Guest guest Posted February 2, 2004 Report Posted February 2, 2004 Pat K I am in the same boat as you with having a new chair, but no van. Of course mine has at least been ordered. You might want to check with your medical insurance about van adaptations. There is something new which putting more pressure on the insurance companies to cover them. MRS was the one that led me in that direction. As far as the sleep study goes, I think it is like any other durable medical good. If the doctor feels you need it, then it is covered at whatever percent they cover durable medical goods. Good luck, laurie > From: PatsyAnnK@... > Reply-To: > Date: Mon, 2 Feb 2004 19:18:50 EST > To: Mitoldies > Subject: BiPAP info > > Hi, > Does anyone know what criteria are necessary for an insurance company to > cover a sleep study for a BiPAP S/T and/or for a BiPAP? The sleep specialist I > went to doesn't know. > I have my new power wheelchair but I can't go anyplace with it because I need > a van with a lift or ramp for it. The hoist I have been using for my scooter > won't work. The problem is that I had to close the business I had for over 20 > years last fall. That leads to 2 problems. 1. The budget for a van or anything > else is very strained. 2. If I was working Michigan Rehab would pay for the > modifications and I would only have to pay for the van. If anyone knows of a > job for a 70 year old woman who uses a power chair please let me know. LOL. > I also can't get the chair in and out of the house since I don't have a ramp > for the house. My husband and son carried it into the house but that is not an > activity they want to do very often. I'm not really thing about the house > ramp too much now. If it does turn out that we can get a van somehow I want to > have every penny on hand that I can. > I didn't expect this to be so long. I just wanted to ask about the BiPAP but > once I started I couldn't shut up. > Pat K > Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 Is there anyway that you can get insurance to approve a BiPap machine if you have a documented restrictive ventilatory defect? I was wondering about use of a BiPap at night to see if that would help me feel more rested but I don't want to endure another sleep study. I also have Blue Cross insurance so was wondering if there was a way around the sleep apnea Dx. Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 Thanks Laurie. What is the difference between a Bipap and Cpap? Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 I'm not sure what the criteria is for BiPap, but my doctor ordered it to give me some help in the evenings and at night despite me not showing apnea on the sleep study. We had thought it might be good to use BiPap to relieve the excessive strain on me physically when I'm most fatigued. Anyway, Blue Cross refused it because they said I don't have apnea. I would guess if you show a definative breathing problem at night they should be able to help you with either BiPap or CPap. The sleep study would be covered most likely too. As for the ramp /mobility situation, first of all I'm sorry you're having such a tough time. You might want to try contacting the Muscular Dystrophy Association to see if they could help you. Other charitable organizations might assist as well. Good luck, bug Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 The criteria for CPap or BiPap must be pretty restrictive. I had a sleep study done which showed 42 episodes of apnea in 6 hours, and it was not prescribed for me. Theresa > I'm not sure what the criteria is for BiPap, but my doctor ordered > it to give me some help in the evenings and at night despite me not > showing apnea on the sleep study. We had thought it might be good > to use BiPap to relieve the excessive strain on me physically when > I'm most fatigued. Anyway, Blue Cross refused it because they said > I don't have apnea. > > I would guess if you show a definative breathing problem at night > they should be able to help you with either BiPap or CPap. The > sleep study would be covered most likely too. > > As for the ramp /mobility situation, first of all I'm sorry you're > having such a tough time. You might want to try contacting the > Muscular Dystrophy Association to see if they could help you. Other > charitable organizations might assist as well. > > Good luck, > bug Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 , You would need a prescription written for this and I don't know if they would do it without an additional sleep study but you could ask your PCP to check on this and it's possible that she will send a representative from the Durable Medical Equipment provider your Blue Cross uses to get you set up. A qualified physician would need to tell the Durable Medical Equipment provider what the appropriate settings are for you on the BiPap or CPAP. I have no doubt at all that Blue Cross should take care of this. Alice From: LILQT4U1984@... Is there anyway that you can get insurance to approve a BiPap machine if you have a documented restrictive ventilatory defect? I was wondering about use of a BiPap at night to see if that would help me feel more rested but I don't want to endure another sleep study. I also have Blue Cross insurance so was wondering if there was a way around the sleep apnea Dx. Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 I would get a second opinion on that. Alice Re: BiPAP info The criteria for CPap or BiPap must be pretty restrictive. I had a sleep study done which showed 42 episodes of apnea in 6 hours, and it was not prescribed for me.Theresa> I'm not sure what the criteria is for BiPap, but my doctor ordered > it to give me some help in the evenings and at night despite me not > showing apnea on the sleep study. We had thought it might be good > to use BiPap to relieve the excessive strain on me physically when > I'm most fatigued. Anyway, Blue Cross refused it because they said > I don't have apnea.> > I would guess if you show a definative breathing problem at night > they should be able to help you with either BiPap or CPap. The > sleep study would be covered most likely too.> > As for the ramp /mobility situation, first of all I'm sorry you're > having such a tough time. You might want to try contacting the > Muscular Dystrophy Association to see if they could help you. Other > charitable organizations might assist as well.> > Good luck,> bugMedical advice, information, opinions, data and statements contained herein are not necessarily those of the list moderators. The author of this e mail is entirely responsible for its content. List members are reminded of their responsibility to evaluate the content of the postings and consult with their physicians regarding changes in their own treatment.Personal attacks are not permitted on the list and anyone who sends one is automatically moderated or removed depending on the severity of the attack. Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 A pulmonary specialist can write a precription for one as well as a sleep doctor. My respiratory therapist checks my pressure and can adjust it some. My sleep doctor added oxygen to my CPAP which made me feel more rested. I have Blue Cross and once the durable medical equipment place has a script on file, I don't have to get another script for additional masks and head gear. laurie > From: LILQT4U1984@... > Reply-To: > Date: Tue, 3 Feb 2004 14:04:29 EST > To: > Subject: Re: Re: BiPAP info > > Is there anyway that you can get insurance to approve a BiPap machine if you > have a documented restrictive ventilatory defect? I was wondering about use > of a BiPap at night to see if that would help me feel more rested but I don't > want to endure another sleep study. I also have Blue Cross insurance so was > wondering if there was a way around the sleep apnea Dx. > Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 Theresa Did a sleep doc order the sleep study? It usually means a second sleep study to determine pressure settings. Could you get your report and see another doctor about it. I had to be assertive in order to get the computer print out for my files and not just a short report. laurie > > Reply-To: > Date: Tue, 03 Feb 2004 19:00:04 -0000 > To: > Subject: Re: BiPAP info > > The criteria for CPap or BiPap must be pretty restrictive. I had a > sleep study done which showed 42 episodes of apnea in 6 hours, and it > was not prescribed for me. > > Theresa > > >> I'm not sure what the criteria is for BiPap, but my doctor ordered >> it to give me some help in the evenings and at night despite me not >> showing apnea on the sleep study. We had thought it might be good >> to use BiPap to relieve the excessive strain on me physically when >> I'm most fatigued. Anyway, Blue Cross refused it because they said >> I don't have apnea. >> >> I would guess if you show a definative breathing problem at night >> they should be able to help you with either BiPap or CPap. The >> sleep study would be covered most likely too. >> >> As for the ramp /mobility situation, first of all I'm sorry you're >> having such a tough time. You might want to try contacting the >> Muscular Dystrophy Association to see if they could help you. > Other >> charitable organizations might assist as well. >> >> Good luck, >> bug > > > > Medical advice, information, opinions, data and statements contained herein > are not necessarily those of the list moderators. The author of this e mail is > entirely responsible for its content. List members are reminded of their > responsibility to