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Help Needed. National Jewish = Medicare Disaster
#1
Help Needed. National Jewish = Medicare Disaster
So, my Mom had a new sleep study recently at National Jewish in Denver, after I begged and begged her "sleep specialist" (it's very hard to get an appointment with an actual MD there). She's elderly and on medicare and has been screwing around with this for over 8 months now. She's on a Resmed Autoset 10 For Her + oxygen and is completely exhausted. She's has a hard time falling asleep and is sleeping for at least 10 hours. I am usually waking her up from the dead just to get her going. She'd easily sleep for 12 hours or more if I didn't wake her up. She's had a full pulmonology test with no evidence of any other issues, separate from Apnea. She needs to lose about 30 lbs, but has no known heart issues or any other physical problems.

Well, we just got the "results" via phone call. They didn't test RERAs. I asked if her centrals were fully treated by the bi-pap (of course, I knew they wouldn't be) and their answer was "no" but we're not worried about them. They feel that the centrals are "overstated". I dunno WTF that is supposed to mean. They stated they failed to get any REM data. They determined that she needs oxygen, but can't write a prescription for it because they don't know why she needs oxygen. They said that they "got her AHI to 2" with bi-pap (but she's already under 2 most nights). They didn't test her on an ASV at all.

I understand what is happening - they are testing to meet Medicare's protocol, not to actually treat the patient, but it SUCKS. So now she will have to spend another 6 months failing Bi-pap to finally get a test for an ASV to treat her central apnea. It's totally unacceptable! The thing is we would be happy to pay out of pocket to get the right machine for her, but they refused to test her on an ASV at all. We actually went into National Jewish before the sleep study and asked them to PLEASE test her on an ASV, and to PLEASE test for RERAs.  Obviously that didn't help. The clinician stated that we wouldn't be allowed to get her raw data from her sleep study. You'd better believe that we will try to pick it up tomorrow.

I guess I'm posting here to try to get some help with what the hell to do next. Any suggestions would be helpful! I've included a night's worth of data. I'm trying to find the original sleep study to post that as well, and will post whatever we can get from National Jewish.


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#2
RE: Help Needed. National Jewish = Medicare Disaster
Check Supplier #2 from the supplier list at the top of this site. I bought a slightly used machine with 1 month use. I did not need a prescription and got it within a week. It may be less than her deductible, mine was. I am not one of the experts here but I would not Wait weeks or months waiting for the Dr have her jump through all the hoops to get what she needs. The people here can give you the setting in just a couple nights OSCAR charts.
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#3
RE: Help Needed. National Jewish = Medicare Disaster
(09-10-2020, 08:49 PM)staceyburke Wrote: Check Supplier #2 from the supplier list at the top of this site.  I bought a slightly used machine with 1 month use. I did not need a prescription and got it within a week. It may be less than her deductible, mine was. I am not one of the experts here but I would not Wait weeks or months waiting for the Dr have her jump through all the hoops to get what she needs.  The people here can give you the setting in just a couple nights OSCAR charts.

+1

And Supplier #2 rocks!
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#4
RE: Help Needed. National Jewish = Medicare Disaster
It's interesting that any technician or researcher can run a test then express the opinion a particular result they observed was over-stated. A test result is what it is, and needs to be accepted at face value. In addition, if someone needs oxygen, that should suffice for a prescription pending further pulmonary examination. Again, we know that increasing the fraction of inspired oxygen (FiO2) will normally increase the saturation in the blood stream. Once the results become available, it would be interesting to review the details of the titration and SpO2 data.

If you are buying a Resmed Aircurve 10 Vauto to replace the Airsense 10, the settings for trigger sensitivity have been observed to help reduce CA. If your mom already has an oxygen generator, adding an oxygen bleed to her CPAP or VPAP circuit is very easy, and you can simply connect the oxygen tube to a ClimatelineAir-Oxy tube. This is the easiest way to increase FiO2, and is very easy to titrate with a pulse-oximeter. See the Oxygen Bleed with CPAP wiki http://www.apneaboard.com/wiki/index.php..._with_CPAP

You should not have to self-guess and self-treat. Take the results, or have her regular physician request them. Look for solutions or a competent referral from him after discussing your concerns. Sleep specialists are commonly incompetent for anything other than plain-vanilla obstructive sleep apnea, and few are qualified for geriatric therapy needs. It's not an insult, just a fact, and the comments dismissing the CA events, failure to evaluate RERA and the flow limitations, and investigate low oxygen saturations (a simple problem) or make an appropriate referral for any of these problems, simply proves that is what you're dealing with.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Help Needed. National Jewish = Medicare Disaster
I was not aware that technicians are writing up medical necessity or test evaluation results based on their own opinions, or in fact doing anything with the actual write-up. It is sort of positive they actually saw and acknowledge CA existed on the report.

OK here's my way of doing this: you can buy via Supplier #2 as suggested or tell the doctor that the CA do in fact matter, they cause disruptions in sleep, and whatever else counts in your mom's case. They are in fact events that not only need acknowledgement of existence, they need treated. If you have the money go with Supplier 2, if you want to have insurance pay, go with option 2.

If you need this through insurance, get upset and mad at the doc and state you do not accept that the CA are just recognized. Make it known you will not accept brushing off CA events. You demand they are going to be TREATED. This requires an ASV, and preference is to the ResMed AirCurve 10 ASV and not the Philips Respironics that would otherwise be delivered.

And no you and your mom do not need to wait 6 months to fail BPAP. I made it very clear to my doctor that after 1 week BPAP/bilevel was a disaster and I was not going to accept it. Apparently, after I called every day for the next week did the doc get the message. Do not accept failure or mediocre treatment. Find your place to draw a line, draw it, and do not allow it to be crossed at any cost.

If you have questions, post it and we will answer it.

PS what this situation is, is a lazy doc and an overly opinionated tech that both need told how to do their jobs better. Put a fire under them and see if they move. If they don't fire them. Get your full detailed report and go elsewhere if they can't do their job.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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