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Post-Polio Health (ISSN 1066-5331)

Vol. 8, No. 1, Winter 1992


Ventilator Considerations:
Lease vs. Purchase

Roberta Simon, R.N., Darien Park, IL

After being monitored over the past four to five years for respiratory and sleep difficulties related to the late effects of polio, it was decided last fall that assisted night-time ventilation was necessary. I was advised by my pulmonologist that prior to a scheduled sleep study I should obtain a letter of necessity from both my cardiologist and my pulmonologist to submit to my insurance company for their review and approval. I was also told to investigate what the insurance company would and would not consider for payment. All of this information turned out to be very good advice and was something I had not even considered.

I obtained the letters, sent them to the insurance company, and, after obtaining approval from their review board, I received a letter of approval prior to the sleep study. I learned that all insurance companies review non-emergency ventilator use to consider
payment and necessity. Their decisions are based upon various considerations of symptoms and diagnosis.

Following up with a telephone call to the insurance company, I learned that they would pay the monthly rental fees up to the purchase price at which time I was responsible for paylng the rental
fees myself or pay the the outright purchase price and subsequent repairs and service as needed. I was glad to learn this, because if I had not, I may have been shocked when my coverage became exhausted after 18 months to two years. (That would have been very costly as I plan to live to be 100 and go skiing on my birthday as my great-grandmother did!) Anyway, I purchased the ventilator, after
renting one for two months.

It was nice renting the ventilator for the first month or two because the respiratory therapist from the small medical equipment company stopped by frequently to check on my progress and assist me
with problems. The primary reason for renting was to give Bi-PAP another try. I had tried Bi-PAP in the sleep laboratory but it did not ventilate me adequately, and I was swallowing large amounts of air
due to pharyngeal weakness. Alas, Bi-PAP was not for me, although many individuals are having wonderful experiences with Bi-PAP.

There were numerous problems with the rental ventilators, including one which set its own breath rate during the night. Needless to say, this caused unpleasant pain and fatigue in my chest. Remember
that rental equipment is rarely new and for the most part has been serviced and rebuilt many times.

For the last ten months, I have been using a PLV-100 ventilator with a nasal mask, and know the quality of both my sleep and my life have improved tremendously. I look at my ventilator as a friend
and in the same context as the other assistive devices I use. For me, purchasing a ventilator has
caused few difficulties.

The main difficulty was related to nasal masks, and many of you know that finding a mast that fits
correctly and fits comfortably is a challenge at best. Having been raised in a family with several siblings, I soon discovered that all the doors, toys, elbows, etc., that had connected with my nose through the years had definitely made an impact.

I tried an ADAMS circuit, but a bony prominence in my nose made that very uncomfortable and impossible. I tried a Respironics mask and a Healthdyne mask, but discovered that the anatomy of my face was again defective. The space between my upper lip and nose was smaller than average so that during the night the mask would slip over my lip and leak, sounding the ventilator alarm. After fighting the battle for several months, I had a custom mask fabricated for me by the staff of my
pulmonologist. What a relief – difficulty solved!

Recently, for the benefit of other ventilator users, I decided to investigate the rental vs. purchase
conundrum. I called three national home health care agencies for their opinions. My first surprise
was their reluctance to share any opinions or information with me.

The first company I called connected me with a respiratory therapist, but when I asked my question,
the therapist put me on hold for several minutes (knowing I had called long distance on day rates), then rang an answering machine which asked for my name and telephone number. I have yet to receive a return call.

The second company stated that the advantage of rental was that service for the equipment would be available any time of the day or night, and that ventilators were high service equipment – meaning they break down frequently. When asked if they would service a purchased ventilator at any hour or replace it with a rental, they stated they would – for a charge. The therapist with whom I was speaking then transferred me to the manager of the respiratory therapy section. I was told he was too busy but would call me later. I am still waiting for that return call

The third company stated they made no follow-up visits after a purchase, and any problems other than equipment-related ones covered by the warranty would have to be taken care of by a home health care company. The advantage of rental from this company was stated to be that they serviced the equipment and the patient and all necessary supplies were included in the rental fee. This latter statement fascinated me because the home ventilator company I had dealt with for two months had managed to run up considerable charges with supplies – over $500.

I guess that by their anxiety in answering questions, they answered them. Subsequently I had a lengthy talk with my insurance company regarding home ventilator use. They stated that the reason they no longer paid for rental equipment was because they felt they were being gouged by home health care companies. Sleep laboratories are now diagnosing and treating sleep apnea with nasal C-PAP; thus nasal mask and home ventilation are more widely used, and these companies have seen big opportunities for profit. The cost has more than doubled in the past five or six years. Granted, the companies do need to pay respiratory therapists to service both the equipment and the clients, plus provide 24-hour coverage for equipment failure or client difficulties which may justify some of the expense.

To me, purchase of ventilation equipment for an individual with a chronic longterm need does make
more sense from an economical point of view, as long as the insurance company is willing to pay for repairs and a temporary replacement while a unit is being serviced. The disadvantage, of course, is that you may have no backup unit in your home for emergency coverage.

I was fortunate to have a physician knowledgeable about ventilators or I could have faced some serious difficulties. I hope all of you will be able to investigate the services, regulations, and rules of your insurance company now so that more decisions and stress will not be facing you in the months to come.

Reprinted from I.V.U.N. News, Fall 1991, Vol. 5, No. 2., a publication of Gazette International Networking Institute.

RECENT, RELATED PUBLICATION: "Pulmonary Dysfunction and Sleep Disordered Breathing as Post-Polio Sequelae: Evaluation and Management" by John R. Bach, M.D. and Augusta S. Alba, M.D. Orthopedics, December, 1991, Vol. 14, No. 12. Pages 1329-1337. This article discusses "Pathophysiology of Late-Onset Pulmonary Dysfunction,""Evaluation of CAH (chronic alveolar hypoventilation) and Sleep Disordered Breathing," "Pulmonary Managements," and "Preparing for Surgical Intervention."


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