Indications for BiPap

It appears I have had my old CPAP machine for four years. One year too soon to get a new one. Which brings up a couple of setbacks for me. No one ever showed me how to use my old CPAP machine and I just got frustrated that it wasn't working correctly. I packed it away.

A couple of years later, I moved to my new address and had to downsize drastically. I'm not sure what happened to my old machine. In a box, I haven't found or just tossed away by over zealous relatives helping me pack. My health has finally gotten the better of me and I know I have to buckle down and wear the CPAP. My mother has Alzheimer's and I have been diagnosed with MCI dementia. I also have Chronic Fatigue Syndrome and am a walking (or prone) zombie. I have BC/BS PPO (all deductible and co-pay fulfilled) and I understand I can't get a new machine for another year. But I will lose the insurance I have now at the end of the year and will be on a HMO Medicaid long term health plan. A DME told me that I can expect to get a $200 machine and have to pay co-pays when I switch to Medicaid. He told me that was all I need as they are all as comfortable and I don't need to know my air leaks as I will know them as soon as they happen.

The only way I can get a new machine he said was if my doctor gave me a prescription for BiPap.

What are the indications for Bi-Pap?

Thanks!

Seems you're thinking a change in delivery as in bipap would be medical necessity thus covered by insurance, right? To make that kind of change generally it's required to "fail" using cpap. What's required to make that failure status I don't know. Being prescribed a high pressure makes the request seem less unusual, as the bipaps are a commonly prescribed machine for higher pressures. Insurance will likely want some sort of documentation as to why your doctor is ordering a bipap.

jshuler43 wrote: What are the indications for Bi-Pap?

The usual criteria for qualifying for a BiPAP are something like at least one of the following:

• The AHI remains above 5 even after using CPAP for several weeks or months as intended---i.e. being "compliant with therapy" AND the efforts to address the problem of the high AHI have been made by one or more pressure increases as well as verifying that the problem is not due to large leak problems.
• Daytime symptoms remain present even though the patient is fully compliant with therapy even though the AHI is under 5. Fully compliant usually means "uses the CPAP for at least 4 hours every night for at least 21 nights out of a 30 night period." And at least one pressure adjustment has been made to try to fix the problem.
• Patient has severe problems tolerating therapy such as aerophagia or air blowing into the eyes through the tear ducts AND the patient is fully compliant with therapy AND the efforts to address the problem through pressure adjustments, changes of masks, use of a heated humidifier, etc, have been made to no avail.
• Patient is at a very high pressure setting (as in a CPAP pressure of >= 15 cm) and cannot exhale comfortably even with a exhalation relief system in use (and patient is compliant with therapy if this problem does not occur on the titration study)

The critical problem you're likely to face, of course, is that the insurance company is going to want to know that you are "compliant" with therapy before they'll buy you another, even more expensive machine ....

And since demonstrating compliance is going to be difficult (to say the least), your best bet may be to get a script for a CPAP and then buy a gently used APAP or CPAP from a place like secondwindcpap.com even though you'll have to pay for the thing 100% out of pocket.

Thanks for the info in BiPap. Sounds like that won't be the route I take.

In a month I will have Medicaid and have no choice. Sounds like they will give me a pretty cheap machine - DME mentioned around $200. I was told I don't need to know about leaks etc as I will know instantly.

I am going through a really tough time financially. Just living on $710 SSI a month. So I can't buy a machine.

I'll just have to take what they want to give me. Got to be better than nothing!

jshuler43 wrote: In a month I will have Medicaid and have no choice. Sounds like they will give me a pretty cheap machine - DME mentioned around $200. I was told I don't need to know about leaks etc as I will know instantly.

Unfortunately it's just not true that you'll know "instantly" if you have leaks. The sad fact is that when we are really soundly asleep we can sleep through some pretty impressive leaks---even when we're prone to insomnia.

In my case, small leaks when I'm "almost" asleep are enough to jolt me wide awake and make me uncomfortable. But once I'm asleep? I occasionally sleep through some pretty impressive leaks; it doesn't happen enough to have a serious impact on my therapy. But there are folks here who have had to deal with serious mouth breathing issues who were literally spending 50% or more of night in large leak territory and were sleeping through it all when they were newbies.

I am going through a really tough time financially. Just living on $710 SSI a month. So I can't buy a machine.

I'll just have to take what they want to give me. Got to be better than nothing!

I'm sorry about the tough times you're going through. And it is true that a brick is better than no machine at all. For what it's worth, the cheapest full efficacy data machine on the market seems to be the ntelliPAP Standard Plus CPAP Machine with SmartFlex[/quote], which our host sells for $395, which is comparable in cost to the [url=https://www.cpap.com/productpage/pr-sys ... chine.html]PR System One REMstar 60 Series Plus CPAP Machine with C-Flex brick at $382 and quite a bit cheaper than the standard Resmed S9 Escape brick at $599.