AT LAST!

After several months has gone by since my titration, I have an appointment for Weds. to hopefully get my BiPaP.
I will be getting it from my DME, as my insurance will take care of everything but $300-500. It would cost me way way more if I bought it outright from Cpap.com.
I do feel some trepidition, though. When the rep called me Friday to set up the appointment, I told her I wanted the Resmed Ultra Mirage FF mask.
She said, "Well, we don't have any of those here." I said, "Isn't that the mask I was titrated on?"
Rustle of papers. "Yes."
me: "Well, that's the one I want."
her: "What size do you wear?"
me: "DONT YOU HAVE THAT INFORMATION FROM MY TEST?"
her: more rustling of papers. "No. You probably need the small or medium."
She said she'd check the other office and if they didn't have it, would order it.
I have this sneaky feeling that I will go Weds. and she'll try to palm off another mask on me.
I will refuse.
I've waited this long, I'll wait until she gets what I WAN'T, dangit!

I can't believe they didn't write down what size I titrated with. This complete lack of efficiency agrees with the fact that I was titrated and never saw the doctor, but he wrote a script for a plain Cpap, without looking at my medical information which showed I have COPD. It took me insisting on a visit with him to discuss this in order for me to get a script for a BiPap.
~Betty~

Hi Betty,
Beginning Wednesday, welcome to the club! I commend you for being assertive with your DME provider. Don't let them push you around. Check on your sleep study. My last one had the mask type and size written on it. If you don't have a copy of it, get one. You are entitled to a copy of it, and it has a lot of important data on it that you may need if, like many of us, you find you have to be highly proactive in your treatment. Get the whole study (10-15 pages) not just the summary page. If they didn't write it on there, go to CPAP.com and check out their mask sizing guide. Using the measurements they suggest, you can properly size yourself. I wish you a painless adjustment period and a lifetime of restful sleep!

I was a bit sneaky in getting mine. Called the sleep center and told them that my doctor did not receive it and he needed it faxed. (which was true) However, I gave them MY fax number. I then forwarded it to my doc. The things we have to do to get our own info...

Talk about sneaky, Mikesus!
I do have a summary of my study, nodding off. I guess I thought that was the whole thing. I don't think the mask size is stated. I just looked for my copy and have misplaced it.
I'll ask when I go up Weds. for the complete study. I figure if we or our insurance companies pay for it, we are entitled to the paper, right?
I feel sorry for my sister. She's on Medicare, and they gave her the straight Cpap with passover cold humidification, not heated. It's a rental.
She said it was freezing her to death. (And she's on the south Texas coast, not cold down there)
She woke up the other night and said it felt like her teeth were frozen, and now she's gotten sick, I think a sore throat. She's a mouth breather like me.
I told her to call her provider and make like a squeaky wheel.

Mikesus!!! (Good boy! )

Betty, actually Medicare seems to be good (better than some private insurance plans) about the kinds of equipment people can get and how often they can get replacements.

If a person knows what to ask for and has a cooperative doctor, all the doctor has to do is write a prescription for the specific things your sister wants -- or the things you tell her "she wants" If she can get her doctor to prescribe those specific things, the DME will have to get them for her and Medicare will pay.

Example: My uncle is almost 80. He's been on straight cpap for over ten years. Medicare has been paying all along. The DME never was checking with him to see how things were going in all that time. He's had the same mask for the last five years!! It's lasted that well because he's been almost totally non-compliant. What mask was it? Whaddya think...one of those "Comfort" things that almost all DMEs push.

Enter "me" at the family Thanksgiving dinner last year. Subject of sleep apnea came up. (Wonder who would be so crass as to mention something like that while everyone is relaxing and snoring after a family dinner?!! heheh.) Anyway, my aunt said, "Richard has that, too. He has a machine." Wow. First I'd heard of his having it despite all the family getting together every year! He's had asthma all his life - the DME had him on straight cpap with no C-Flex and no humidifier, all those years.

Well, as you can imagine, I went into high gear. Within a short time my uncle's doctor had written him a prescription with it all spelled out: Respironics Remstar Auto with C-Flex and heated humidifier and Activa mask. The DME filled the order immediately and Medicare paid for all of it.

