BiPAP or CPAP?

My sleep study shows moderate OSA. AHI was 28 with minimum SaO2 of 81%. I was in to do my titration study at a hospital last Sunday and I've been waiting for my results to get what I thought would be a CPAP. I've done my research and knew what I wanted and which DME I wanted to go through. The hospital that I had the sleep study and titration with also have the DME equipment. When finished my titration study they wanted me to choose my DME then but I didn't check any of them and told them I wanted to see which DME carried what brands first.

This morning I get a call from the hospital DME to say that they've gotten my order and I will be on a BiPAP and did I want to go ahead and get it set up. WOW. First I did not specify which DME I was going to go through. Second, my doctor has not gotten the test results yet. She goes, Your Doctor is Morrison right. I go NO! I told them several times that it was Morris. So I'm guessing that some doctor I've never seen has my test results. I told the hospital DME that I would call them when I'm ready -- which will not happen.

I called my insurance THANKS to many of you who have said that most insurances require you to try CPAP and fail before they will cover a BiPAP. Yes, that is true with my insurance. First she told me I was covered but when I explained that from my reading, most insurance require the CPAP first, she did further research and found a spot on my insurance that said YES, I have to try the CPAP first.

So next is my call to my doctor office and I've left a message for my doctor's nurse to see if I'm going to have to track down my Rx or if they will be able to request it from the person who read the titration results. And I also told them I'm required to fail with a CPAP first before my insurance will cover my BiPAP. I am waiting for a call back.

The hospital DME did tell me that my settings would be 20/14 on the BiPAP. My sleep study did not show any central apnea and they classified it as moderate OSA. So the only thing I can see why a BiPAP vs CPAP is my weight.

Any suggestions about how to handle this or am I doing it right????? What's the differnce on pressure setting on the CPAP vs BiPAP. I'm not sure I understand that.

Thanks for any help.

20/14 would be pretty hard on just a CPAP. You would be exhaling against a high pressure rather than the BiPAP adjusting when you exhale to make it easier to breath.

I would think a BiPAP is the right answer.

Take a deep breath (jokingly) and continue with what you are doing.

1. Get a copy of your sleep study to see what it actually says.

2. Get a copy of your prescription to see what it says also. A prescription that calls for 20/14 cm H2O requires a bi-level machine. Straight CPAP's don't do different pressures for IPAP and EPAP (inhale and exhale pressures.)

3. With these in hand, have another chat with your insurance company. It may be that the titration study needed to get to the pressures mentioned to adequately treat your apneas. If that is so, then you would be trying a CPAP at the very top of the pressure capability with no room for adjustment. That alone, may justify the BiPap machine which allows for higher pressures. It may be that what the policy actually says is that you must fail at straight CPAP (including a BiPap) before you can be approved for an Auto BiPap. But that should be clarified when you have the actual results.

4. Most insurance companies will require that they have both the sleep study results AND the prescription in hand before they give approval for reimbursement. Normally, the DME does the paper work to get that done.

BTW, the use of the term BiPap implies a Respironics machine since it is their trade term for a bi-level machine. VPAP is ResMed's term for the same thing. The usage might imply that the hospital DME is proposing to supply Respironics equipment. Have you decided that Respironics is the manufacturer that you want?

JDS74 wrote:Take a deep breath (jokingly) and continue with what you are doing.
LOL
1. Get a copy of your sleep study to see what it actually says.
I have one. That is what I was giving you the info from. I do not have a copy of the titration study since they sent it to the wrong doctor. I'm trying to locate where it is.
2. Get a copy of your prescription to see what it says also. A prescription that calls for 20/14 cm H2O requires a bi-level machine. Straight CPAP's don't do different pressures for IPAP and EPAP (inhale and exhale pressures.)
The 20/14 is what the hospital DME where I had the study said I needed.
3. With these in hand, have another chat with your insurance company. It may be that the titration study needed to get to the pressures mentioned to adequately treat your apneas. If that is so, then you would be trying a CPAP at the very top of the pressure capability with no room for adjustment. That alone, may justify the BiPap machine which allows for higher pressures. It may be that what the police actually says is that you must fail at straight CPAP (including a BiPap) before you can be approved for an Auto BiPap. But that should be clarified when you have the actual results.
When I called the insurance company they said I have to have a "therapeudic trial" on a CPAP. I forgot to ask how long a Therapeudic trial was. Thanks for the info.
4. Most insurance companies will require that they have both the sleep study results AND the prescription in hand before they give approval for reimbursement. Normally, the DME does the paper work to get that done. I have a call into the DME that I want to go through to check that out.

BTW, the use of the term BiPap implies a Respironics machine since it is their trade term for a bi-level machine. VPAP is ResMed's term for the same thing. The usage might imply that the hospital DME is proposing to supply Respironics equipment. Have you decided that Respironics is the manufacturer that you want?

I didn't know that although I knew that ResMed called them VPAP. The hospital does carry the Respironic brand.

Again, thanks for the great advice.

Since I didn't hear back from my doctor today, I decided to call the doctor that read my sleep study that ordered the titration. Here is what I learned: The doctor has been on vacation this week but will back in the office on Monday. I talked to the nurse and found out that the doctor hasn't even seen the results of the titration yet since he was on vacation and the orders are not transcribed yet. She is putting mine on the top and will talk to him on Monday. I gave her the info of which DME I wanted to go thru and she will get it sent to the right one. She had a note on the report that said I wasn't sure who I was going to use, either ..... or ..... The one that called this morning was not one of the ones that I thought I'd go through. They had seen my suggested results from the titration study because they are with the hospital where I had the testing done. Hmmm..... Maybe a little unethical thinking they could grab my business by calling me ahead of time and get me started on the bi-level before the doctor even ordered one.