from the clinician screen of my S9. When I sent that prescription to cpap.com (whom I’ve order supplies from for years) they could only sell me machines that were much more expensive than I was expecting. Fearing my insurance company wouldn’t cover the excess cost, I stopped the transaction and kind of gave up.

I need to take care of this before the machine actually stops working as it’s been over a year since the message began appearing. I don’t have any complex breathing issues that, from what I can tell, are triggering the need for a more complex machine. The only “complex” thing that I need is a Bipap machine.

I’ve reproduced the text of the prescription above. What parts of it are causing me issues? What can I tell my family doctor so he can simplify the prescription?

This community was SUPER helpful when I began my journey and I’m hopeful that you will come through for me again. Thank in advance for your help.

[Pugsy]

When I sent that prescription to cpap.com (whom I’ve order supplies from for years) they could only sell me machines that were much more expensive than I was expecting.

What were you expecting/hoping to pay cpap.com?
Will your insurance reimburse you if you bought from cpap.com?
They don't carry inventory of the bilevel machines that are ultra expensive and for people who have a problem with central apneas....so I don't know what price you were quoted and what machine you were looking at.

This is the latest ResMed version of their bilevel machines that cpap.com carries
https://www.cpap.com/products/resmed-ai ... 0750117180
It's on sale right now.

I think that you had more information written in the RX than is needed to justify purchase and that may have caused some confusion.

What exactly is the full model name of your current S9 bilevel machine?

All you need to purchase is....
full exact model name and brand with these settings
Minimum EPAP
PS
IPAP either max or fixed depending on what your current machine is and mode used.

Prescription: New Bipap. Max ramp 45 min epap 4.0 ipap 8.0 epap 5.8 TI max 3.0 min 0.3 Risetime 300

These settings don't make sense
And you don't need to list TI max or rise time on the RX. Usually the settings for those values are left alone and not changed from factory defaults unless some special circumstances are in play. For the majority of people the factory defaults are quite adequate.
The main EPAP and IPAP and PS (pressure support) are needed and wording depends on if you are using fixed or auto adjusting pressures.

[Pugsy]

Picture of current machines with settings??????

[Pugsy]

Just remembered...you may have the S9 bilevel in fixed mode or the S model machine which only has a fixed mode and not a specific PS/pressure support setting. PS is just the difference between inhale and exhale and in S or fixed mode you only have EPAP and IPAP settings beyond those factory defaults that I mentioned above.

I am quite familiar with the ResMed bilevel machine because I have used one for years but I use the auto adjusting mode.
I have had the S9 version as well as the AirCurve 10 model which I currently use and I did the same thing....I got my PCP write a script for the AirCurve 10 VAuto. He didn't have a clue what to write so I wrote it for him and told him to sign it. Which he did and I got it from cpap.com.

[_details_]

First, thank you for your replies.

I was expecting prices under $2k, not over $3k, lol. My insurance should reimburse me at their normal rates. My fear was they would balk at a machine over $3k and I’d be responsible for the excess, or even all of it. I’m not sure what machines they offered me as this was several months ago and I was in shock at the price. They said to meet what was in that prescription they only had the high end machines.

image2.jpg (254.24 KiB) Viewed 271 times

image3.jpg (207.67 KiB) Viewed 271 times

[_details_]

Two more images

image1.jpg (180.42 KiB) Viewed 271 times

image0.jpg (193.5 KiB) Viewed 271 times

[Pugsy]

ResMed part number 36006A is the ResMed S9 VPAP Auto, an auto-adjusting bi-level positive airway pressure device designed to treat obstructive sleep apnea and provide comfortable breathing support.

Your current machine does have Auto adjusting mode as well as the S or fixed pressure mode.
That's the machine I used when I was using the S9 model but in Auto adjusting pressure mode.
If you are happy with the results in S (fixed pressure so no auto adjusting of the pressure) there isn't any reason to use the auto mode at this time but the S mode machine isn't all that less expensive compared to the model that will have the Auto mode available and at some time in the future you might want to try auto adjusting mode so I suggest you get the model that will/can auto adjust the pressure.
Better to have it and not need it than not have it available.

