Advice concerning S9 Autoset/ Insurance

Hi, I recently was given an S9 Autoset through Blue Cross/Blue Shield. I've been given a pressure of 13 from my Dr.
My initial feeling at the sleep study facility and the Home Health Patient place was that they had didn't know what they were doing. The girl who gave me the machine had no idea how to work it other than how to turn it on. She actually had trouble hooking up the tube. The gal who fitted me for my mask during the "Pap-Nap" didn't try different sized nasal pillows on me and did not appear to know what else was required of her. So...I began researching at home.

I've downloaded a card reader, set my machine to use a ramp, EPR (this was the biggest revelation!), nasal pillows, auto-on and adjusted everything. I tried the Autoset feature last night and the pressure seemed very low and comfortable. I slept through the night with an AHI of 2.4

My concern is that, when I bring my card in for the required check-up on me, will I get in hot water with the insurance company for making these settings without my Dr.'s consent. I really don't want to go back to that nut-house and pay another 50.00 copay for what I feel is poor care. I love the machine and think I can get great results with it.

Any advice from folks with similar experiences would be appreciated.

If the RT is as ignorant as you claim, they won't even notice what settings you are using. All they will care about is compliance - hours used. As long as you are keeping your mask on at least 4 hours a night, you should be good.

If you are compliant, they get paid, and that is all they care about.

The insurance company only cares that you use the machine for so many hours each night and so many nights a month.
Not sure what your insurance company requires but normally it is at least 4 hours a night for 70% of a month of nights.
That's all they care about.
Now your DME might or might not even notice that you changed things. Depends on how deep they look at the reports.
At worst all they can do is slap your hands for changing things yourself.

Unsure what you meant by downloading a card reader. The S9 uses a SD card and if your computer has a slot for a SD card then you don't need a card reader to use SleepyHead or ResScan software. If your computer doesn't have a SD card slot then all you need is a card reader/adapter. One end to plug into the USB port on your computer and the other end to plug the SD card into. Nothing to download.
Did you maybe mean your downloaded the software to read the SD card?

Card reading software? SleepyHead or Rescan?

richp wrote:

I've downloaded a card reader, set my machine to use a ramp, EPR (this was the biggest revelation!), nasal pillows, auto-on and adjusted everything. I tried the Autoset feature last night and the pressure seemed very low and comfortable. I slept through the night with an AHI of 2.4

I love to hear stories like this. You are doing it the right way. Most people working for DMEs are in no position to be very helpful. DIY!

Yes, insurance and DME only care about the compliance hours.

What are your pressure settings?

Thanks everyone. Good to know that I can figure what's working for me without worrying about red tape.

I did mean that I downloaded the software. Sorry for the confusion. I've been given a prescription of 13 but I'm averaging about 8 with the machine set to Autoset. Sleeping very well and had an AHI of 1.8 last night (0.1 central). I have a leak rate of 15 L/M. These are good numbers, right?

richp wrote:These are good numbers, right?

Yes, those are good numbers. Sounds like you have a good handle on things.
Your leak number to avoid is 24 L/min. It isn't the end of the world if you hit it or even above as long as it is brief time there. Stay below it all the time and as long as leaks don't wake you up then you are good.
If you find that small low level leaks are disturbing your sleep then they need to be worked on but not because they are impact therapy so much but because they are disturbing your sleep. Good sleep is number one goal.

Excellent! The RPSGT told me that he could not legally set the machine for anything other than the RX; but the patient could.
If the doctor disagrees later (if you even see one), just show him your RESULTS!

chunkyfrog wrote:Excellent! The RPSGT told me that he could not legally set the machine for anything other than the RX; but the patient could.
If the doctor disagrees later (if you even see one), just show him your RESULTS!

That's exactly what my DME said. The prescription was written as 4-20 and I asked whether they could change it to be a smaller range. Legally, they can't change it.

So... after 9 days of 4-20 and EPR of 2, I went into my settings and changed it to 7-20 with EPR of 3. That was based on looking at the past 9 days of Sleepyhead charts, looking at the pressure graphs, noticing that I had events / snore flags below 8-9cm, but which went away above 8cm.

In another week, I may even knock down the upper-end of the pressure range to be only 16cm as I find pressures above that give me aerophagia and chipmunk cheeks. Or I might not. Won't decide until I've been on the new settings for a bit. Depends how often I get bothered by pressures above 16.

My sleep doc? Well, he'll have to accept that I made a considered choice to muck with my settings so that I'd be more comfortable and happy.

Relax, there's no such thing as CPAP police. You're doing a GREAT job of self-treatment, and if anyone has an argument with that for the sake of "propriety" they are out of their minds.

Fortunately, you were given a good machine to begin with. Think of the poor suckers stuck with data-less bricks and bozo DME staff. That's about 99% of CPAP users, sad to say.

Well, he'll have to accept that I made a considered choice to muck with my settings

I used to read people posting "optimize".

I adopted it to replace "tweak", "meddle" and "muck with".

Optimize is more accurate IMO.

But whatever, keep at it until you get it right! Remember, you pay that doctor to help you and he should be humble and work for you, not vice versa.