How to rent/buy a Bi-Level without prescription?

[cby1]

I've posted here before - basically, my sleep doctors prescribed an Auto CPAP set from 18-20cm. This was after a sleep study where I was out of pocket $1400, and these guys are in network. Some history:

viewtopic.php?f=1&t=110457&p=1058778#p1058778 (relevant info near the end)

I have been seeing pressure bump up against the 20 cm limit (SleepyHead) more and more. Last night, it stayed there for an hour. I desperately want to try an Auto Bi-Level, but my docs say I'll need another titration (so another $1400, *if* insurance even goes for it). It doesn't matter if I tell them I have aerophagia (which I do) - they just won't do it - and who's to say another study will "prove" to them I need a Bi-Level? I'm really getting fed up with these docs.

How can I get a BiLevel on a trial basis (or not, for that matter) without a prescription? Kind of wary of CraigsList.

[chunkyfrog]

Buy a used one from an individual.
Some regulars here might know who, GreyGhost for one.

[grayghost4]

I have several S9 vautos and Aircurve 10 vpap autos new and used .

I have a high time s9 I will send you to try PM me an address and you pay shipping.


I also have a nice Aircurve 10 vauto :

http://sfbay.craigslist.org/eby/hab/5543437508.html

[packitin]

Sounds like me. In 2012, I wanted a bipap and the doc didn't agree, so we had a (minor) argument. Being a little irked, I searched for several months in 2012 until I found the one I presently use. (I paid $450 then, but that's probably not a great deal now). I also decided to have a dentist fit me with a Somnomed appliance. In fact, I just last week asked the doc if he would allow me to test it by using the all-night Resmed (nasal prongs over-the-ear and finger insert-taped - I forgot the name). Well, this morning they called and said the device was "adequate". I persisted in asking for more details, but, alas, that's all I could get out of her (his nurse).

Its been eight years now since Medicare has provided me with a machine, so I thought I might persuade the doc to prescribe a new one. But he won't.
I'm the type of person that if I get frustrated, I'll seek out other doctors and other DME suppliers. So I'm thinking it over. As of right now, when I use both the machine and the MAD, I find that my AHI is around 2.5 or 3, which is ok, I suppose. The data below is from night before last, using both the machine and MAD.
I would appreciate any advice. Should I just leave things as the are?

[Tatooed Lady]

I will vouch for ghost. I've got a pair of s9 bilevel machines that I bought from him. When I'm in the market for another (hopefully not soon), I will go to him.

[SewTired]

Just to clarify, you cannot rent or buy a new Bi-Level without a prescription. Federal law runs the game on DME. However, you CAN buy it from the used market and I agree that Grey Ghost is a good source.

[Judge Nap]

you cannot rent or buy a new Bi-Level without a prescription.

Generally, this is correct. But, there are ways around it for the creative among us.

[Sleeprider]

While buying from one of the forum members is a great idea, you should not give up arguing with your doctor about the need for a bilevel machine...without a new titration. You have sleep apnea and have a need for PAP therapy. Your auto machine has titrated you to the maximum available pressure on that series of CPAP, and the next logical step is auto bilevel. Like your auto CPAP it will titrate your pressure needs without the need for a new study. It is normal for doctors to prescribe bilevel when CPAP pressure are above 14 due to comfort considerations. When the CPAP machine cannot provide the needed pressure, and the patient is uncomfortable with constant positive pressure, that is a sufficient criteria for bilevel.

You deserve to have your equipment covered by insurance. Tell your doctor that an additional study is a show stopper and to please prescribe the bilevel as medically necessary based on your results, and that you will self-titrate and follow-up with him/her. You can suggest initial pressure settings for his prescription. i.e. EPAPmin 14, PS 4.0, IPAP max 20.0. This will start your therapy at 18/14 and will allow the machine to titrate up to 25/21. I really don't see how he could object! Be clear that you will be seeking out a new physician to manage your care if he will not assist you to get effective treatment.

You want to have this prescription if you can get it or you will forever pay out of pocket until you are again under medical direction. Your CPAP should be able to be traded in and costs applied by the DME towards a bilevel, if you can get the prescription. Keep in mind, having the history of the prescription is going to be ever more important when your coverage comes under Medicare. I fully support self-funding, but you should be treated for your diagnosed condition, in accordance with professional standards. That can be done without a new titration study and your doctor knows it.

[cby1]

Thanks SleepRider - I agree. They just keep telling me that another study will be needed - and I have to "fail" CPAP. I know you know how that reasoning goes. I had the tech tell me pressures over 17 were a "gimme" for getting a Bi-Level, insurance-wise. So I don't know who's giving me a line of BS on that. They didn't go past 17 in the split-night study, but they also only had 209 min. of "titration", due to the split.

If I can't convince the doc, I think I will have to tell her that I will need go elsewhere (where I don't pay $1400 out of pocket - labs in my plan vary wildly) if that's what insurance is going to require.

[WRX03]

I wish I could do something with the +/- 120 new and used PAPs that are sitting on my shelf. They are what we call the adaption list. They can only go back to DME's, sold through a DME, or can be sold to a medical supplier. If it's not the newest version, nobody wants it. The S9 and PR1 50 series are outdated and are hard to get rid of.

[Jay Aitchsee]

Just to clarify, you cannot rent or buy a new Bi-Level without a prescription. Federal law runs the game on DME. However, you CAN buy it from the used market and I agree that Grey Ghost is a good source.

Not quite true, as the posts from Grey Ghost and Judge Nap imply. Your post should have included the qualifier "from a DME provider". I, and many others I am sure, have purchased a brand new, never used, 0 hour, latest model machine from a private seller. I obtained mine at a good price from a reputable forum member that has machines for sale occasionally.

[Hornnumb2]

I wish I could do something with the +/- 120 new and used PAPs that are sitting on my shelf. They are what we call the adaption list. They can only go back to DME's, sold through a DME, or can be sold to a medical supplier. If it's not the newest version, nobody wants it. The S9 and PR1 50 series are outdated and are hard to get rid of.

I am sure there would be more than a bunch of happy people if you would just sell them off...

[VVV]

I wish I could do something with the +/- 120 new and used PAPs that are sitting on my shelf. They are what we call the adaption list. They can only go back to DME's, sold through a DME, or can be sold to a medical supplier. If it's not the newest version, nobody wants it. The S9 and PR1 50 series are outdated and are hard to get rid of.

I'm interested in a new S9 AutoSet to use as a backup machine. You have your profile set up so I can't send you a PM.

[Guest]

I wish I could do something with the +/- 120 new and used PAPs that are sitting on my shelf. They are what we call the adaption list. They can only go back to DME's, sold through a DME, or can be sold to a medical supplier. If it's not the newest version, nobody wants it. The S9 and PR1 50 series are outdated and are hard to get rid of.

I am sure there would be more than a bunch of happy people if you would just sell them off...

I would love to if I could. I have around 8-10 S7 lightweights new in boxes I can't get rid of, been trying to get the bigwigs just donate them for at least 5 years now. Can't move without the bigwigs permission, but the bigwigs won't move. Sounds like congress.

[Jay Aitchsee]

I would love to if I could. I have around 8-10 S7 lightweights new in boxes I can't get rid of, been trying to get the bigwigs just donate them for at least 5 years now. Can't move without the bigwigs permission, but the bigwigs won't move. Sounds like congress.

You might as well donate the S7's. I doubt you'd find anyone here that would be willing to even pay shipping on one. S9's now, another story.