Max ramp isn't a setting per se....it's the factory default setting and only of use if you have ramp turned on for a set time frame.
Shouldn't need to be turned on with your rather low settings anyway.

Your current settings (once any ramp is satisfied) are
EPAP 5.8
IPAP 8.0
and that makes your PS 2.2

I’m not sure what machines they offered me as this was several months ago and I was in shock at the price. They said to meet what was in that prescription they only had the high end machines.

Whomever told you this doesn't know their machines but it sounds like they thought your settings were for the high end bilevel machine model which is the ASV mode and yours simply isn't. Now if you got that high dollar price from a DME/equipment supplier that might well be the retail or price they bill the insurance company. Brick and mortar suppliers who file insurance often bill out at a higher rate....either that or they are just stupid. Your bilevel machine is NOT an ASV machine at all and ASV machines are usually billed out to insurance at something in the neighborhood of $5K. Insurance always reduces that high dollar billed amount though and if the DME/supplier has a contract with your insurance company then they have to write off the difference between billed out amount and the allowed or approved amount.

The machine I linked to in my first post would be a great machine for you and it's on sale now at cpap.com for around $1350 down from original price of around $1800.

Now here's a different thought for you....your current settings don't require a bilevel machine anyway. The main difference between a regular cpap and a bilevel machine is the PS available.
Regular ResMed cpaps/apaps won't go higher than 3 cm PS (it's called EPR on the cpap/apap machines) but bilevel machines can offer much more of a difference between EPAP and IPAP if needed.
You are using only 2.8 PS right now. If you aren't having any problems exhaling and inhaling at these settings you could probably do just fine with the AirSense 10 or the newer AirSense 11 model.....the Autoset model of either.

So.....have I confused you?

Call up your equipment supplier and ask them about the cost to your insurance for the
ResMed AirCurve 11 VAuto.....which is what I linked to in my first post
or if you want to try the AirSense 11 Autoset because it will do either fixed or auto adjusting pressures like you are using currently.
Talk specific model names like I have here instead of just giving them the settings you see.

So...the RX needs to state exact brand and model name .....ResMed AirCurve 11 VAuto
and these settings
Mode S
EPAP 5.8
IPAP 8.0
and that is really all it needs to say besides "dispense as written" because you don't want them substituting some Chinese knockoff.

Or if you want the the AirSense model let me know and I will give you the wording for it.

Any questions?

[Sleepzilla]

The "REF 36006" product code on the label indicates the machine is an S9 VPAP Auto model. (model code reference here.)

The presence of Rise Time + TI Min/Max therapy settings indicates that it's configured for use in "S" (spontaneous) therapy mode. In a nutshell, S mode is simple fixed EPAP and IPAP pressure, triggered by the patient's spontaneous transitions between respiratory inspiration and expiration.

Currently available Resmed BiPAP machines with "S" mode and similar settings include:
AirCurve 10 VAuto
AirCurve 10 S
AirCurve 11 VAuto
AirCurve 11 S

Personally, I'd opt for the AirCurve 10 VAuto over the newer and more cheaply manufactured 11-series models. The algorithm, settings, and therapy efficacy are the same for both, but the 10-series machines are well-known for being built with better blowers, swiveling right-angle hose connections, and higher capacity humidifier tanks. Choosing a VAuto machine from either series gives you the option to switch from S mode to VAuto mode to experience auto-adjusting EPAP pressure between a min/max range, if desired to increase therapy comfort. The S-only model machines don't have this capability, which is why you only see the VAuto variants offered by CPAP.com and similar online CPAP/DME providers.

Hope this helps!

Edit: Just saw that Pugsy replied while I was typing mine.

[Pugsy]

Just to be clear....I have NOT used the latest Resmed AirCurve 11 VAuto.....It wasn't yet released when I got my machine a couple of years ago. I have tried the AirSense 11 AutoSet though....it's okay but I don't think it lives up to the hype.
But some people just want the latest and greatest of everything.
I probably prefer the 10 model series myself....like Sleepzilla..... but brick and mortar suppliers may not have the 10 series bilevels now.