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Future BiPAP user.. Which machine to ask for?
#21
Doesn't look promising.

HealthGrades.com: 8 reviews, 2 stars

Comments: "abrupt", "impatient", "disrespected my inquiries", "never had such a low opinion of a doctor".

I'm going in with an open mind, but what are my options if this turns into a train wreck?


I had my primary doctor request the polysomnography data disk.

If I have to, I'll push through HIPPAA, and California patient record laws to get the study data.

Once I have the data, what then?

Can I get reimbursed from Medicare if I just purchase a Aircurve 10 ASV?
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#22
Definitely go in with an open mind. The thing is most of the people that bother to post online are the dissatisfied ones. There are a number of reasons why their interactions could have gone badly with the doctor. It MAY not have been the doctor's fault. Stay positive but firm in what you want. At least you know what your recourse is if you aren't satisfied. Best of luck!
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#23
SleepRider,

You mentioned in post #14 that if I can get approved for a HCPCS code E-0472, I'm golden.
BTW, shouldn't it be E-0471 (bi-level, backup feature, non-invasive interface)?

The sleep center said I was going to get a BiPAP ST, a E0471 device I assume.

They were working on the final paperwork to give to the local DME they work with when I requested the appointment, so it's on hold.
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#24
(03-29-2017, 10:49 AM)Herb Wrote: Can I get reimbursed from Medicare if I just purchase a Aircurve 10 ASV?


You would have to call them.  There are different Medicare policies, some have deductables, some don't. Some will reimburse a lower percentage of cost, and some policies won't cover at all unless through a DME or supplier.

Even if they agreed to reimburse, they will probably want doctors proof of need for said equipment.  If your doctor will only give you a script for bipap, that could be an issue with them.

You could try asking you doctor for a script with the correct code as in your post above.

Either way, buying online will still require a script, unless you can find a good used ASV somewhere.

Wish you luck and hope your doctor is on board with what you want.
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#25
I'll probably have to request a prescription if I want to shop DMEs for an ASV myself, but what about the settings.

Won't the specified BiPAP ST settings on the doctor's order force the issue?
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#26
Herb, best to ya on the quest to get what you know you need. I think Sleeprider covered what's best for you setting wise in post #18 above. For what it's worth, do not accept what won't help, but can in fact actually harm you, as in the wrong machine. Stand your ground, and post back so we know how you're doing.

My experience was similar, but far less serious or dramatic. I initially took a sleep study 2 years ago which indicated the need to be on an xPap device. In this case CPAP was prescribed. I tried it and failed miserably due to the doc wanting it set at 20. Well, sorry doc I can't breathe out. I had to return the CPAP due to failing compliance, no surprise there. I recently did another sleep study after requesting that and asking to be considered for a BiPap. The doc set the study stating if my pressure crossed 12, it transitioned into a BiPap scrip. My first at bat I didn't take time to educate myself what I needed, the 2nd time at bat I did research.

Note I not only have OSA but early COPD too, so I'm not implying our diagnoses or needs are the same. But what is similar is we needed to be armed with knowledge of what we knew we did need. Powerful thing there. Good luck.
Due to my sarcastic nature, it may not be obvious that I am not a doctor nor do I pretend to be one. My advice is from personal experience. Follow my advice as a choice not as an order. 2 of these  Coffee Coffee per day keep the bad times away.
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#27
(03-29-2017, 12:23 PM)SarcasticDave94 Wrote: Herb, best to ya on the quest to get what you know you need. I think Sleeprider covered what's best for you setting wise in post #18 above. For what it's worth, do not accept what won't help, but can in fact actually harm you, as in the wrong machine. Stand your ground, and post back so we know how you're doing.

My experience was similar, but far less serious or dramatic. I initially took a sleep study 2 years ago which indicated the need to be on an xPap device. In this case CPAP was prescribed. I tried it and failed miserably due to the doc wanting it set at 20. Well, sorry doc I can't breathe out. I had to return the CPAP due to failing compliance, no surprise there. I recently did another sleep study after requesting that and asking to be considered for a BiPap. The doc set the study stating if my pressure crossed 12, it transitioned into a BiPap scrip. My first at bat I didn't take time to educate myself what I needed, the 2nd time at bat I did research.

