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Medicare Denial
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Kidnap Offline

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Posts: 20
Joined: Sep 2015

Machine: Respironics DreamStation
Mask Type: Full face mask
Mask Make & Model: Quatro Air 62703
Humidifier: DreamStation
CPAP Pressure: 5cm - 20cm
CPAP Software: SleepyHead Other Software

Other Comments: I'll try DreamMapper

Sex: Male
Location: Pittsburgh, PA USA

Post: #21
RE: Medicare Denial
My test results are in and my test showed AHI of 48 and SpO2 at 75%. This is better than last year but my doctor said it can change from day to day. I scheduled a titration study for Oct. 30, 2016. The hospital has a 4 bed lab and they are that busy. I was asked if I would take a cancellation, I said yes, but really!, a lot of people ahead of me probably said yes too.
I'll Keep you all informed.
10-02-2016 12:51 PM
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Sleeprider Online
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Posts: 3,388
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #22
RE: Medicare Denial
With the clinical sleep study Dx in hand, you may be able to re-submit for auto-CPAP and self titration. It's not hard to do, saves a lot of money, and would get you treatment faster. Figure you will have another potential delay after the titration study a month from now. Perhaps talk to your doctor and the DME about resubmitting the approval request for that Airsense 10 Autoset and see if you can move ahead of that curve. No denying now that you have severe obstructive sleep apnea and will require a machine and mask. If you can self-titrate successfully before the titration study, everyone wins.

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10-02-2016 12:57 PM
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Kidnap Offline

Preferred Members

Posts: 20
Joined: Sep 2015

Machine: Respironics DreamStation
Mask Type: Full face mask
Mask Make & Model: Quatro Air 62703
Humidifier: DreamStation
CPAP Pressure: 5cm - 20cm
CPAP Software: SleepyHead Other Software

Other Comments: I'll try DreamMapper

Sex: Male
Location: Pittsburgh, PA USA

Post: #23
RE: Medicare Denial
I asked my DME they are impossible. It's been a year I hope one month won't kill me.

Thanks for the suggestions.

Your Friend Kidnap
10-02-2016 11:19 PM
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PoolQ Offline

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Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

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Sex: Male
Location: Sillicon Valley

Post: #24
RE: Medicare Denial
just to give you an idea, my sleep lab was booked for 3 months. Be ready they will call and say can you come in by 7pm or something, many don't answer or say no. for me it went from 3 months to under two weeks, called me when I was out to dinner at 6pm and asked if I could make it in by 7:30. no problem I said. Keep your phone charged and handy. They will not leave a message, answer or they are on to the next
10-03-2016 02:05 AM
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srlevine1 Offline

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Posts: 229
Joined: Sep 2015

Machine: ResMed Airsense Autoset (S10)
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage Activa LT
Humidifier: Internal to S10
CPAP Pressure: 12-15.6
CPAP Software: ResScan SleepyHead Other Software

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Sex: Male
Location: Westlake Village, California USA

Post: #25
RE: Medicare Denial
(09-14-2015 07:57 PM)Sleeprider Wrote:  You said that you have a hemocrit of 52.2, but that is not diagnostic of OSA.

I have both an elevated HCT and RBC and it was suggested that there could be a relationship with sleep apnea.

You may wish to read http://www.sleepreviewmag.com/2015/07/sl...onnection/ and https://www.ncbi.nlm.nih.gov/pubmed/16770648.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
10-03-2016 04:35 AM
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Sleeprider Online
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Advisory Members

Posts: 3,388
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #26
RE: Medicare Denial
(10-03-2016 04:35 AM)srlevine1 Wrote:  
(09-14-2015 07:57 PM)Sleeprider Wrote:  You said that you have a hemocrit of 52.2, but that is not diagnostic of OSA.

I have both an elevated HCT and RBC and it was suggested that there could be a relationship with sleep apnea.

You may wish to read http://www.sleepreviewmag.com/2015/07/sl...onnection/ and https://www.ncbi.nlm.nih.gov/pubmed/16770648.

I posted that a while ago, and was not aware of the correlation. I also have mild polycythemia, but it arose from HRT. Was not aware of the apnea correlation. By itself it's not diagnostic, but i guess it is a strong co-morbidity. Thanks.

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10-03-2016 09:53 AM
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Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,388
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #27
RE: Medicare Denial
(10-03-2016 02:05 AM)PoolQ Wrote:  just to give you an idea, my sleep lab was booked for 3 months. Be ready they will call and say can you come in by 7pm or something, many don't answer or say no. for me it went from 3 months to under two weeks, called me when I was out to dinner at 6pm and asked if I could make it in by 7:30. no problem I said. Keep your phone charged and handy. They will not leave a message, answer or they are on to the next

The decision lies mostly with your doctor, not the supplier. They cannot order a sleep study. If your doctor writes the prescription for self-titration with auto CPAP, that is the order. All insurance wants is a Dx and subsequent compliance. Don't ask the DME, talk to the doc.

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10-03-2016 09:56 AM
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Kidnap Offline

Preferred Members

Posts: 20
Joined: Sep 2015

Machine: Respironics DreamStation
Mask Type: Full face mask
Mask Make & Model: Quatro Air 62703
Humidifier: DreamStation
CPAP Pressure: 5cm - 20cm
CPAP Software: SleepyHead Other Software

Other Comments: I'll try DreamMapper

Sex: Male
Location: Pittsburgh, PA USA

Post: #28
RE: Medicare Denial
Well my pessimism was overwritten today. The sleep lab has an opening tonight. OK ! No caffeine today and all ready to go.

More to follow.

Your Friend Kidnap
10-04-2016 10:23 AM
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Kidnap Offline

Preferred Members

Posts: 20
Joined: Sep 2015

Machine: Respironics DreamStation
Mask Type: Full face mask
Mask Make & Model: Quatro Air 62703
Humidifier: DreamStation
CPAP Pressure: 5cm - 20cm
CPAP Software: SleepyHead Other Software

Other Comments: I'll try DreamMapper

Sex: Male
Location: Pittsburgh, PA USA

Post: #29
RE: Medicare Denial
I'm home from the sleep study. The technician said I have complex apnea , sometimes called mixed apnea. I have both obstructive and central apnea. Instead of ordering a CPAP from my DME, he is sending the results to my pulmonary doctor to evaluate. I may need another night in the sleep lab to determine if a more advanced machine is necessary. My oxygen was low but more importantly my carbon dioxide level was high. I guess I'll wait and see.

Your Friend Kidnap
10-05-2016 06:04 AM
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Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,388
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #30
RE: Medicare Denial
The gold standard for complex apnea is a ASV bilevel machine (Adaptive Servo Ventilator). It uses a normal bilevel pressure (IPAP/EPAP) when you are spontaneously breathing, but can implement a higher IPAP pressure when you do not initiate a breath on your own, overcoming the central apnea. The machines are considerably more expensive, and it's harder to get insurance approval. Often, insurance requires you be issued CPAP and demonstrate intolerance/failure before moving to simple bilevel, and another intolerance/failure and finally approves ASV. I hope you find a streamlined path.

Once your Dx is finalized, be sure to request a detailed copy of the study and Dx for your records, as well as a paper copy of any prescription. Good luck! Looks like this might take a while. Meanwhile if you have questions about complex apnea and its treatment, don't hesitate to ask here. Several members share this problem and have successfully dealt with it.

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10-05-2016 08:43 AM
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