He's using his new setup regularly now. He couldn't believe how much more comfortable the Activa was, and how much better warm, humidified air felt. I installed the software for my aunt and she bought a card reader from cpap.com. His data looks great (I'd kill for that beautiful low leak line he gets with no tape! lol)

His titrated pressure of 12? Well, it's been many years since that one study, but his weight hasn't changed much since then. Now, with his autopap set for 6 - 15, he stays at 6, 7 and 8 every night with an AHI usually well below 2. He never has come close to hitting a pressure of 12 yet.

Long story. Point is, your sister needs to get her doctor to prescribe what she needs, starting with a heated humidifier right away! Medicare absolutely will pay for things like that.

If she wants an autopap (and if her doctor will prescribe it) Medicare will buy that too. An autopap is considered a "CPAP" machine for Medicare billing purposes. It's an auto-titrating CPAP machine. If the doctor prescribes an autopap for your sister, the DME will have to fill the order with an autopap, and Medicare will pay for it...will pay "cpap" price. Medicare will pay for a bi-level machine too, (like a BiPap) and does have a separate billing code for a bi-level machine.

Some DMEs are not going to volunteer that kind of info to your sister, or even worse, might try to mislead her into thinking Medicare won't cover an autopap because there's no separate Medicare billing code for "autopap". What the DME would rather not tell her is that an autopap does fall under the "cpap" category as far as Medicare is concerned.

That's often the reason why some DMEs discourage autopap - they won't make as much profit since Medicare is going to reimburse them only for "cpap", whether the machine is what we think of as a straight cpap - or is an autopap.

You've armed yourself so well to stand your ground, Betty. I'm betting you can help your sister fight for what she needs, too.

You told her right:

I told her to call her provider and make like a squeaky wheel.

Rested Gal,
I copied everything you told me and sent it to my sister by email just now. I told her knowing the information you gave was half the battle, the other half is getting her doctor to JUST DO IT.
Thanks so much.<bowing down and paying homage to Rested Gal) My sister is a sweetie, but she just doesn't know how to fight for what she wants in this new arena of her life, because she doesn't know anything but what they tell her.
This is what I got from my doctor after I was prescribed the straight Cpap, but wanted the Auto. I waited several weeks to get in to see him. When I asked him for a new RX, this is what he said. (I didn't get to see the Pulmonologist connected with the sleep lab, so the RX had to be written by my family doctor. They told him what to write and that's what he did.)
"It sounds like you've done your homework, and it sounds like the machine you want is what you really need. (considering my asthma) But I don't know anything about Cpap machines, and don't want to get into that. I suggest you get an appointment with Dr. Lewis (Pulmonologist with the lab) and let him take care of it."
So I get an appt. with Dr. Lewis for a month away, even though I explain I need surgery and need to get in as soon as possible. After 2 1/2 weeks, with my torn rotator cuff hurting me worse and worse, and causing me as many sleep interuptions as the OSA, I called them and raised a little hell for my appt. to be moved up. I got it moved up by one week. That's when Dr. Lewis said I needed the BiPap and wrote a new RX for it.
After I get my Pap, I will get a pulmonary function test and then get a clearance from my cardiologist, as I will be under anesthesia for at least 1 1/2 hours during the shoulder surgery, and the surgeon won't do it without clearance from both doctors.
Once that is done, I will schedule surgery. Hopefully the BiPap will work well enough to enable me to sleep on my back after surgery and BREATHE, Thank You Lord.
Meanwhile, I have one semi-healthy shoulder to sleep on, and it is getting sore and inflamed. I have to use a pillow under the shoulder with the torn cuff to support it. The other night, after repositioning the pillow, my arm rotated inward in a loose, unnatural way and I felt a tremendous pain shoot through my shoulder, almost like the rotator cuff tore a little more. I find I am waking up on my back or semi-back because of all of this, and my apnea events are higher. I wake up constantly all night long, with my chest feeling stressed.
A lot is hinging on Weds., and hopefully I will come home with what I need.
Betty

Betty