Note I not only have OSA but early COPD too, so I'm not implying our diagnoses or needs are the same. But what is similar is we needed to be armed with knowledge of what we knew we did need. Powerful thing there. Good luck.

Hi Dave,

Sorry to hear about all your problems getting the correct machine.

There seem to be LOTS of stories on the forums with people suffering with the wrong machine.

I'm sticking to my guns on this.

My concern about the settings is that even though the code is the same, the DME will refuse the option of a ASV machine due to the pulmonologist prescribing settings for a BiPAP ST.

I just got back from paying $75 to get a disk containing the waveform data.

I also contacted a local CPAP supply and got a name for a good pulmonologist that can prescribe a ASV if need be.

Problem is, he's 70 miles away in Palm Springs, and his earliest appointment is in May.

That's plan B.

Tomorrow it's plan A.
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#28
(03-29-2017, 11:22 AM)Herb Wrote: SleepRider,

You mentioned in post #14 that if I can get approved for a HCPCS code E-0472, I'm golden.
BTW, shouldn't it be E-0471 (bi-level, backup feature, non-invasive interface)?

The sleep center said I was going to get a BiPAP ST, a E0471 device I assume.

They were working on the final paperwork to give to the local DME they work with when I requested the appointment, so it's on hold.

Herb, yes I misspoke. You need E0471 which includes ST devices and ASV (all non-invasive).

I just want to reply to one post that seemed to question my attitude about doctors.  I grew up in a medical family and know what good care and empathy is.  My current primary care physician, and the specialists I have seem to share that ethic.  My admonitions do not come from bad personal experience because I know enough to get good doctors, and know when it's time to change horses, say no, or let them know in plain layman's terms what my expectations are, and work as a team to get there.

There is no way the specialist you are working with is the only game in town. You just happen to have a more complex case than most of the docs run across everyday. If yours has not progressed his knowledge beyond BiPAP ST, you're on the right track to find one that can. Here is a starting point http://www.sleepeducation.org/find-a-facility . With your diagnostic study your primary care physician can give you the script your need, but call around and find someone willing to work with complex / mixed apnea and that will use your studies to prescribe ASV. Your sleep study didn't get very good success on ST, and that should have been a clue.
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#29
Cool 
My situation was more nuisance and waste of time than your situation in my opinion. After my first attempt to address the OSA had failed, I didn't quit per se, I redirected efforts to weight loss bariatric surgery that is. It's working to help as I've lost 72#in 6 months, but still had to come back to address OSA anyway. The diagnosis of COPD is now added in to my issues, but I'm still on this side. My BiPAP and I will just have to get to like each other.

Keep sticking to what you know is best for YOU. Again best to ya.
Due to my sarcastic nature, it may not be obvious that I am not a doctor nor do I pretend to be one. My advice is from personal experience. Follow my advice as a choice not as an order. 2 of these  Coffee Coffee per day keep the bad times away.
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#30
SleepRider,

Should they have gotten AHI below 5?


I wasn't very confident with the tech on the second night who performed my titration.

In fact, I sure hope someone else was in the control room overseeing the adjustments.

I fell asleep during CPAP ramp up, but later woke up and noticed the pressure was higher by feeling the mask vent discharge.

Fell asleep again, but awoke abruptly at 3 am when I was switched to BiPAP ST.

The inspiratory timing seemed too short, and I felt starved for air.

At first, I had to open my mouth to get some air (nose mask).
Not an easy task fighting the machine, and had to act quickly before they thought the mask was leaking.
 
I seemed out of sync with the machine but noticed I had control of the expiratory length.

If I exhaled for a short period, it would quickly switch back when I started to breathe in.

So I tricked it into double doses to get comfortable.

I finally got comfortable with the rythm, and fell asleep again.

I was told by the tech I went into REM after that.

Felt really refreshed when I awoke, in spite of the short sleep.
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