evaluate the content of the postings and consult with their > physicians regarding changes in their own treatment. > > Personal attacks are not permitted on the list and anyone who sends one is > automatically moderated or removed depending on the severity of the attack. > > > > Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 The study was performed at a sleep disorder center at a leading university hospital in Philadelphia, by a sleep disorder specialist. Even though I showed apnea, the doc was convinced that my problems were related to depression. Depression? Of course I was depressed! I was sleeping 90 minutes a day. That was the only issue addressed, and after a year of monthly follow up, I didn't go back. Some battles are not worth fighting. I found my own ways of dealing with it. Theresa > >> I'm not sure what the criteria is for BiPap, but my doctor ordered > >> it to give me some help in the evenings and at night despite me not > >> showing apnea on the sleep study. We had thought it might be good > >> to use BiPap to relieve the excessive strain on me physically when > >> I'm most fatigued. Anyway, Blue Cross refused it because they said > >> I don't have apnea. > >> > >> I would guess if you show a definative breathing problem at night > >> they should be able to help you with either BiPap or CPap. The > >> sleep study would be covered most likely too. > >> > >> As for the ramp /mobility situation, first of all I'm sorry you're > >> having such a tough time. You might want to try contacting the > >> Muscular Dystrophy Association to see if they could help you. > > Other > >> charitable organizations might assist as well. > >> > >> Good luck, > >> bug > > > > > > > > Medical advice, information, opinions, data and statements contained herein > > are not necessarily those of the list moderators. The author of this e mail is > > entirely responsible for its content. List members are reminded of their > > responsibility to evaluate the content of the postings and consult with their > > physicians regarding changes in their own treatment. > > > > Personal attacks are not permitted on the list and anyone who sends one is > > automatically moderated or removed depending on the severity of the attack. > > > > > > > > Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 Theresa I hear you. My brother is having a similar problem. He showed apnea on the first study, but they would write a script because he couldn't sleep with the CPAP the second night. Have they ever tried sleeping with one for the first time? laurie > > Reply-To: > Date: Tue, 03 Feb 2004 20:31:14 -0000 > To: > Subject: Re: BiPAP info > > The study was performed at a sleep disorder center at a leading > university hospital in Philadelphia, by a sleep disorder specialist. > Even though I showed apnea, the doc was convinced that my problems > were related to depression. > > Depression? Of course I was depressed! I was sleeping 90 minutes a > day. That was the only issue addressed, and after a year of monthly > follow up, I didn't go back. > > Some battles are not worth fighting. I found my own ways of dealing > with it. > > Theresa > > > >>>> I'm not sure what the criteria is for BiPap, but my doctor > ordered >>>> it to give me some help in the evenings and at night despite me > not >>>> showing apnea on the sleep study. We had thought it might be > good >>>> to use BiPap to relieve the excessive strain on me physically > when >>>> I'm most fatigued. Anyway, Blue Cross refused it because they > said >>>> I don't have apnea. >>>> >>>> I would guess if you show a definative breathing problem at night >>>> they should be able to help you with either BiPap or CPap. The >>>> sleep study would be covered most likely too. >>>> >>>> As for the ramp /mobility situation, first of all I'm sorry > you're >>>> having such a tough time. You might want to try contacting the >>>> Muscular Dystrophy Association to see if they could help you. >>> Other >>>> charitable organizations might assist as well. >>>> >>>> Good luck, >>>> bug >>> >>> >>> >>> Medical advice, information, opinions, data and statements > contained herein >>> are not necessarily those of the list moderators. The author of > this e mail is >>> entirely responsible for its content. List members are reminded > of their >>> responsibility to evaluate the content of the postings and > consult with their >>> physicians regarding changes in their own treatment. >>> >>> Personal attacks are not permitted on the list and anyone who > sends one is >>> automatically moderated or removed depending on the severity of > the attack. >>> >>> >>> >>> Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 CPAP is a continuous flow of air at a set pressure. The biPAP changes air pressure. It gives out a flow of air at a certain pressure and then you have to breath against it at a lower pressure. According to an MDA article, people with muscle weakness should use the biPAP, as it can also be used on different modes. Of course I got mine before the article was published. laurie > From: LILQT4U1984@... > Reply-To: > Date: Tue, 3 Feb 2004 15:20:00 EST > To: > Subject: Re: Re: BiPAP info > > Thanks Laurie. What is the difference between a Bipap and Cpap? > Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 --- I would take the report showing the apnea to another doctor and have them order it. You are entitled to a second opinion. In , " sygeek " <reesanick@h...