would you accept a bi-level when you really want an autopap?

[sister]

Hi everyone,
I had posted in another thread that my dr. prescribed a autopap for me last week because I have 'failed' c-pap.How ever medicare won't cover an autopap because an autopap and a c-pap have the same code.
My dr.'s office returned my call and said maybe I could use a bi-level instead since that has a different filing code.
The nurse said that she would check with the dr. to see what he wanted to do since autopap is not covered.
Now my question is, why should I have to accept a bi-level when what I really want is an autopap?
what I really want is the resmed v pap auto 25, do I have to settle for less?
Thanks so much!

[cflame1]

a VPAP Auto 25 is a S8 Resmed auto bilevel

and yes I'd definately accept it.

[RDawkinsPhDMPH]

Generally, CPAP is better for obstructive apnea than bilevel. Bilevel is good for hypoventilation. In years past, bilevel was sometimes more tolerable than CPAP for some people, and that is still true to some degree. Modern autoset machines with flex/epr are much more tolerable so the difference is less.

However, your doctor is right, CPAP and autoCPAP have the same number which is why we use autoCPAP almost exclusively from the start. But by going to another device number you might get it paid for and it's not an unreasonable way to go.

[GumbyCT]

Hi everyone,
I had posted in another thread that my dr. prescribed a autopap for me last week because I have 'failed' c-pap.How ever medicare won't cover an autopap because an autopap and a c-pap have the same code.
My dr.'s office returned my call and said maybe I could use a bi-level instead since that has a different filing code.
The nurse said that she would check with the dr. to see what he wanted to do since autopap is not covered.
Now my question is, why should I have to accept a bi-level when what I really want is an autopap?
what I really want is the resmed v pap auto 25, do I have to settle for less?
Thanks so much!

Certainly I would YES. Bilevel is the ultimate in exhale relief and they do make auto-bilevels. Be careful if they try to give a BiPap with the word Plus in it. The Plus models do not even show if you are leaking which is prob the most important part of your therapy.

While auto and cpap are the same billing code - depending on how long you have had this cpap - the equipment provider (doc or dme) should simply swap out the machine for you and NOT be interested in billing again for something they already billed for. Something smells fishy here.

Do let us know if there is more to this and how you make out.
If you haven't had this cpap more than say 9 months you should be provided a swap for the auto-cpap, period.

[sister]

a VPAP Auto 25 is a S8 Resmed auto bilevel

and yes I'd definately accept it.

I'm sorry,I guess I wasn't clear.i want a VPAP Auto 25 but the nurse said,probably you'd be ok with a bilevel only.
Thanks!

[jules]

well find out what machine the DME will give you for the script you have - and shop around until you find a DME that will give you the machine you want with the script you have

[GumbyCT]

a VPAP Auto 25 is a S8 Resmed auto bilevel

and yes I'd definately accept it.

I'm sorry,I guess I wasn't clear.i want a VPAP Auto 25 but the nurse said,probably you'd be ok with a bilevel only.
Thanks!

Maybe she meant a lower quality bilevel? I've never used a VPAP Auto 25 but would jump at the chance. Just make sure it is data a capable machine too.

[sister]

Hi Gumby,
I've had this machine since November 2006 so I think I have given it a good trial.He wrote a prescription for an autopap but medicare won't cover it so I asked for a Resmed V pap auto 25.
Nurse called me back, said she had to check with him but she thought I would be ok with just a bilevel
I really want an autopap.
Thanks so much!
GOD BLESS YOU !!!

[onlyme]

Now, if you could wait till November 2011 you could get medicare to cover a new machine, as they consider the machine 'life' to be 5 years. But try all the suggestion above! Good luck!

[sister]

Now, if you could wait till November 2011 you could get medicare to cover a new machine, as they consider the machine 'life' to be 5 years. But try all the suggestion above! Good luck!

Thanks,I really have considered just waiting until november,I told my dr. that I wasn't due another machine until then.
He said,let's just go ahead and get you set up with an autopap.
I might just explain to him that I prefer to wait,that way I can get an s9 auto.
But, I don't want to do anything to upset what he thinks is best.
I know that he is concerned and trying to help me.
So that's why I was going to try and do what he says,he really is very nice.
thanks again!!

[fidget]

Medicare makes it very clear how to qualify you for the machine you want, which is a bilevel.

I think your doctor and nurse were confused by the VPAP part, thinking you meant you wanted a servo adaptive machine.

The machine you want is a bipap, which Resmed can't say, cause bipap is a Respironics owned term.

Here's what the doctor needs to do. You need face to face office notes from him, which means you need an office visit. In his dictation the doctor needs to state that you have been on cpap and are not tolerating it. That the mask you are currently using is the proper size and the most appropriate one. (very important, Medicare guidelines specifically state that.) And then he writes a script for the machine you want, using the brand name. You get a copy of your original sleep study, those office notes and that script, and any provider who accepts Medicare can help you out, as long as you have those.

If medicare audits whoever you get this machine from, and they are unable to produce exactly those face to face office notes, they'll demand a refund from your provider.

The guidelines are changing every few months. In April, the guidelines specifically said the doctor's office notes had to say, "more than one interface has been tried, and the current interface yada yada" We had several patients we couldn't put on a machine under those guidelines, as they were put on bipap during their initial titration study, so had never used another mask other than the one used for that study. Also, patients who were long time users, loved the mask they've always used, and had another titration, needed bilevel, and didn't meet the new "more than one interface" verbage. In August, they changed to the "current interface", thankfully.

[sister]

Hi everyone,
Thanks so much for your help, dr's office called me back saying I can't get a new machine until november 2011, which I already knew.He wants me to have an autopap so i am going to wait for the resmed 9. It really won't be that long.
I don't want to settle for anything less than what I want so I decided to just wait.
Thanks again!!

[cflame1]

sister... you mean auto bilevel right? 'Cause an autopap is like an Autoset.

[Titrator]

I would go for an Auto Bipap.... Best of both worlds.