Just diagnosed

Pugsy - Thank you, it is good to know that either way I wouldn't get a brick. Based on the titration sleep study, my airway claustrophobia played havoc on my ability to fall asleep until they turned down the level. Once they did that I fell back to sleep without much issue. I think if it isn't an auto I should refuse it...

Thoughts?

If the RX is for the Auto then there shouldn't be any question or hooplah.
DMEs are supposed to dispense what the RX says.
Did the doc happen to write a RX that included some variable pressures beyond EPAP/IPAP...that would cinch it if he did. If he didn't (then that leaves the door open a bit to sneak in the fixed bilevel unless the RX has the Dispense as written box checked.
The DME might hem and haw and say "your rx doesn't support it" but they could easily just dispense the Auto in fixed bilevel mode and satisfy the RX if they would just do it.

The same thing applies to bilevels as applies to cpap/apap...just depends on how much the DME wants to dig in their heels to save a buck and exactly how the RX is written. The billing code for auto bilevel is the same as for fixed bilevel. DMEs get paid the same for either because they get paid by billing code.

If you have your heart set on auto...fight for it because you will always be "what iffing" if you don't.
Now you might not need or like auto mode but again you might.

AEmedic wrote:I think if it isn't an auto I should refuse it...

Thoughts?

I agree, an auto is much easier to adapt to. If the doc changes his mind or doesn't write it out on the script correctly you may have to find another.

Also be on the lookout the day you get the machine to make sure they haven't made an error and you get the straight bi-lelvel. Contact your insurance so you know who is in network and have all your paperwork ready, sleep study and script.

Pugsy wrote:Did the doc happen to write a RX that included some variable pressures beyond EPAP/IPAP...that would cinch it if he did. If he didn't (then that leaves the door open a bit to sneak in the fixed bilevel unless the RX has the Dispense as written box checked.

I didn't get to see the script, it went directly to the MA. I talked to the doc about marking it with "dispense as written". I'm just not sure if he really done what I asked. At this point I can only hope...

The next step is the mask fitting apt, then they get Tricare to buy off on everything. Once that happens I get to visit the DME.

AEmedic wrote:

Pugsy wrote:Did the doc happen to write a RX that included some variable pressures beyond EPAP/IPAP...that would cinch it if he did. If he didn't (then that leaves the door open a bit to sneak in the fixed bilevel unless the RX has the Dispense as written box checked.

I didn't get to see the script, it went directly to the MA. I talked to the doc about marking it with "dispense as written". I'm just not sure if he really done what I asked. At this point I can only hope...

The next step is the mask fitting apt, then they get Tricare to buy off on everything. Once that happens I get to visit the DME.

You need to get your hands on that script. One of the main reasons is that you may need it when travelling if something breaks or gets left behind.

BlackSpinner wrote:You need to get your hands on that script. One of the main reasons is that you may need it when travelling if something breaks or gets left behind.

Once they help me decide on a mask, I intend on getting a copy of the script.

AEmedic wrote:

BlackSpinner wrote:You need to get your hands on that script. One of the main reasons is that you may need it when travelling if something breaks or gets left behind.

Once they help me decide on a mask, I intend on getting a copy of the script.

The script can just say "Mask of patients choice" Don't lock yourself in.

I wish I had known that...oh well, I guess. I have no idea how they are going to write it, but they wanted to know what would fit me. As it turns out, the Respironics Amara FFM seems to fit me best and does not leak, even on my side. I am also going to pick up a ResMed AitFit P10 to teach myself to be a nose breather. Or at least to use when my sinuses are clear!

Just went over to the Doc today and got a copy of the script, it has everything I wanted it to say.

- Resmed Auto PAP - VPAP
- Humidaire H5I Heated Humidifier
- Climateline Heated Tubing
- EPAP 3
- IPAP 18 (Does this range seem wide?)
- Dispense as Written

Now it's up to Tricare and the DME to fulfill the script.

AEmedic wrote:- EPAP 3
- IPAP 18 (Does this range seem wide?)

EPAP can't be 3...the machine won't go lower than 4 cm for EPAP.
3 would make a nice PS Pressure Support number to start with though.
With just these numbers it's impossible to set the machine...not enough information.

