So...can't wait till Friday

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
Pugsy
Posts: 43983
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: So...can't wait till Friday

Post by Pugsy » Fri Apr 13, 2018 7:12 am

Yep...horrible as usual.

Crossing my fingers for you that the doctors will be more aggressive this time about treating those centrals and get off their butts.

When you had this last most recent sleep study...was it with or without a machine?
I may have to RISE but I refuse to SHINE.

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: So...can't wait till Friday

Post by Barb (Seattle) » Fri Apr 13, 2018 7:18 am

Pugsy wrote:
Fri Apr 13, 2018 7:12 am
Yep...horrible as usual.

Crossing my fingers for you that the doctors will be more aggressive this time about treating those centrals and get off their butts.

When you had this last most recent sleep study...was it with or without a machine?
she wired me up, placed that mask on me and ordered me to sleep so she could try and qualify me for ASV LOL

I tried to sleep and went out at about 9ish which is early for me lol I used a Resmed AirFit F20 and LOVED LOVED LOVED it.
DreamStation
21 years on CPAP

User avatar
Pugsy
Posts: 43983
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: So...can't wait till Friday

Post by Pugsy » Fri Apr 13, 2018 7:27 am

That's good...they already had accepted the fact that the centrals were real and a problem and wanted to fix them.

I was afraid they wanted to go back to step one...and prove the centrals were even real and happening without cpap as first step...
Wouldn't likely have changed the outcome but would have taken longer and this crap has taken way too long as it is.
I may have to RISE but I refuse to SHINE.

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: So...can't wait till Friday

Post by Barb (Seattle) » Fri Apr 13, 2018 2:42 pm

weird turn of events. ASV (or machines like this) are not covered under my insurance :shock: :shock: ??!!!! weird.



this is complicated and I'm trying to figure out the easiest way to explain what I was told....

the Dr is hoping that this high pressure works.....he really WANTS me on ASV, but my insurance won't cover it so we're crossing our fingers this works.
The DME that works with this Dr called the insurance and got a no..it's not covered, they don't even have a code for it..just regular bipap.
So, I called. They looked into it a bit, and said it MIGHT be covered if the Dr could prove I have medical necessity...but I don't want to do
that because you have to rent the machine for 9 months...and I go on Medicare in 6. so....ugh

The Dr put me on bipap pressure 22/18. I just took a nap with it, and I am burping...that's a lot of air :shock: :lol:
DreamStation
21 years on CPAP

Jas_williams
Posts: 131
Joined: Tue Dec 19, 2017 2:12 pm
Location: Somerset UK

Re: So...can't wait till Friday

Post by Jas_williams » Fri Apr 13, 2018 3:42 pm

Barb


Let’s see if I understand something does not smell right here


There is no separate code for an ASV it is the same code as a BiPap with a backup rate I think as below. Your doctor just needs to specify the exact machine.

E0471 Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

YOu need to go back to your insurance and DME with the above code and check coverage I would be very surprised if it’s not covered

_________________
Mask: AirFit™ F10 Full Face Mask with Headgear
Additional Comments: Using sleepyhead and a pressure of 9-16 Resmed S9 Adapt SV
Last edited by Jas_williams on Fri Apr 13, 2018 4:07 pm, edited 1 time in total.

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: So...can't wait till Friday

Post by Barb (Seattle) » Fri Apr 13, 2018 4:06 pm

Jas_williams wrote:
Fri Apr 13, 2018 3:42 pm
Barb


Let’s see if I understand something does not smell right here


There is no separate code for an ASV it is the same code as a BiPap with a backup rate I think as below. Your doctor just needs to specify the exact machine.

E0471 Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

ASV is a Bipap with a backup rate. I am not sure extra pressure will help
in any case, they won't cover a machine for 4 more years....I just got it last May. I go on Medicare in 6 months, and that messes with the timing..I have to rent the machine for 9 months...I have only 6 months to work with. Medicare will pay for it. Meanwhile...I'm screwed.
DreamStation
21 years on CPAP

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: So...can't wait till Friday

Post by Barb (Seattle) » Fri Apr 13, 2018 4:08 pm

Jas_williams wrote:
Fri Apr 13, 2018 3:42 pm
Barb


Let’s see if I understand something does not smell right here


There is no separate code for an ASV it is the same code as a BiPap with a backup rate I think as below. Your doctor just needs to specify the exact machine.

