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Medicare Denial

I got a call from the sleep lab today. They are contacting the DME and I asked about the Resmed Aircurve 10 ASV. They don't have a problem and if the Doctor agrees that the ResMed is applicable they will order it. Fingers Crossed. They also asked me if I would accept a local company near St. Margaret's Hospital that they have a good relationship with. I agreed, I would like a local supplier if something goes wrong.
Your Friend Kidnap
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To All My Apnea Board Friends.

After a month of pain I got my new PAP. I saw the Dr. on 1/30/17 , had sleep study on Wed. 2/1/17, on Friday, the 3rd, I called the Dr., his office clerk asked why I specified Verus HeallthCare as my DME I told her they took over when Allegheny HealthCare (old Klingensmith HealthCare) lost the medicare competitive bid for PAP Equipment. She said they would prefer to work with someone local that they communicate with  already. She picked Advacare Home Services. On Wednesday the 8th I finally heard from Advacare. This was the last time the two communicated well. Advacare said they need info. I called the Dr. They said they sent it. then it was I called each of them on the ;13th, 15th, & 20th. Advacare Financial lady called me on the 22nd & 24th. on each of these days I called the Dr.s office to say they had to return the Billing List signed by the Dr. A young man found it and finally on Monday Advacare called me & made me an appointment for Friday March 3 @ 1:00. over a month delay.

I was given a Philips Respironics System One BiPAP AutoSV. The one I didn't want! I was told the Dr. said the "Metrics" I needed matched this machine more & it was just as good.

Next I think I got a used machine. DreamMapper won't read the SD Card & Sleepyhead says "Your Philips Respironics CPAP machine (Model 260P) is unfortunately not a data capable model. I'm sorry to report that SleepyHead can only track hours of use and very basic settings for thise machine." . When the lady set it up she deleted some 1900 hours of blower time. A lot of testing?It won't even report my Centrals (SH says Clear airway) data. The Zipper on the case is even broken. The DreamStation bag was 100% better.

The only good news is my AHI was down to 3.4. Wonder what my Central Apnea is?

Sorry for rambling!
Your Friend Kidnap
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Kidnap - Something is way wrong - if you have a PR Sys One BiPap Auto SV Advanced it is fully data capable - it is either a model 950 or 960 - NOT a 260. Turn the puppy over (after taking out the water chamber Smile ) and look at the label for the model number and the date of manufacture. It will be the label at the bottom with the bar code when you are looking at the underside of the machine. On that label the model # will on the 2nd line. The date of manufacture will be bottom right of the label in YearMoDy (today would be: 20170304). DreamMapper, as useless as it is, can read AutoSVs. Sleepyhead, depending which model you have can be funky.
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Thanks Robert,

    Sooo I turned that puppy over rubbed it's belly & saw :
                              Model; 960P
                              Date;   20130805
                              Rev. 00

    The menu on the machine super secret back door set-up says run time 964 hours.

    The SleepyHead software gave the following revelation on the Changes to Prescription Settings page:

Changes to Prescription Settings
First                         Last                         Days    AHI          FL       Machine                                Pressure Relief      Mode                            Pressure Settings
Fri Mar 3 2017    Fri Mar 3 2017                 1         1.53          0.19    BiPAP autoSV Advanced     Bi-Flex x2    ASV    (Variable EPAP)            Min EPAP 8.0 Max IPAP 25.0
                                                                                                    60 Series (960P)                                                                                      PS 0.0-17.0 (cmH2O)

Fri Oct 21 2016       Thu Mar 2 2017        131         14.63       0.45     Auto CPAP (500X110)           None                     APAP (Variable)           Min 5 Max 20 (cmH2O)

Wed Oct 7 2015      Tue Nov 17 2015      28          11.38       0.38    BiPAP autoSV Advanced       Bi-Flex x2    ASV    (Variable EPAP)           Min EPAP 12.0 Max IPAP 25.0
                                                                                                   60 Series (960P)                                                                                      PS 5.0-7.0 (cmH2O)

Fri Sep 25 2015       Tue Oct 6 2015        12           9.57         0.19    BiPAP autoSV Advanced      Bi-Flex x3  ASV    (Variable EPAP)           Min EPAP 12.0 Max IPAP 25.0
                                                                                                    60 Series (960P)                                                                                      PS 5.0-7.0 (cmH2O)

Thu Sep 24 2015      Thu Sep 24 2015     1             0.00          0.00   BiPAP autoSV Advanced      Bi-Flex x3    ASV    (Variable EPAP)           Min EPAP 12.0 Max IPAP 25.0
                                                                                                    60 Series (960P)                                                                                      PS 5.0-7.0 (cmH2O)

Yes Settings changed on Thu Sep 24, 2015. Shows 173 hours here!