Need a minimum EPAP...and 4 is as low as the machine will go for EPAP
and a PS number which 3 to 4 to 5 is usually typical
and an maximum IPAP number.

Right now if they assume that the EPAP 3 thing means pressure support without a real EPAP number...they might think you need IPAP at 18 and EPAP at 15 which would be a fixed bilevel setting.

A RX for an auto with a range might be...this one is what I used with my VPAP Auto
EPAP minimum 9.
PS 4
IPAP max of 20
this means when I started the night my EPAP was 9 and my IPAP was 13 but it could go to 20 which it did on occasion but never for very long. It stayed at 9/13 until I went to sleep and any apnea events started driving the machine to increase the pressure.
When it went to say 18 IPAP it drags EPAP up to 14 because there always had to be a 4 cm difference between EPAP and IPAP..that's the way it is with the ResMed VPAPs...Respironics has a different roaming PS.

So for auto RX...these are needed.
Minimum EPAP..... xxx cm where you start the night and with PS you get starting IPAP
Maximum IPAP..... xxx cm where it can go to and drag EPAP up with it
and a PS xxx cm number whatever works or doctor wants or feels the best and is a setting when in auto mode and inferred in fixed mode.

Pugsy wrote:

AEmedic wrote:- EPAP 3
- IPAP 18 (Does this range seem wide?)

EPAP can't be 3...the machine won't go lower than 4 cm for EPAP.
3 would make a nice PS Pressure Support number to start with though.
With just these numbers it's impossible to set the machine...not enough information.

Need a minimum EPAP...and 4 is as low as the machine will go for EPAP
and a PS number which 3 to 4 to 5 is usually typical
and an maximum IPAP number.

Right now if they assume that the EPAP 3 thing means pressure support without a real EPAP number...they might think you need IPAP at 18 and EPAP at 15 which would be a fixed bilevel setting.

A RX for an auto with a range might be...this one is what I used with my VPAP Auto
EPAP minimum 9.
PS 4
IPAP max of 20
this means when I started the night my EPAP was 9 and my IPAP was 13 but it could go to 20 which it did on occasion but never for very long. It stayed at 9/13 until I went to sleep and any apnea events started driving the machine to increase the pressure.
When it went to say 18 IPAP it drags EPAP up to 14 because there always had to be a 4 cm difference between EPAP and IPAP..that's the way it is with the ResMed VPAPs...Respironics has a different roaming PS.

So for auto RX...these are needed.
Minimum EPAP..... xxx cm where you start the night and with PS you get starting IPAP
Maximum IPAP..... xxx cm where it can go to and drag EPAP up with it
and a PS xxx cm number whatever works or doctor wants or feels the best and is a setting when in auto mode and inferred in fixed mode.

Thank you Pugsy!

Not that I was sure, but I though that the way he wrote the RX was odd. Honestly, he seemed so clueless about the machines and the settings when I was talking to him that I'm not surprised that he got it wrong...

Hopefully the DME will just issue me the machine without having to get clarification on the RX that would delay issuing me the machine. I'm guessing that they are going to have to get the Doc to tell them something that makes sense though.

When the Doc wanted to give me a fixed rate bilevel machine, he wanted the rates to be IPAP @ 10 and the EPAP @ 6. And his impression of the auto bilevel was that he just had to tell them the overall range and the machine did everything else.

Thank you for the expertise and experience!

AEmedic wrote:he wanted the rates to be IPAP @ 10 and the EPAP @ 6. And his impression of the auto bilevel was that he just had to tell them the overall range and the machine did everything else.

Common misperception about any auto adjusting pressure machine...and it can work for some people with factory defaults but it doesn't always work for everyone. Most of the time it needs a little bit of a helping hand by setting the parameters to give the machine a head start.

A potential choice for the above settings in auto mode and let it auto adjust..
would be EPAP min 6...PS of 4 and IPAP max of anything above 10 depending on how far you want it to be able to roam around if needed.

DMEs sort of have their hands tied with whatever is written on the RX..if it's not clear they can't do it without checking with the doctor. Kinda like getting a RX that just says....antibiotic 3 times a day...with no name. Pharmacists can't insert a name or dosage if either is missing.