help - calling ENT today to ask for APAP

jcarn · Post by **jcarn** » Tue Dec 20, 2005 7:10 am

Hi all,

My doctor left a message for me that he had an answer on my request for an APAP prescription (neither YES or NO ,, I have to call back today). Before I call them back I need some ammo in case they shoot it down.
Right now I have a F&P CPAP 234 which is set at 13 .. I find that the constant pressure keeps waking me up late into the night. I think that something automated will relieve this .. I also want to monitor my sleep data. The 2 machines I am considering are the REMStar Auto and PB 420E.
I have TUfts insurance and I want them to cover this.
What's a good strategy when calling back my doctor to convince him that I need the APAP?

Thanks ..

smyles · Post by **smyles** » Tue Dec 20, 2005 8:24 am

I was recently successful in obtaining a new APAP w/HH. I went to my ENT and explained a feeling of a lack of quality sleep with a sore throat and chest discomfort from the pressure. My pressure is 14. I too experience walking up at night due to the discomfort of having to exhale against the "high" pressure. I asked him to write a prescription for APAP w/C-Flex and a HH. He conducted a physical exam of my nose and throat and concurred that my therapy would be enhanced with the use of APAP and HH. He wrote the prescription. The insurance company was another matter. It took 3 weeks of "negotiation" to obtain the APAP. Do NOT let the insurance company/DME weasel out with excuses. If your assertive, you'll get what you need.

jcarn · Post by **jcarn** » Tue Dec 20, 2005 8:58 am

thanks .. I made the call.
Spoke with the doctor's assistant. She told me that there was no such thing as an APAP .. lol
But, the doctor would send a prescription for an auto titration machine to determine the correct pressure for me. After a month when they see the right pressure, a CPAP would be setup. Funny stuff.
Basically, they will send the prescription to the DME and it's outta their hands. I can probably talk to the DME and have him set me up with something nice and permanent for my needs. Then it's up to my insurance to OK it.
420E or RemStar auto?

popcorn machine · Post by **popcorn machine** » Tue Dec 20, 2005 11:58 am

jcarn,

APAPs and CPAPs have the same billing code, so your insurance will pay the same price whether you get an APAP or not. This is why DMEs are reluctant to provide you with an APAP because they are more expensive for them to buy. Usually the only way to get an APAP out of the DME is to have your Doc specifically insist on one. It sounds like your Doc does not want to do that.

You can always buy one yourself... online.

Colorado Jan · Post by **Colorado Jan** » Tue Dec 20, 2005 12:06 pm

You need to go back to your ENT and educate him on what is available on the marketplace. Sounds like he really doesn't know....

Jan in Colo.

jcarn · Post by **jcarn** » Tue Dec 20, 2005 12:21 pm

The ENT said they will forward a prescription for the auto titration machine to the DME .. I'll cross my fingers and get ready for battle

ozij · Post by **ozij** » Tue Dec 20, 2005 1:25 pm

In addition to the above:
Insist on recieving a copy of the Rx. You can then use it to buy online if you want to.

Once you've got the auto titrating machine in your hands, insist on seeing the full details of the therapy.

Compliance data is what the insurance company needs to convince them that paying for your machine isn't a waste of money - you really use it. Breathing events data is what you (and hopefully your doctor too) need. If you pressure needs are variable the proof of the pressure changes will be in the data.

I mentioned my multifocals, which correct my vision depending on my eyes' position, and said I want my CPAP to to the same - adapt to my needs - higher pressure when I'm on my back, lower when I'm on my side.

You can also try to mention insuline - the amount a person needs is variable.

O.

popcorn machine · Post by **popcorn machine** » Tue Dec 20, 2005 1:58 pm

jcarn wrote:The ENT said they will forward a prescription for the auto titration machine to the DME .. I'll cross my fingers and get ready for battle

jcarn,

ozij is right! best to have them send the prescription to you. Then you can take it wherever you want to buy.

Cpaper Incognito · Post by **Cpaper Incognito** » Tue Dec 20, 2005 2:41 pm

[quote="popcorn machine"]jcarn,

APAPs and CPAPs have the same billing code, so your insurance will pay the same price whether you get an APAP or not. This is why DMEs are reluctant to provide you with an APAP because they are more expensive for them to buy. Usually the only way to get an APAP out of the DME is to have your Doc specifically insist on one. It sounds like your Doc does not want to do that.

You can always buy one yourself... online.

popcorn machine · Post by **popcorn machine** » Tue Dec 20, 2005 3:58 pm

Cpaper Incognito wrote:
Cpap's and Apaps aren't as inexpensive as popcorn machines, so do the math and do what is best for you.

-CI

CI,

My popcorn machine cost 3 times as much as the two APAPs I've purchased... but somehow I think that is irrelevant to anything jcarn was asking.

jcarn · Post by **jcarn** » Tue Dec 20, 2005 8:32 pm

I have 3 masks:

- Ultra Mirage II (My first mask .. asked for a nasal mask)

- Breeze (My DME gave it to me, made a special trip because I asked for it. Didn't even charge me)

- Aiomed Aura (bought it from CPAP .. currently my fav)

Done the mask thing .. Now I just want the best machine.

Linda3032 · Post by **Linda3032** » Tue Dec 20, 2005 10:48 pm

I got my rx from my doctor (only saw him the once in over 2 years - lol - typical in rural Arkansas). Then I checked with my insurance company (Tricare Standard - government insurance for military - similar to medicare). I asked them if I could buy my own equipment and get reimbursed from them. Answer was yes, and long as I sent them my prescription when I sent in my filing.

Moral of the story - CHECK WITH YOUR INSURANCE COMPANY TO SEE IF YOU CAN BUY AND GET REIMBURSED. As others have said, the insurance code is the same for CPAP and APAP. My insurance company could have cared less which one I bought - plus I saved them bunches of money by not going through a DME.

Good luck.

OH by the way - I love my Remstar Auto - my one and only.

Cpapper Incognito · Post by **Cpapper Incognito** » Wed Dec 21, 2005 6:10 am

[quote="jcarn"]I have 3 masks:

- Ultra Mirage II (My first mask .. asked for a nasal mask)

- Breeze (My DME gave it to me, made a special trip because I asked for it. Didn't even charge me)

- Aiomed Aura (bought it from CPAP .. currently my fav)

Done the mask thing .. Now I just want the best machine.

popcorn machine · Post by **popcorn machine** » Wed Dec 21, 2005 7:11 am

Cpapper Incognito wrote: And Popcorn Machine, if your popcorn machine cost more than both of your CPAP's, you must be running a regular Circus there

No Circus...just Pop!...Pop!...Pop!

jcarn · Post by **jcarn** » Wed Dec 21, 2005 7:22 am

I modified my humidifier settings, soldering in a turbo chip. Now my CPAP machine is perfect for popping corn .. just add butter!

Humidifier

Additional Comments: Auto range 11-15

Humidifier

Additional Comments: Auto range 11-15

Humidifier

Additional Comments: Auto range 11-15

Humidifier

Additional Comments: Auto range 11-15

help - calling ENT today to ask for APAP

help - calling ENT today to ask for APAP

APAP's are good!