Insurance requirements for BiPap?

[Buckhorn]

Hello all. My husband has a 4 month, ALS clinic appointment next week. He will have his respiratory function measured then. I am not sure how that will go, but I am assuming his values have decreased (sorry, I don't know his MIP/FVC as I was still too stunned at the first clinic to absorb everything / write everything down). Dave has no problems breathing during the daytime; at least he admits to none. However, just two nights ago he told me he has been having some trouble breathing when he is lying on his back and that he didn't want to tell me. I already knew this because I was watching him try different pillows/two pillows/wedge pillow, etc. to raise his head. Also, I have spent over 5 months lying awake for many hours at night listening to him breathing. Last night sounded pretty good.......! IF he takes a sleeping pill (Ambien or a Xanax which also helps him sleep) he does have loud "snerking" going on when in REM sleep. I do not hear him stop breathing and then gasp, etc. He has terrible allergies and has had those for as long as I have known him. We are experiencing a high pollen time of year right now with many trees and shrubs blooming. He has trouble clearing his throat of "gunk" - sinus drainage, but again, that has been typical for many years. (I have noticed some, slight problems with speech volume because he has to clear his throat at times, but again, he says it is his sinus drainage, and this has happened for years - I'm just really tuned into it right now). He has no problems chewing, or swallowing, not even thin liquids.

My questions are:

IF his respiratory values have decreased, at what (measurement) point will a BiPap be recommended at night? Will this require a referral to a pulmonologist and a sleep study so that Medicare will pay for it? With ALS, I think the answer is no, but just wondering .......

Does use of the BiPap at night diminish the strength of the respiratory muscles during the day (& not useing BiPap)?

Is a "Voldyne Volumetric Respiratory Exerciser" beneficial? I had purchased one for my husband a week after he was diagnosed, and he uses it, but just once per day.

Is "pressure-cycled ventilation" ever recommend to PALS?

Are respiratory difficulties challenged when on a commercial passenger plane (we are scheduled for a flight in 2 weeks)?

Thank you!

 

[Buckhorn]

I somehow missed the thread started by KimT (sorry!!), so that answers my questions regarding Medicare coverage. Excellent information provided Laurie and Diane - TY! Sounds like I will have to bring up the Medicare reimbursement changes/issues with the ALS social worker if it is suggested that my husband should get a BiPap.

 

[gooseberry]

You might want to ask for it regardless. These things take time. When they measure his breathing at clinic, make sure he is sitting up and laying down. The difference in the measurements is important. The old theory was 50% fvc but now they like to srart it as soon as there is any difficulty.

 

[lgelb]

1) Is traditional Medicare or another plan your primary? Criteria vary somewhat. And then, are we talking an "NIV" or "BiPAP" ? See Kim's thread.
2) Use of BiPAP prolongs life if it is set properly. It does not diminish the muscles but helps them be leveraged.
3) Incentive spirometer type machines should not be used to exhaustion until/unless we find out it doesn't hurt. Opinions vary. That's mine.
4) Many PALS are on BiPAPs that lack a VAPS mode so by definition they are in "pressure-cycled" (a set pressure for IPAP and EPAP, or ranges) instead of volume-driven therapy. With the right machine and settings, and a willingness to adapt it to the disease's progression, I believe VAP is best, unless pre-existing apneas are more prominent.
5) If the PALS is on the brink of needing BiPAP when asleep and s/he falls into deep sleep at altitude, it's possible that s/he could have some level of symptoms, but it doesn't sound like your husband is quite there -- is it a flight where he would have to sleep? Not to would be best. Or to doze.

 

[Buckhorn]

Hi Laurie - sorry for the delay in my response. Dave has "straight" Medicare, plus an excellent Blue Shield plan as secondary insurance. Yes, I am only talking BiPap here, no invasive procedure (trach). I need to ask the social worker / nurse specialist about what the current requirements are to "qualify" for a BiPap. Dave does not want a vent, but would consider a phrenic nerve stimulator / diaphragm pacer, if he feels his quality of life otherwise is at least decent.

I have Dave use the Voldyne respiratory exerciser ("incentive spirometry") but not to exhaustion ...... just a few attempts, then rest, then try again. I appreciate your opinon on that, and I agree. I tell him he should not do anything to exhaustion/extreme fatigue.
I am hoping to find out more about a BiPap / AVAP machine, hopefully one with variable settings to adjust tidal volume and to adjust for variant breaths that replicate what most of us without respiratory compromise take quite frequently. I do not know much about this; willing to learn, while respecting my husbands wishes.
Regarding our upcoming air travel plans, it is a long flight - two 5 hours segments on the outbound trip, and a 7 hour trip at one point on the return. I will have to keep an eye on him ...... I'm not sleeping too well anymore anyway. The cabins are pressurized, so I don't think there is much stress on the lungs, but again, I am no expert on this.

 

[lgelb]

It is not the pressurization -- I was sure you would be flying commercial -- but the altitude, which is less forgiving of respiratory compromise.

VAPS (AVAPS/VPAP) = volume control mode options, which you are asking about, on BiPAP. I wasn't asking about a trach -- you're not there -- but whether you are seeking an Astral or Trilogy, which function as portable BiPAPs but are classified as NIVs (non-invasive ventilators) for reimbursement purposes. Those are the machines that as you can see on other threads are less easily reimbursable than they used to be.

Both ResMed and Respironics machines have volume control modes, though not in all models. Setting an adequate but not excessive tidal volume coupled with personalized pressure ranges and trigger/cycling/Ti values is the best way to minimize the impact of those errant breaths.