doctor says complex insurance says use a bipap s/t

[LSAT]

is there any bipap other than an ASV type that will possibly handle central/complex apnea

i think the DME is trying to impose some medicare rules on my insurance while ignoring that my doctor says the bipap failed and to use an ASV
and my insurance rep is clueless and believing everything they tell her

is there any bipap s/t that claims to help complex/central apnea ??

The AirCurve 10 ASV bilevel machine offers truly personalized therapy for central breathing disorders, such as Cheyne-Stokes respiration (CSR), central sleep apnea (CSA) and associated obstructive events. Featuring the most clinically-studied and proven ASV algorithm, AirCurve 10 ASV is the only adaptive servo-ventilator that targets the patient’s own recent minute ventilation.

What is BiPAP or Bi-Level machine? BiPAPs, or BiLevels are positive pressure airway devices that offer 2 separate pressure settings that consists of 1 inspiratory pressure and one expiratory pressure. These 2 BiPAP pressure settings are usually separated by a pressure range of 3 cm/H2O to 6 cm/H2O, and example of that would be IPAP of 12 cm/H2O and EPAP of 8 cm/H2O, please note these pressures vary patient to patient. Also available are Auto Bi-Levels or Auto BiPAPs, which will automatically adjust the BiPAP pressures.

[TASmart]

So go to a different DME, they are after all, a service provider - no service no business.

[Okie bipap]

Maybe it's time to look for a new DME. If the doctor writes the scrip for ASV with pressure settings that cannot be met with the ST machine, then the only option is to issue the ASV machine. The ST and ASV have the same HCPCS code, but the ASV costs more. Insurance companies pay according HCPCS codes. The DME is hoping to maximize their profit.

[chunkyfrog]

The frog says to FIRE them.
If you are on Medicare, file a grievance with MEDICARE, with copies of all documents, especially the doctor's statements.
These shenanigans may conflict with the rules of Medicare, whose displeasure can ruin a business.
You may be able to leave these crooks, but they need to be prevented from harming others.

[LSAT]

If the doctor says use an ASV and writes a prescription to that effect, they must fill it as written.

[chunkyfrog]

Blue Cross has rubber-stamped DME misdeeds before.
Since the HCPCS code is the same, insurance has to cover ANY machine with that code.
They should ONLY fill the prescription EXACTLY as written.
Make sure the doctor writes it to allow NO "wiggle room", then resubmit.

[CarpeNoctum]

is there any bipap other than an ASV type that will possibly handle central/complex apnea

i think the DME is trying to impose some medicare rules on my insurance while ignoring that my doctor says the bipap failed and to use an ASV
and my insurance rep is clueless and believing everything they tell her

is there any bipap s/t that claims to help complex/central apnea ??

Your initial question reveals that you don't know what a BiPap ST is. Not all BiPaps are ST's. There are plain Bipaps without the ST The ST portion means that the machine has a back up breath rate which is adjustable. What that means is...for example, if the rate is set at 15 breaths per minute, that a breath will be initiated spontaneously if the patient doesn't breath for over 4 seconds.

So a Bipap ST and a Bipap asv will both treat central apneas. The asv is a more sophisticated machine and is used with copd patients and patients with more complicated issues such as cheynes-stokes and such. I know there are similar machines in the Resmed line...but these are Respironics phrases.

So if you have OSA with a central component...and no complicating medical issues: then a BiPap ST will do nicely...to treat central apneas.
CN

[tmiker]

Sounds like the DME trying to play doctor, or insurance company. They are a supplier and should provide what the doctor prescribes and insurance covers. I had a similar issue ... insurance required cpap fail, bipap fail and bipap st fail to get to asv. I ended up buying one on my own after the bipap fail since I was desparate for sleep. The ASV's are great, I think everyone should have one. Good luck on your struggle, hope you get it resolved soon.

[palerider]

The asv is a more sophisticated machine and is used with copd patients

correction, the asv is not a good fit for people with COPD, that requires a different treatment strategy.

[CarpeNoctum]

The asv is a more sophisticated machine and is used with copd patients

correction, the asv is not a good fit for people with COPD, that requires a different treatment strategy.

COPD is a phrase that implies a handful of different Dx. ASV machines are used with some copd patients while others use avaps...but that's totally off the mark for this thread.

Nice obfuscation though.
CN

[palerider]

COPD is a phrase that implies a handful of different Dx. ASV machines are used with some copd patients while others use avaps...but that's totally off the mark for this thread.

you might want to argue the point with the resmed titration guide, then... since it says that indications for ASV therapy are:

• Periodic breathing, both normocapnic and hypocapnic
• Other forms of central and concomitant obstructive events (mixed sleep apnea)
• Complex sleep apnea (CompSA)

it goes on to say about patients with obstructive lung disease (such as CObstructivePD):

Patients with obstructive lung disease have chronic airflow limitation. These patients have particular difficulty exhaling air, which leads to air trapping and hyperinflation. These patients require a longer exhalation, which often leads to asynchrony with standard bilevel settings.
The recommended settings use a faster rise time to ensure that the lungs are filled quickly, and a high cycle sensitivity to provide an earlier cycle to exhalation. The rapid inhalation and prolonged exhalation will help to prevent auto-PEEP and preserve synchrony.

none of that is applicable to, or addressed by an ASV.