So what can I do? Call Medicare? They are paying $600.00 U.S.D. per month for a used machine!
Maybe the PA Attorney General Fraud Line?

Your Friend Kidnap
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Seriously? They gave you a 3-4 year old machine.

I told you hold out for the Resmed. Go into the clinical menu (control knob + ramp button), the go to Info and look at the machine hours. If this is a used machine, Take it back.
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(03-04-2017, 10:12 PM)Sleeprider Wrote: Seriously? They gave you a 3-4 year old machine.  

I told you hold out for the Resmed.  Go into the clinical menu (control knob + ramp button), the go to Info and look at the machine hours.  If this is a used machine, Take it back.

SleepRider Yes! Even the mask was a medium & I need a large I got no choice. When I said it came up high on my chin she told me to push it down my nose.

The Machine Hours were the 964 hours. Oh !  "the clinical menu (control knob + ramp button) " was what I called "The menu on the machine super secret back door set-up"

This Doctor seams to be in cahoots with PR. he wouldn't change though I begged everyone I talked to. He said it was the "Metrics" Woopie!!!

There is so very much to hate about the System One after using a DreamStation. For starters the menu sucks. The font is circa 1980 IBM and about 4 point. Instead of paging through the info API, Sleep Time etc. you page through the titles then click to read then click to go back. SUCKS BIG TIME ! The humidifier tank is two part & slides into the box and you have to use force  to close the lid. Way more steps. You must remove the modem to take out the SD Card and remove the power cord to safely remove the modem. I may be able to take it back but I think they are beyond negligent and should be punished. Why to you think they beat out a reputable company in the competitive bid.

thanks Again
Your Friend Kidnap
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That's horrendous.  I do hope you'll take it back.

My situation wasn't bad like yours, but I still returned my machine to my sleep dr... and trotted right over to a real DME (NOT connected with a sleep dr) and got the machine I wanted.
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Agree, take it back now...dont think twice about it!

You do not have to deal with this DME. If you have a copy of your perscription, find another supplier.
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If a doctor had to use the equipment they prescribe, they wouldn't be using the Auto SV Advanced. However, the way it works, is the doctors get complimentary equipment and treatment by Respironics sales people, and you live near the headquarters.

I had to change DMEs recently, and my wife started CPAP 2 months ago with the new supplier. On the day she was to have the machine delivered, I called to find out what they planned to dispense. They had an old PRS1 Auto (560) all set to go because they were out of stock on the Dreamstation. I told them we would decline that machine since it is a discontinued, older model, and asked if they had the Resmed Airsense 10 Autoset. They did, and offered no resistance at all when I told them I wanted the Resmed setup for her. They did it and delivered it to our home.

The AutoASV mode on the Resmed Aircurve 10 ASV is a miracle, and works so well with most people. Resmed invented ASV and has done the majority of research on the technology. No studies compare the Resmed and Respironics ASV head to head, but if there was, I think Philips would have to go back to the drawing board. The "excuse" your doctor give that he likes the algorithm better, is easy to challenge..."what is it you specifically like that is not available on the Resmed?" He won't be able to answer because he truthfully hasn't got a clue.
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Agreed that you have a machine that is not new and that was manufactured several years ago and you should get new one. I base this on the label's date of manufacture, and that you did not receive therapy in 2015 when it was used for 40 days.

What I wonder though is about the data shown for the period Fri Oct 21 2016 to Thu Mar 2 2017 for an Auto CPAP (500X110) set at Min 5 Max 20 (cmH2O). That looks very much like the day you got your first machine and the settings it was at. Did the DME transfer the data from that machine to the SD card so that your information was all contained in one place? I mention it just because when you scream at them you want to be 100% correct and not give them anything to throw back at you.
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