ASV Titration

So, I finally heard back from the Sleep Study place. The last time I had heard from the tech was on 12/30 and I was told they were waiting on the doctors to sign off on my paperwork and that he would call me when they faxed it over to my doctor. Obviously he forgot to call me. He called today to find out if I had the script from my doctor for the ASV titration. The last time I talked to the tech he said they would going to try the BiPap again before the ASV so I'm not sure if things changed or if I'm just easily confused.

But, despite my attempts to get all my testing done before the end of last year, it didn't happen since they want me to come back for another titration. I have a primary insurance (horrible - but I'm required to have it or my husbands insurance won't cover me) and my husbands insurance changed at the beginning of the year. So, I had to talk with the insurance biller to update my secondary insurance. My primary insurance covers a very minimal amount so is pretty much useless. The girl is checking into what the secondary insurance is going to cover and I don't know if it's something we're even going to be able to afford right now because the new deductible is a lot more. Am I on some kind of a time limit to finish this testing?

I appreciate any help. Thanks!

First a general comment (and a lesson you've learned the hard way) .. It is our responsibility to but the snot out of the DMEs and other medical professionals. We are the ones with the vested interest. Don't wait for them to call. Call them. Become a pain in the neck until they deliver the service that you need and when you need it. I know that I've personally had to learn this the hard way. Hopefully others will read and learn.

Second, I'm really sorry you've had such a hard time with getting things scheduled. It sometimes takes all the effort we have to get things scheduled and get our sleep issues addressed. Unfortunately, we all have to become our own advocates. The DMEs and other medical professionals see so many different patients that they really can not become your advocate.

Third, a lot of us have poor insurance. Way to many insurance companies only want the money and don't want to fulfill their end of the contract. It's a frustrating situation.

Finally, you wonder:

Ladyflower wrote:... Am I on some kind of a time limit to finish this testing? ...

Most DMEs require that the doctor's orders were written within the past year. They can call and confirm the orders if there is some concern.

Hope that helps.

It's a lesson I've tried beating into my husband for a while now! He has had some major health issues in the recent past and I'm always getting on him about calling when they don't call him back.

I was calling the sleep place repeatedly in November and December, trying to hurry them along. But, when January came around I knew there was nothing I could do about the insurance anyway so it got pushed to the back of my mind. I have ADD so I can hyperfocus on something like nobody's business. But I can also completely forgot about something that isn't on my priority list.

I did just hear back from the insurance biller at the sleep place. I have to give her a lot of credit for all that she has tried to do for me. One would think having 2 insurance policies is a good thing. It's absolutely not. It's costing us so much more (and even she questioned why I have both policies) but as long as I'm working, we don't have a choice. Basically, the deductible is more than the cost of the ASV titration so I would have to pay the entire amount. She is going to call my primary doctor and talk with the sleep study doctor to see if they can bypass the second lab study and just have me use the ASV unit at home and they would assess the card after 90 days.

I guess I just have to hope for the best. Thank you for taking the time to answer my questions!

Like I say .. Sorry to hear you are dealing with such insurance problems. You may want to explore purchasing your ASV unit from an online store, such as CPAP.com. You may also see notes here from time to time about used ASV units for sale.

And I was not criticizing you on getting on your DME .. believe it or not a couple of months is not an excessively long time for the process. Also, add I've mentioned, I have had the chance to learn that lesson over and over and over ... (I guess that I'm a slow learner!)

Honestly, I should have had the testing done a long time ago. But, I made lots of excuses why I was tired. 2 young children, stress, going to bed too late, getting up too early...

I wouldn't say you're a slow learner! My best friend was constantly fighting to see specialists (brain issues) and my husband has had to see his share of specialists as well. So, unfortunately I've seen how long it takes to get appointments and get return phone calls. (Especially when the surgeon just "forgets" to call on multiple occasions.)

As far as the unit itself, I am a little confused. She said the unit is around $4K. And she said the "billable amount" would be $350/month. Does that mean that is the amount they would bill my insurance? I believe my insurance covers 80% of durable medical equipment. Does that mean I would have to pay the deductible and then they would pay 80% of the $350/month after that? My husband has a regular CPAP machine and I think the insurance had covered most of the cost.

Thanks!

I can't speak to the specifics of your insurance plan, but an ASV is indeed much more expensive (5x-6x) than a regular CPAP.

You need to call your insurance and find out how your plan pays for an ASV.

This was my experience:

My plan stipulates that they allow $450 per month for my ASV therapy. They pay nothing until my deductabe is met, then they pay 70% after that. They never "buy" the machine at the end of the lease - I will have to pay for therapy forever.

I have a $6800 deductabe. Baring a major illness or injury, I never meet the deductabe, even last year with 2 sleep studies and a suspected blood clot (thankfully not a clot- they don't know why my foot is swollen).

It didn't take advanced math to figure out it would be much cheeper to buy the machine outright.

I called 2 DMEs in my area (there only is 2), both said the cash price for the resmed s9 ASV adapt would cost 4k, that does not include humidifier, hose or mask. I also called cpap.com and asked them about the machine, as I could not find it on their website. They said those machines are not available for them to sell, per resmed's policy.

I bit the bullet, got some help from my dad, and bought the machine and etc myself.

I hope your policy will pay better than mine! It was a big ouch to buy the machine after the sleep studies, too. But I feel like a new person! It was worth it.

As previously noted, ASV units are sometimes on sale on this forum ...

For example:
viewtopic.php?t=95053

You can try http://www.secondwindcpap.com/ for a machine. They offer low hour machines at a good price, all reconditioned and checked and with a warranty.

TahoeGal wrote:You need to call your insurance and find out how your plan pays for an ASV.

Yup. In contrast, mine pays for it over 15 months (assuming ongoing compliance), at which point I own it.

I also called cpap.com and asked them about the machine, as I could not find it on their website. They said those machines are not available for them to sell, per resmed's policy.

Weird. Anybody know what policy that would be? They sell other ResMed gear, and they sell the PR ASV.

Thank you everyone for the help/advice! It is very much appreciated. Once I find out exactly what the doctor decides, I will call the insurance companies and find out the specifics on how DME's are handled and what exactly my cost will be.

sawinglogz wrote:... Weird. Anybody know what policy that would be? They sell other ResMed gear, and they sell the PR ASV. ...

Not sure of the specifics, but several years ago Resmed went on a war path against online sellers for undercutting DMEs. As a result (at that time), CPAP.com stopped selling the Resmed ASV unit. So, my guess is that Resmed put their higher ticket items out of the reach of the online sellers.

I guess that gives the advantage to the competition.
Go figure.

JohnBFisher wrote:

sawinglogz wrote:... Weird. Anybody know what policy that would be? They sell other ResMed gear, and they sell the PR ASV. ...

Not sure of the specifics, but several years ago Resmed went on a war path against online sellers for undercutting DMEs. As a result (at that time), CPAP.com stopped selling the Resmed ASV unit. So, my guess is that Resmed put their higher ticket items out of the reach of the online sellers.

I know Resmed has a minimum price requirement, but it seems like CPAP.com must be abiding by that in order to sell anything by Resmed. Maybe Resmed just decided to withhold the ASV, as they state is their right.