New stuff, fight insurance :/

I m newbie and I have one question and any advice will be greatly appreciated

I got my results:

moderate obstructive sleep apnea/hypopnea syndrome 327.23, REM dependent, supine accentuated. the patient qualifies for CPAP
therapy based on medicare criteria

AHI : 16 events per hour
longest apnea 43 seconds
lowest SpO2 = 84 %
increased sleep latency

recommandations
consider one month trial of autopap versus cpap/bipap/ titration study.

I finished my trial in autopap (respironics 1 month), I slept well, no problem, sometimes I waked up to restart the machine because
a lot of pressure inside the masque. ( every two nights). My mask leaks because I put a nasal pad.
october, wednesday 20 th , I went from my local DME with a philips respironics remstar plus system one. (rent machine).

Now, I have a lot of difficulties to expire inside the masque. I have also a lot of pain in my ears, in my chest/stomac,
and I feel like a ballon after to use the machine.I think it's because it's a CPAP machine and the pressure it's 12. I put the ramp but it's the same after 20mn.
I can't put this machine anymore. Now I sleep without it.

I would like to have a resmed s9 autoset , I want monitor my sleep and see how many apnea, i have during the night.

but it's impossible because the nurse said : you need to wait 1 month (our policies) to see if you can adapt with this
machine. My DME said if the physician prescribe a resmed S9 , I will buy it.

if no prescription for a S9 , I will give you a bipap machine respironics.

Can I choose my machine? or it's not possible because the insurance policies. is it still possible to change my DME? ( and/or my physician)

opadm wrote:I can't put this machine anymore. Now I sleep without it.

Hi,

That is not good. You have to find a way to work through this. Apnea can cause some really nasty things, such as heart damage, brain damage, stroke, and rapid weight gain. You have to find a way to be able to use a machine.

The issue is that CPAP doesn't work on a sliding scale. For example, if you need a pressure of 12, running at 9 doesn't give you 75% of the treatment, or even 50%. Rather, it gives you almost 0% of treatment. CPAP pressure works like a light switch. Once the machine hits that magic pressure level, you can sudden breathe. Being even 1 cm of pressure low can keep it from working at all.

So, how was the pressure of 12 arrived at? Did you have a hospital or overnight sleep study? If so, that pressure level of 12 is probably correct. If not, and this was just guessed at or ball-parked, then all bets are off.

opadm wrote:Can I choose my machine? or it's not possible because the insurance policies. is it still possible to change my DME? ( and/or my physician)

Yes, you can always change your doctor, DME, or clinic. The issue is being dependent on insurance. If you are self-pay, then you get to determine what you want (for the most part). If it is the insurance company paying, then they are in the driver's seat.

By the time you rent a machine and pay your co-pays, you might end up having more invested than if you bought your own machine. As a result, even with insurance, you might find it better to buy a data-capable APAP. The machine that they stuck you with (Remstar Plus) is an old bottom of the line machine. When set right, that machine is very reliable and will give you good treatment. But if you want to monitor your treatment, you need something better than that. A BiPAP might be a good choice if you are having troubles with air in your stomach. At the very least, you want a PR1 or S9 machine.

-john-

jweeks wrote:The issue is that CPAP doesn't work on a sliding scale. For example, if you need a pressure of 12, running at 9 doesn't give you 75% of the treatment, or even 50%. Rather, it gives you almost 0% of treatment. CPAP pressure works like a light switch. Once the machine hits that magic pressure level, you can sudden breathe. Being even 1 cm of pressure low can keep it from working at all.

I'm not sure this is correct. At least not for everyone. Per my titration study, most of my apneas were eliminated way at a much lower pressure than my final prescribed pressure. And so far as I know the total number of apneas do matter. Can you point me to any references for this?

Thanks.

MidnightOwl

The number of apneas (or "severity" of OSA) is not very important in terms of how much pressure is needed in a given individual to keep their airway open. We all have different anatomy, but the number of times we stop breathing is another issue and shouldn't be calculated on the same scale. You can have 100 events per hour, but if your airway is wider than someone else's, you won't need as high a setting as they do.

You cannot take what the DME says as gospel as far as what machine they will cover. They lie like snakes. You need to find out for yourself what your insurance covers. Most likely your fight is not really with the insurance company, anyway--it's with the DME.

You need to call your insurance company yourself and find out exactly what they cover and under what criteria.

I have a list of questions you should ask on my blog here: http://maskarrayed.wordpress.com/what-y ... me-part-i/

Most insurers cover machines by HCPC's codes. The same exact code is used for bare bones straight CPAP machines like they gave you and for auto PAP's that will adjust the pressure to your needs--it's E0601.

The DME is going to be very reluctant to give you an S9 Autoset now because they make very little money on that machine (it's the most expensive). That DME may or may not carry ResMed machines and they won't want to special order for you. Most likely your insurance company has already purchased the System One humidifier--a new one won't be covered and they aren't interchangeable. So you might try for the System One Auto instead--it's a very good machine as well and you won't be stuck paying out of pocket for a new humidifier.

Oh my, I saw you come into the chatroom last night, but it was while some clowns were playing around with coming in under several identities. Regretfully, it was not an inviting place for a newbie to show up. I'm sorry you had that experience, especially in your time of need. Next time, PLEASE interrupt any chatroom drivel with your questions. Believe me, that would have been a welcomed relief last night. Even those clowning would have stopped to help you.

