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+--- Thread: Any idea why Medicare would reject a BiPap machine to address Hypoxia? (/Thread-Any-idea-why-Medicare-would-reject-a-BiPap-machine-to-address-Hypoxia)
Any idea why Medicare would reject a BiPap machine to address Hypoxia? - elisio - 09-27-2024
I just had a sleep study which showed that with cpap therapy, my apnea was fully treated (AHI < 5), but that I had persistent hypoxia (SpO2 between 87-89%). With BiPap, both the apnea and hypoxia were treated (SpO2 93-94%). So, my sleep doc ordered a BiPap machine, but the DME just told me that Medicare rejected it because hypoxia is not an adequate reason for requesting a BiPap machine and they will only allow a CPAP machine. Anyone have any information about this or whether an appeal to Medicare might be successful?
RE: Any idea why Medicare would reject a BiPap machine to address Hypoxia? - mesenteria - 09-28-2024
I don't know, but I suspect that <5 AHI was the killer. Sorry.
I would get a second opinion, and maybe a full polysomnography if that wasn't what led to the original diagnosis, and then appeal.
RE: Any idea why Medicare would reject a BiPap machine to address Hypoxia? - Deborah K. - 09-28-2024
Your problem would likely be fixed if you added an oxygen feed to your machine. Many here have successfully done this. A ResMed AirCurve 10 Vauto is a wonderful machine. It may be that you have other issues that will qualify you for one, such as unrelenting high flow limits. Someone just posted to my old, very long thread about my journey, with SleepRider's help, to get a Vauto myself. You could skim this and see if something there might help you obtain one for yourself.
Best of luck!
RE: Any idea why Medicare would reject a BiPap machine to address Hypoxia? - srlevine1 - 09-29-2024
Perhaps the correct treatment modality is an oxygen concentrator for nocturnal oxygen desaturation with a xPap as an add-on as a treatment for a co-morbidity. Depending how your doctor writes the diagnosis, prescription, and prognosis, you might have grounds for a “reasonable” appeal.
RE: Any idea why Medicare would reject a BiPap machine to address Hypoxia? - staceyburke - 09-29-2024
Why not try another DME. It couldn't hurt. With the RX in hand you should be given what the Dr prescribed.