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Future BiPAP user.. Which machine to ask for?
#11
(03-25-2017, 11:51 AM)OpalRose Wrote: Herb,
Unfortunately, it's unlikely you will get an ASV machine, unless your doctor can pull some strings.    

Insurance/Medicare usually require you to try and fail at bipap first before approving an ASV.  

I know that doesn't make sense, but that's usually the procedure.

Oh great.

How can I substantiate failure if hypopnea & apnea are uncountable with BiPAP ST? 

Would my recording oximeter show low saturation?

My AHI was only reduced to 7.3 during the sleep study.

Does Medicare consider 7.3 acceptable treatment, or can I request better treatment if it's over 5?
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#12
Herb,

I live in SoCal too. What city do you live in? I have a good sleep doc that I would recommend to you if you are anywhere close to him. He is in Fontain Valley in Orange County.

Best Regards,

PaytonA
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#13
I live above the Ontario airport, so Orange County is do-able.

Don't mind an hour drive if I can see a good doctor.
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#14
(03-25-2017, 11:51 AM)OpalRose Wrote: Herb,
Unfortunately, it's unlikely you will get an ASV machine, unless your doctor can pull some strings.    

Insurance/Medicare usually require you to try and fail at bipap first before approving an ASV.  

I know that doesn't make sense, but that's usually the procedure.

It's the same code as any bilevel with backup like the ST machines in the first post.  ASV is just the more modern automatic solution.  A diagnosis with centrals and failure at CPAP is the usual prerequisite. If you can get approved for a HCPCS code E-0472, you're golden
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#15
(03-26-2017, 03:06 PM)Sleeprider Wrote:
(03-25-2017, 11:51 AM)OpalRose Wrote: Herb,
Unfortunately, it's unlikely you will get an ASV machine, unless your doctor can pull some strings.    

Insurance/Medicare usually require you to try and fail at bipap first before approving an ASV.  

I know that doesn't make sense, but that's usually the procedure.

It's the same code as any bilevel with backup like the ST machines in the first post.  ASV is just the more modern automatic solution.  A diagnosis with centrals and failure at CPAP is the usual prerequisite.


Ok, thanks for clarifying. It seems that I've read that some docs move their patients from cpap to bipap before asv, although that never made sense to me.
OpalRose
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#16
The doctor specified "BPAP 11/6 cmH2O with backup rate of 10".

I gather Medicare is requiring a CPAP contrary to the doctor's specification.

When I talked to the sleep study tech about how I did on CPAP, he said I didn't improve until he switched to BPAP ST.
(Even then, the AHI only decreased to 7.3, so yeah, I should be on ASV) 

So, that's why BPAP ST was specified in my sleep study.

I failed CPAP.


I can see Medicare's point of trying to save money, but maybe they should take these test results into account.

Forcing CPAP when I have already failed has to cost quite a bit.

*End of Rant*


Well, all this is just speculation on my part until the Medicare request comes back.

Then I'll know what my next hurdle is.

(Magic 8 ball says I'll be asking questions about which CPAP machine to choose next.) 

You all have been a GREAT help.

Excellent advice.

Thank you!
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#17
I called the sleep center yesterday morning and was surprised when she said I will be getting a BPAP ST rather than a CPAP first.

I then asked if I could request an ASV instead of a BPAP ST, and she said it was only for patients with severe conditions.

So I asked to speak with the prescribing Pulmonologist, and made an appointment for Thursday 3/30.

Now, I need to support my case and convince him I'm better off with ASV.

I've found a number of research reports, but all the studies were conducted on Heart Failure patients with Central Sleep Apnea Disorders.

I haven't found any research papers supporting the advantage of ASV over BPAP ST for Cheynes-Stokes, other than patient rejection.


So, any ideas how I can convince my Pulminologist to approve a ASV machine instead of the BiPAP S/T?
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#18
Herb, ask your doctor if he has successfully treated a CA (complex) patient using a BiPAP ST, and whether he is aware of the Resmed Aircurve 10 ASV. This avenue is a complete waste of time and money. The high fixed pressure support will make you 100% dependent on the backup rate of the machine, and I will bet the next worthless step will be increase the backup rate and pressure support because you my friend are going to turn blue. I suggest you decline this machine and based on the questions above take your diagnostic study to someone that has a clue.

The Resmed Aircurve 10 can be programmed with a low variable EPAP pressure range, and a PS range of 0-20 to deal with centrals and hypopnea. There is no comparison. Unfortunately, I know the misery you are headed for if you accept his prescription. Tell him what you want... Resmed Aircurve 10 ASV on ASVauto mode, EPAP min 5.0, EPAP max 7.0, PS min 0, PS Max 12. IPAP max 19. Done.

What you, and especially your doctor need to understand is that a person with complex sleep apnea needs is a machine that ONLY supports respiration during a central or hypopnea event. At all other times, spontaneous breathing should be supported and encouraged. What the ST does is provide the work of respiration at all times, and is intended for individuals who have obstructive pulmonary disease, or who need pressure support as a component of EVERY breath. ASV is the solution for central and complex apnea. ST and AVAPS is the solution for individuals with constant respiratory support needs.
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#19
SleepRider,

I've been reading scientific studies for three days now.

No studies I've found report that BiPAP ST is superior to ASV.

Many reports state that compliance rates are much higher with ASV, as they are simply easier to live with.

ASV is the superior technology. 

The only caveat concerning ASV is a Special Safety Notice pertaining to central sleep apnea patients with symptomatic heart failure and LVEF <45%. For this group, ASV might be harmful.

My last echo cardiogram showed >70% LVEF, and no heart failure, so I'm OK in that department.

So what's the problem... cost?

I shopped online, and found a Resmed Aircurve 10 ASV for $2,150 and a Resmed S10 Aircurve ST for $1,650.

$500 less.

I would gladly pay the difference if possible.


Well... Thursday morning I'll know more after talking to the Doc. 

Thanks for the info to plead my case.
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#20
Herb, it's important you go in well-informed, because for some reason, your doctor is not. Don't hesitate to confront him on his apparent misguidance...we'll stop just this side of saying malpractice. You want the correct script and he can make this right. Mostly, congrats to you for doing the homework he should have done.
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