Update

[UKwildcatfan]

This sucks, I really hope this works. I am almost in tears worrying about it. Also, what kind of DME doesn't keep CPAP machine's in stock? Why'd they have to order it? I just really really hope this works. At least sufficient enough to get my DOT physical card.

[Wrz77]

Just in case you DO end up getting saddled with a non-APAP if it's the DreamStation Pro.. then you can enter the clinician menu and use the A-Trial feature to get APAP/Variable mode. You'll need to go back in every 28 days and set it to 29 days, then back to 30 to keep resetting the A-Trial counter to 0 so that it doesn't use up one of the five supposedly lifetime usage limits on the device.

Note: After using 5 months of A-Trial (if you let it accrue 30 days each time) it permanently reverts to fixed pressure CPAP supposedly.

The only thing I noticed that is different from A-Trial and DreamStation Auto besides Auto not having a time limit was the lack of a 'Flow Limitation' graph on the Pro in A-Trial mode.

However, if you get stuck with the baseline non-Pro model the A-Trial feature is not available.

I am currently using the A-Trial and setting it to 29 days every 28 days to reset the counter to 0 to avoid using up one of the 5 month limits. I am hoping this workaround works until 5 years from now when Medicaid will pay for a new machine - which then I will get an APAP machine Rx in writing.

I don't know how changing the therapy settings work in terms of compliance though. It may or may not make you non-compliant if you diverge from the prescribed settings. I'm sure others here know for sure.

For me, with my Humana CareSource MCO Medicaid, they paid for the machine by monthly rental from May to October and then I owned the machine and could do what I wanted with it. I think the standard is they only monitor for 'compliance' the first 90 days. I know they at least make sure you've used the machine for 4 hours or more for 21 or more days per 30 day period. I don't know if they also factor in whether or not you diverged from the prescribed settings.

If you do get the DreamStation Pro and wish to use A-Trial since you were recommended a setting of 14 cmH2O a range of around 8-14 will probably be ideal. You can monitor using SleepyHead to fine tune it from there. Or even throw out their recommendation entirely and self-titrate from scratch by setting it to 4 - 20 cmH2O (the maximum range allowed) and use it for a week or so, then set the minimum pressure to what SleepyHead indicates was the "90% Pressure"

[UKwildcatfan]

Pretty sure it is the baseline model I will get stuck with. Will this crap even help me enough to get a physical card?

[Wrz77]

Pretty sure it is the baseline model I will get stuck with. Will this crap even help me enough to get a physical card?

Yeah I'm pretty certain it will. All they care about AFAIK is that you used it for 4 hours a night for at least 21 days out of 30 - and they check once a month for 3 months (90 days) then they usually don't care after that. And the cellular modem module, or SD card, or "phone-in" feature will be used to determine this. They either give you a modem that is installed in the side of the device that automatically uploads usage hours each day at noon; or they have you call a special number and read off a long number from the "Phone-In" screen under 'My Provider', or they have you mail in your SD card. Most use the first method to determine compliance.

I don't think they delineate on what kind of machine you have, as long as it is being used as per compliance rules.

After each night of turning off the machine it will show you a screen that indicates how many hours you used the device for that 24 hour period (12:00PM to 12:00PM) and if the bar is green that means you used it long enough that night to be in compliance for that day; if it is dark yellow it means you have not.

But again you are allowed 9 days out of a 30 day period to not be in compliance usually. It's recommended to use it every time you sleep though.

If you don't have the time to get the machine you want and you get stuck with the baseline model, then you'll likely need to wait 5 years to get another one after you've accepted it. Medicaid entitles you to a new machine every 5 years. The only ray of hope once you accept a brick that has other models that are not bricks is that someone will release a modified firmware file that has 'cracked' (illegally modified) the code in the firmware to make a baseline model have Pro and/or Auto features -- but I wouldn't count on that happening.

I tried to take a stab at cracking the firmware for DreamStation series but I can't even figure out what format the firmware file is in.

I don't know about WellCare MCO Medicaid, but there is one online DME that another Medicaid MCO in KY accepts that takes online orders -- the Edge Park site (note: it's not on the supplier list). You might try your luck with that if you get a written copy of the prescription you can scan it and upload it to EP and try to get an APAP that way. Or at least a data capable CPAP. I'm sure there's many other online DMEs that can take your MCO and ship it to you as well, but I only have experience with EP (for wound care supplies not xPAP). The DME vendor I use for my CPAP supplies and machine doesn't even have a website. So I doubt they take orders from out of the region.

[UKwildcatfan]

I mean, I want it to help me too. My doctor insists that it will so I guess maybe I will trust her, I don't know. She said if I felt it didn't work after using it for 2 weeks, to call her and tell her and she will adjust the pressure.

[Hydrangea]

You will be totally okay. It will work.

Edited to Add...
You may want to call the DME and ask them "Just out of curiosity, which machine are you planning to give me?"

If they say "A DreamStation.", you can ask "Great! Which one? The Pro or the Auto?" And if they say "No, the regular CPAP." then you'll have time before the appt to decide what you want to do. But if they say it's the Pro, then at least you can go into the appt confident that you're getting a data-capable machine that you'll be able to really work well with.

When I did that (after I fired my first DME, and was checking out a different DME), they told me which machine... and then I was able to 1) have time at home to decide if I was going to accept it, and 2) go into the appointment with confidence in what was happening (rather than trying to think on my feet - oh no, is this a brick, uh oh, am I going to regret taking this?). That way, I only had to concentrate on finding a mask, rather than spending my emotions and brain on also making sure I was ok with the machine.

[rafairchild2]

I am so sick of Doctors, in particular in medical groups where it is "Profits over Patients"!

I just fired my endocrinologist this week ,as I feel I have lost confidence in her. She took me off a medication, cold turkey that was helping me. She needed to put me on a post cycle treatment (lack of a better term) but did not. The thing is this medication was working for me AND it allowed me to cut down/ out 3 other medications and NO LONGER SEE other specialists. But a couple blood markers were high. I asked if a certain simple and FREE process was how the numbers could be lowered.. She would not answer it. Well... I did it, and it is true.. Giving blood lowers certain markers. It is actually called therapeutic phlebotomy. (Good old blood letting to me!)

Yet she would not tell me to do it as it would SOLVE my issue with high blood values and she would not be needed!

By cutting me off cold turkey I went into what is now a 4 month spiral, undoing nearly 2 years of health/ physical gains. When I saw what was happening I had called back in December and STILL COULD NOT GET in to see her for 3 months!

I save ALL my bloods, data, etc.. I ask for ALL results, paperwork from the doctor and receive it that day. I put it all in a spreadsheet so I can correlate and see what is happening. I asked for a specific blood test and they tried to tell me I did not need it. I explained to them the science but then said I AM THE ONE PAYING FOR THE TEST NOT YOU. Order the test, or i do it on my own.

Remember.. Yes... Knowledge is Power... BUT I SAY... Data is Knowledge, THUS DAT *IS* Power!

Let me add she had prescribed a mediation that was costing me $160 co pay for a one month supply.. There was a generic alternative, that is actually better in results although inject-able, that would cost me $70 for 3 months (WITHOUT INSURANCE) $5 for 3 months WITH!!! Why was I not even counseled or told about the alternative? What benefits did she get keeping me on the more expensive LESS effective medication than an established generic? Even a name brand of the med is FAR cheaper!