E0471 Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

YOu need to go back to your insurance and DME with the above code and check coverage I would be very surprised if it’s not covered
The DME called my insurance, and they told her there was no code for a machine that handles centrals.
DreamStation
21 years on CPAP

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: So...can't wait till Friday

Post by Barb (Seattle) » Fri Apr 13, 2018 4:09 pm

results of my study....kinda.....

30714136_10214309966917553_8397100056582291456_n.jpg
30714136_10214309966917553_8397100056582291456_n.jpg (133.37 KiB) Viewed 268 times
DreamStation
21 years on CPAP

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: So...can't wait till Friday

Post by Barb (Seattle) » Fri Apr 13, 2018 4:33 pm

the machine is about $7,000....that is a staggering amount for this...imho
DreamStation
21 years on CPAP

User avatar
palerider
Posts: 18544
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).
Contact:

Re: So...can't wait till Friday

Post by palerider » Fri Apr 13, 2018 5:55 pm

Barb (Seattle) wrote:
Fri Apr 13, 2018 4:33 pm
the machine is about $7,000....that is a staggering amount for this...imho
That's "fantasty DME price".

around 2149 for a new aircurve10 asv at secondwindcpap, 1795 for a gently used one, 1249 for a s9 vpap adapt, (get the 36037 model, it's got the same functionality as the aircurve10 asv.)

Even less if you see one on craigslist... (which is where all my machines came from).

Aircurve 10 ASV or S9 VPAP Adapt (36037 REF number).

_________________
Machine: S9 VPAP™ Auto BiLevel Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Vpap Auto

User avatar
Pugsy
Posts: 43983
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: So...can't wait till Friday

Post by Pugsy » Fri Apr 13, 2018 11:36 pm

Barb (Seattle) wrote:
Fri Apr 13, 2018 4:08 pm
The DME called my insurance, and they told her there was no code for a machine that handles centrals.
This simply isn't true.

It's a bilevel machine with a back up rate. E0471 All insurance companies use these codes.
ASV is just one of several E0471 machines that will treat centrals.

If you could get your hands on the ResMed S9 Adapt model 36037...it would do what you need and do it very well.

Here's the list of equipment codes...everyone uses these same HCPCS codes. They might not all have the same replacement schedule as Medicare but everyone uses these codes.

Image
I may have to RISE but I refuse to SHINE.

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: So...can't wait till Friday

Post by Barb (Seattle) » Sat Apr 14, 2018 6:09 am

how do I get around the fact that I would have to rent it for 9 months....6 till I switch to medicare. It wouldn't work.

I can't afford to pay out that much $$ for a machine on my own. I'm just going to have to wait.
I will be calling the Dr on Monday to try to work this out.


22/18 isn't going to work.

My stomach hurts I have so much gas. :( I'll put the pressure back down and deal with higher AHI. at least it's not 70 ahi like my 1st sleep test years ago.

some things just can't be solved and this is one of them.
DreamStation
21 years on CPAP

User avatar
Pugsy
Posts: 43983
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: So...can't wait till Friday

Post by Pugsy » Sat Apr 14, 2018 7:53 am

Give me a bit of time...let me see what I can find. It can be done.

In the meantime check your PMs in just a bit.
I may have to RISE but I refuse to SHINE.

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: So...can't wait till Friday

Post by Barb (Seattle) » Sat Apr 14, 2018 11:25 am

thank you :)

I will call her on Monday and ask why I can't just hand over the machine in 6 months, and then switch to Medicare then. (if I can get the machine through my insurance)
DreamStation
21 years on CPAP

User avatar
Okie bipap
Posts: 1493
Joined: Thu Oct 15, 2015 4:14 pm
Location: Central Oklahoma

Re: So...can't wait till Friday

Post by Okie bipap » Sat Apr 14, 2018 11:43 am

If it were me, I would go ahead and get the machine as soon as I can. Rent it for six months, then get a new one through Medicare. I would then offer to purchase the used machine from the DME at a much reduced price since it is a used machine that few people need. That would give me a new machine and a fairly new back up machine.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ F20 Full Face CPAP Mask with Headgear
Additional Comments: IPAP 12-22, ps 4, Sleepyhead software