> wrote: > The study was performed at a sleep disorder center at a leading > university hospital in Philadelphia, by a sleep disorder specialist. > Even though I showed apnea, the doc was convinced that my problems > were related to depression. > > Depression? Of course I was depressed! I was sleeping 90 minutes a > day. That was the only issue addressed, and after a year of monthly > follow up, I didn't go back. > > Some battles are not worth fighting. I found my own ways of dealing > with it. > > Theresa > > > > > >> I'm not sure what the criteria is for BiPap, but my doctor > ordered > > >> it to give me some help in the evenings and at night despite me > not > > >> showing apnea on the sleep study. We had thought it might be > good > > >> to use BiPap to relieve the excessive strain on me physically > when > > >> I'm most fatigued. Anyway, Blue Cross refused it because they > said > > >> I don't have apnea. > > >> > > >> I would guess if you show a definative breathing problem at night > > >> they should be able to help you with either BiPap or CPap. The > > >> sleep study would be covered most likely too. > > >> > > >> As for the ramp /mobility situation, first of all I'm sorry > you're > > >> having such a tough time. You might want to try contacting the > > >> Muscular Dystrophy Association to see if they could help you. > > > Other > > >> charitable organizations might assist as well. > > >> > > >> Good luck, > > >> bug > > > > > > > > > > > > Medical advice, information, opinions, data and statements > contained herein > > > are not necessarily those of the list moderators. The author of > this e mail is > > > entirely responsible for its content. List members are reminded > of their > > > responsibility to evaluate the content of the postings and > consult with their > > > physicians regarding changes in their own treatment. > > > > > > Personal attacks are not permitted on the list and anyone who > sends one is > > > automatically moderated or removed depending on the severity of > the attack. > > > > > > > > > > > > Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 I am also not sure what the criteria is for BiPap. I know most everyone here has had a sleep study who has a BiPap. I have one, but have never had a sleep study or a sleep apnea dx. I probably have apnea, as it really runs in my family and the nurses in the hospital when I don't use it, asked me if I had it. Anyway, my doctor ordered it due to the respiratory muscle weakness. It was affecting my breathing, especially at night. I have Blue Cross, and originally the refused it, but the doctor wrote a note explaining why he ordered it, the Restricted Lung Disorder, due to mito, the muscle weakness, which would be progressive and he sent in copies of my PFT's, which showed my low lung capacity. It didn't take long for them to okay the BiPap, but this was back in 1997, when insurance wasn't so strict on durable medical equipment! a I'm not sure what the criteria is for BiPap, but my doctor ordered it to give me some help in the evenings and at night despite me not showing apnea on the sleep study. We had thought it might be good to use BiPap to relieve the excessive strain on me physically when I'm most fatigued. Anyway, Blue Cross refused it because they said I don't have apnea.I would guess if you show a definative breathing problem at night they should be able to help you with either BiPap or CPap. The sleep study would be covered most likely too. Quote
Guest guest Posted February 3, 2004 Report Posted February 3, 2004 Hi gram ! I had a script that the dyspnea/pulmonary clinic called in for approval and they still refused it. bug Quote
