The machine has a lot of settings that can/should be set (based on a titration study) that will help the machine work better when run in ASV mode.xxyzx wrote: now an ASV self titrates but the DME and bcbs bureaucrats demand that the doctor tell them numbers to use to set it up
WTF! after 5 seconds those numbers will be changed and the machine will be setting the values automatically
In particular: Setting an appropriate back up rate, and setting appropriate values for TiMin, TiMax, trigger sensitivity, and cycle sensitivity, are all critically important to insure the machine is following the patient's respiratory rate when the breathing is normal, but stepping in correctly to trigger inhalations when the respiration is unstable. Get any of those things wrong, and you can easily feel like the machine is forcing you to breath at an unnatural rate while you are awake as well as making it harder for the machine to correctly respond to the apnea when the respiration is unstable. Get any of those settings wrong, and you can also increase the number of spontaneous arousals caused by discomfort from using a machine that's not properly tracking your breathing.
Also, most patients do better if the minEPAP is NOT left at the default 4cm. And some patients do best if the maxIPAP is NOT set at the default 25cm. And given the connections between PS and central sleep apnea, it's critical to get the min PS set low enough to not trigger the start of strings of CAs and the max PS high enough to step in and trigger inhalations when the breathing is irregular and it looks as though a CO2 overshoot/undershoot situation is starting.
See above: Yes, the doctor could just write a script that says, "ASV with default settings." But you might be much more comfortable while using the machine if a proper titration study was done to determine quality starting values for all the settings that need to be correct for you to get both high quality and comfortable ASV treatment of your problems.they are waiting for the doctor to fax the numbers to them
the fear is that he wont do that and say that i have to have another overnight test at the sleep lab he is financially involved with
(Comfort while using the machine is critically important: It is impossible to get a good night's sleep if you're uncomfortable all night long because the machine is not set up correctly.)
This kind of behavior by insurance companies is NOT new. It existed well before the regulations in the ACA/Obamacare were put into place. Should the GOP succeed in repealing the ACA/Obamacare, you may find that other insurance companies will choose to not cover your sleep apnea related expenses as a "pre-existing" condition should you try to switch insurance on the private market. And if your insurance is not through your job, you may find that bcbs will bump your premiums up dramatically based only on the fact that you have been diagnosed with central sleep apnea. Or because you are now between 50 and 65. Or both.i did file an internal complaint with bcbs but they will probably give her a promotion and bonus check for doing a good job with their
DIE GRAMMA DIE !!!
policy to making more money by delaying and denying treatment.
Under US law, insurance companies are allowed to set whatever criteria they want to set for determining whether a particular expense is going to be paid for by the insurance company, and many of them do decide to use Medicare criteria. And this happened before the ACA/Obamacare was passed, it happens under the ACA/Obamacare, and it will continue to happen if the GOP repeals the ACA/Obamacare.if AHC had not been psychopathic assholes and screwed me over perhaps they would have sent in for approval of an ASV
but they preferred to tell me medicrap bullshit that i had to fail an s and an st first yada yada
The sad fact is that there are no government regulations that prevent an insurance company from setting rules and regulations (such as you have to fail CPAP/APAP, bilevel, and bilevel ST before we will pay for an ASV machine.) The GOP wants fewer regulations on insurance companies, and in the long run, that may mean fewer insurance companies will be willing to pay for an ASV under any circumstances.
And, by the way, Medicare sets up criteria that sound arbitrary to you primarily because Medicare is charged by Congress with minimizing the total costs for covering everybody who is over 65 while attempting to provide reasonably decent care to as many 65+ year olds as possible. The budget limitations on what Medicare can spend are strongly supported by the GOP, and the GOP would love to further restrict Medicare spending. And the only way Medicare can restrict spending is to make it more difficult for people with medical problems to quickly obtain expensive medical treatments.
And should Paul Ryan get his dream of dismantling Medicare altogether, private insurance is not at all eager to sell policies to 65+ year olds with pre-existing health conditions at rates a retiree can afford. And employers are not eager to take on providing lifetime health benefits to retirees. So without Medicare, paying for health care would be a huge financial problem for all but the wealthiest of the wealthy senior citizens.
Doesn't matter to the insurance companies. They can choose to deny coverage for FDA approved treatments if they deem them too expensive. They can also require additional hoops to jump through before paying for FDA approved treatments if they deem them too expensive. And again, this phenomenon is not new: It happened before the ACA became law, continues under the ACA, and will continue regardless of whether the GOP manages to repeal the ACA or not. As long as an insurance company's main motivation is to bring in as much or more money in premiums than it spends in paying out benefits, insurance companies will have the motivation to force patients who need expensive equipment to jump through hoops before paying for that equipment.sorry but ASV is the ONLY FDA APPROVED TREATMENT for primary central apnea
Pardon my saying it, but .... My guess is that if/when you are set up with an ASV that has default values for all the therapeutic settings, you will likely find that you still don't sleep well with the machine.writing the doctor today to add the oximeter
i may actually have the ASV by next week
In my opinion, if the doc wants another sleep study to properly titrate the ASV machine, he is behaving in an ethical fashion.but the way things have gone i expect some jerk will screw it up with some silly bureaucratic rule that he just made up
or the doctor will be unethical and push for another sleep lab study
Again, a doctor who is honest about not having the expertise to properly and correctly treat a complex and uncommon medical problem such as central sleep apnea is being highly ETHICAL. The last thing anybody needs is a doc who prescribes something they know nothing about (an ASV) to treat a condition that they know little or nothing about (central sleep apnea.)or my family doctor will just throw up his hands and say see the sleep lab again because he doesnt know anything about sleep medicine
Why was the sleep lab "4 time zones ahead" of you? Where do you live and where is the sleep lab located?worst case i appeal to bcbs and suggest they set up an in home titration if they really feel they need numbers
but never ever going to be tortured in that sleep lab where i could not sleep due to it being 4 time zones ahead of me and a totally strange environment
Should you get your wish about the GOP killing Obamacare, you will find it HARDER to get the stuff you need rather than easier. The rules and regulations you are complaining about are NOT Federal rules/regulations. They have been set by Blue Cross/Blue Shield. Should the ACA go away, insurance companies will once again be free to set up even more ridiculous rules about what is/is not covered. Insurance companies selling policies on the private market will again be allowed to tell a person with central sleep apnea, "Sorry we won't cover any expenses related to your sleep apnea treatment any more." And they'll be allowed to just drop you outright should they decide that the fact that you've got central sleep apnea makes you way too high of a risk to cover in the first place.i hope the RINOs finally grow a pair and kill all the bamacare and medicrap programs completely
and let the free market work without their bureaucratic nonsense screwing things up
The fact is that a "free market" will never make it easy or cheap to treat a condition like central sleep apnea. And as long as you are relying on someone else (i.e. bcbs or another insurance company) to pay the vast majority of your bills, they're going to make up rules, including arbitrary rules, that will affect your therapy.