I just want to add to this discussion that often one has 30 days to return a machine, and if you follow the nurse's advice you'll be past that time frame and have a harder time getting the exchange. I am one who can use either a straight CPAP or an auto. If your titration was halfway decent your pressure should at least be in the ballpark and can be tweaked as needed, but there in no way to know the treatment is working at its optimum without data. Can anyone tell me if this machine is data capable? I didn't see that in the link. If not, that's a dealbreaker for me. Sometimes a patient must "fail" at using their machine before anyone takes them seriously about needing a change. Sometimes given time, the things you describe will work themselves out, but why struggle if you don't have to? But, being REM dependent means with a straight CPAP you are forced to use a higher pressure than you actually need most of the night when you are not in REM. To me this is a reasonable arguement for an auto set in a fairly narrow pressure range around your titrated pressure. Talk to the DME, nurse, doctor - everyone. Tell them you are unable to use the treatment as-is, and that you are disappointed that they are not making every effort to help you succeed (in view of your long apneas and low oxygen), and that you will be returning the machine for one more likely to help you get the treatment needed. (Do check with your insurance about accepted providers first to make sure you are able to back it up is necessary.) A machine you're not using is doing you no good. Best wishes as you go forward.

If the machine is really the Remstar Plus it is NOT data capable.

Welcome to the forum, opadm! You've come to the right place to get help with your cpap problems. I agree with those who have said you need to return your base-model machine right away. You MUST have a fully data-capable machine. Without full data neither you nor your doctor can monitor your therapy. Clearly, the machine you currently have isn't working, and NOBODY will be able to determine why because NOBODY knows what your AHI, leak data, etc. is. Call your insurance asap, return this machine, and get what you need.

Thank you very much Guys for your replies

I come back with my brand new used machine :/ loll
The resmed S8 autoset vantage , I think this machine is not a data capable machine :/.
I think this machine is used because I don't open the bags or box.
I saw a lot of dust and white hair on the machine. I exchanged a new machine for a used machine :/
is it normal ?
but the timers is on 0:00:00 day.

I need your advise

If it says Escape on it... it isn't fully data capable. Otherwise it is... but nevertheless it's an old machine.

I see on the machine : S8 autoset vantage but no manual and no card (sd or smartcard).
and I can't change my DME,because the insurance bought the machine :/. I need to wait one year for that.

Thanks guys

opadm wrote: october, wednesday 20 th , I went from my local DME with a philips respironics remstar plus system one. (rent machine).

Now, I have a lot of difficulties to expire inside the masque. I have also a lot of pain in my ears, in my chest/stomac,
and I feel like a ballon after to use the machine.I think it's because it's a CPAP machine and the pressure it's 12. I put the ramp but it's the same after 20mn.
I can't put this machine anymore. Now I sleep without it.

I would like to have a resmed s9 autoset , I want monitor my sleep and see how many apnea, i have during the night.

but it's impossible because the nurse said : you need to wait 1 month (our policies) to see if you can adapt with this
machine. My DME said if the physician prescribe a resmed S9 , I will buy it.

My two cents: It's possible that your prescribed pressure is too high. I think you should call your sleep doctor's office and ask to speak to the doctor or one of his/her nurses or physician's assistants and report all your new symptoms that are making it impossible for you to use the Remstar plus system one. Stress to the receptionist that you are now having symptoms that indicate you are NOT adapting at all to the machine, but don't mention to the receptionist that you've felt compelled to quit using the machine at night. Be firm but clear that you need to talk to the doctor if at all possible. Once you get the doctor, nurse, or physician's assistant on the phone, tell them that the pain in your ears and stomach and the fact that you now feel like a balloon all started after you were switched from the APAP that was used during the autotitration and that you are worried that your pressure setting is too high. I think you should also tell the doctor (but not the nurse you spoke with) that the new symptoms are serious enough where you cannot force yourself to use the current setup and that you are deeply bothered by this. Stress that you did NOT have any difficulty using the loaner APAP that was used for the autotitraion except for standard new user problems of mask fitting and mask leaks. Keep calling them every day to report the same exact problems until the receptionist manages to get the message to the doctor and either he/she or a nurse or a PA gets back to you to discuss these problems.

It may be the case that they won't let you switch machines for a month, but they could certainly relook at the data and see if changing the pressure down to 10cm is a reasonable thing to try.

You should also call the DME and ask if your machine has C-flex or something similar that could be turned on in order to make it easier to breathe out against the pressure.

And finally one question for clarification: Is the nurse who told you to wait a month with the DME or the doctor's office? Or is it a combined facility?

Now, the Resmed S8 is my definitive machine.it's an autopap but I can't manage my data ----> no sd card.
I got a new prescription for an APAP machine by the nurse and the doctor.(RX). I asked for a S9 but it was not in the catalog.
the DME switch the respironics (new machine CPAP) by a resmed S8 used machine APAP (exchanged) and the insurance pay for a new machine.
my pressure is 4 to 18 with the APAP . ( before with respironics CPAP --> 4 to 12). I m still not happy because I can't follow my therapy.

Call your insurance and claim fraud because they sold you an old and used model and charged the insurance for a new machine.