Guest guest Posted February 4, 2004 Report Posted February 4, 2004 bug You should probably appeal it. You might want to ask for a case manager to fight for you. It should be easier with the Lupus diagnosis as they know about it. laurie > > Reply-To: > Date: Wed, 04 Feb 2004 03:53:14 -0000 > To: > Subject: Re: BiPAP info > > Hi gram ! I had a script that the dyspnea/pulmonary clinic called > in for approval and they still refused it. > > > bug > > > > Medical advice, information, opinions, data and statements contained herein > are not necessarily those of the list moderators. The author of this e mail is > entirely responsible for its content. List members are reminded of their > responsibility to evaluate the content of the postings and consult with their > physicians regarding changes in their own treatment. > > Personal attacks are not permitted on the list and anyone who sends one is > automatically moderated or removed depending on the severity of the attack. > > > > ---------------------------------------------------------------------------- > > Quote
Guest guest Posted February 4, 2004 Report Posted February 4, 2004 I agree with Laurie, Bug. This is something you should appeal. I know you have significant medical issues going on but one very good way to help you with some of your issues is to get this equipment. I can't tell you how much it has helped me to use my CPAP every day. Do you have a case manager? If not.. you and everyone else on this list should contact your insurance company and request one. It makes a world of difference as they go to bat for you. Alice From: Laureta Fitzgerald bugYou should probably appeal it. You might want to ask for a case manager tofight for you. It should be easier with the Lupus diagnosis as they knowabout it.laurie> > Reply-To: > Date: Wed, 04 Feb 2004 03:53:14 -0000> To: > Subject: Re: BiPAP info> > Hi gram ! I had a script that the dyspnea/pulmonary clinic called> in for approval and they still refused it.> > > bug > Quote
Guest guest Posted February 4, 2004 Report Posted February 4, 2004 I can't say it too many times and will second Alice here. Get a case manager if at all possible. My case manager actually knew of things the insurance would pay for that I had no knowledge of and had paid for myself. laurie > > Reply-To: > Date: Wed, 4 Feb 2004 08:20:59 -0700 > To: < > > Subject: Re: Re: BiPAP info > > I agree with Laurie, Bug. This is something you should appeal. I know you > have significant medical issues going on but one very good way to help you > with some of your issues is to get this equipment. I can't tell you how much > it has helped me to use my CPAP every day. > > Do you have a case manager? If not.. you and everyone else on this list > should contact your insurance company and request one. It makes a world of > difference as they go to bat for you. > > Alice > > From: Laureta Fitzgerald > > > bug > > You should probably appeal it. You might want to ask for a case manager to > fight for you. It should be easier with the Lupus diagnosis as they know > about it. > > laurie > >> >> Reply-To: >> Date: Wed, 04 Feb 2004 03:53:14 -0000 >> To: >> Subject: Re: BiPAP info >> >> Hi gram ! I had a script that the dyspnea/pulmonary clinic called >> in for approval and they still refused it. >> >> >> bug >> > Quote
Guest guest Posted February 21, 2004 Report Posted February 21, 2004 Pat, Any luck with getting coverage for your sleep study? PatsyAnnK@... wrote: Hi, Does anyone know what criteria are necessary for an insurance company to cover a sleep study for a BiPAP S/T and/or for a BiPAP? The sleep specialist I went to doesn't know. I have my new power wheelchair but I can't go anyplace with it because I need a van with a lift or ramp for it. The hoist I have been using for my scooter won't work. The problem is that I had to close the business I had for over 20 years last fall. That leads to 2 problems. 1. The budget for a van or anything else is very strained. 2. If I was working Michigan Rehab would pay for the modifications and I would only have to pay for the van. If anyone knows of a job for a 70 year old woman who uses a power chair please let me know. LOL. I also can't get the chair in and out of the house since I don't have a ramp for the house. My husband and son carried it into the house but that is not an activity they want to do very often. I'm not really thing about the house ramp too much now. If it does turn out that we can get a van somehow I want to have every penny on hand that I can. I didn't expect this to be so long. I just wanted to ask about the BiPAP but once I started I couldn't shut up. Pat K Medical advice, information, opinions, data and statements contained herein are not necessarily those of the list moderators. The author of this e mail is entirely responsible for its content. List members are reminded of their responsibility to evaluate the content of the postings and consult with their physicians regarding changes in their own treatment. Personal attacks are not permitted on the list and anyone who sends one is automatically moderated or removed depending on the severity of the attack. Quote
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