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Need advice
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Sleeprider Online
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Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
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CPAP Software: ResScan SleepyHead EncoreBasic

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Location: Where they make Respironics

Post: #11
RE: Need advice
Deepbreathing, I should have noted the tests were conducted using full 12 channel PSG. The methodology and time of the sleep study left no doubt that the results were valid and evaluated all positions and were clearly capable of differentiating central, mixed and obstructive apnea.

The sleep study was very professionally written and recommendations were valid, including, recommended next evaluation step, warnings against operation of heavy equipment and vehicles, etc. They contained full names, addresses, phone numbers and a great deal of private information that should have been blacked out for the internet, thus my suggestion to delete.

My principle objection to the studies was that they were designed with singular objectives; the first to diagnose, and the second to evaluate CPAP. A study can and should be designed to minimize financial impacts by combining diagnostic studies with comprehensive titration studies. Where the studies are divided, at least the titration study should be prepared to advance through CPAP and bilevel and evaluate ASV where indicated (as it was in this case). The concern being that the current recommendation for a titration study in bilevel, will not progress to the inevitable ASV evaluation until the fourth study.

At this point if the original poster can clarify their insurance situation, we can make some very pointed recommendations to get the right treatment in their hands. If insurance is lacking, the first step is to ask the sleep doctor to prescribe what he KNOWS is the correct therapy, and forego further study. If he won't do that, then the next step is to find a doctor that will prescribe ASV, using the studies' clear results.

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12-31-2015 10:24 AM
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Sleeprider Online
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Posts: 3,345
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: #12
RE: Need advice
I should add, insurance demands, and receives significant discounts on sleep studies that the O.P. may not be getting if he is paying out of pocket. You should negotiate the price of any additional study and demand that the scope include evaluation of all foreseeable therapy options. This should have already been done, and it's frustrating to see an individual being taken advantage of by the 'system' which is designed to extract the maximum amount of cash from his pocket.

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12-31-2015 10:37 AM
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Hornnumb2 Offline

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Machine: Respironics series 60 Bipap auto sv
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Sex: Male
Location: Baytown, TX

Post: #13
RE: Need advice
Well with the new year I am back to a $1500 deductible, from what I have paid already is $750 for each study and that was after I had meet my deductible on other test. So out of pocket would be $1500 and $750 for the third one and $750 for the 4th. Lots of money I do not have. As I see it I have 2 options. I can go to my doctor(neurologist) who requested the study or make an appointment with the sleep Doctor (Todd Swift) for a prescription for ASV that I would just have to pay out of pocket. Any thoughts? Thanks Michael
12-31-2015 12:07 PM
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Sleeprider Online
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Advisory Members

Posts: 3,345
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: #14
RE: Need advice
You have insurance, but a high deductible. My first move would be to ask the sleep doctor to write the prescription without further study. At the very least, he should assure you that the next study will be the last and will evaluate bilevel including ASV. The deductible for the final study may be unavoidable, however you should express some outrage and object to the poor design of the last study that did not evaluate a therapy appropriate to the central apnea that was already diagnosed. They screwed up and they should make it right. Tell them about it and if they won't make it right inform your insurance company that you have been treated unfairly by piecemeal evaluation that has cost more than a properly designed and performed study would have cost. Don't quit, be mad and see if they won't make it right. In this case the insurance may actually go to bat for you. Neither one of you should pay for 3-4 studies when 1-2 would have been sufficient.

Once you get a prescription for the ASV machine, the cost is going to be at least $3500 for ASV (or $1700 for BiPAP) with humidifier, hose and filters, plus the costs of mask and other supplies. This will be covered under your policy durable medical equipment coverage. You need to call the insurance company and find out what deductibles or co-pays apply to DME if any. Sometimes deductibles are not required for DME, but you need to know.

You do not really have the option to say "I don't have the money". Your condition is serious and will eventually compromise your long-term health and ability to make a living. You need to get this done, but fairly. It sounds to me like you'll hit your 2016 deductible limits early, and just have to deal with it. I do wish you good luck and hope you can get some satisfaction by having further evaluation costs or deductibles waived. You should already have in hand a titration to meet your needs, but for what-ever reason, your studies are being performed individually, rather than as a progressive protocol. Here is a poorly kept secret; the clinical PAP device used to perform your CPAP titration was fully capable of doing a bilevel and an ASV evaluation in one night. They didn't do it, and it's costing you money.

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12-31-2015 01:51 PM
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Hornnumb2 Offline

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Machine: Respironics series 60 Bipap auto sv
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CPAP Pressure: none
CPAP Software: SleepyHead

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Sex: Male
Location: Baytown, TX

Post: #15
RE: Need advice
I was thinking I would make an appointment with the sleep Doctor but he is the one that signed off on the cpap study when it should have been something else. I feel he might have a better understanding of what I need but I also feel that my doctor will do the script no problem. After the first sleep study, I complained about the money and he said he would prescribe the cpap if I didn't want to do the second study. I just not sure what to do.
12-31-2015 10:40 PM
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Sleeprider Online
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Posts: 3,345
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: #16
RE: Need advice
(12-31-2015 10:40 PM)Hornnumb2 Wrote:  I was thinking I would make an appointment with the sleep Doctor but he is the one that signed off on the cpap study when it should have been something else. I feel he might have a better understanding of what I need but I also feel that my doctor will do the script no problem. After the first sleep study, I complained about the money and he said he would prescribe the cpap if I didn't want to do the second study. I just not sure what to do.

I think you need a good talk with the sleep doc first. Explain your situation and ask his opinion about ASV therapy. It's pretty clear CPAP isn't going to work for you, so that last study was not a waste. BiPAP will not work either since it does not treat central apnea. I'm pretty sure your doc knows the right answer, and it would be best if you can have him as a supporter to consult when you find an affordable machine. Once you have a prescription in hand, there are ways to find deals on ASV machines that make them much less expensive.

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01-01-2016 11:11 AM
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SideSleeper Offline

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Location: Western Oregon, USA

Post: #17
RE: Need advice
Since this isn't a commercial site, I think it is OK to post the website for the American Sleep Apnea Association. On the first page of their website they have a link to possible help with the costs of a machine.
http://www.sleepapnea.org/resources/cpap-assistance-program.html

If the link has to be removed, do a search.
01-01-2016 02:33 PM
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vsheline Online

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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CPAP Pressure: 15 EPAP, PS 5-10
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Post: #18
RE: Need advice
(12-30-2015 10:53 PM)Sleeprider Wrote:  For situation 1. request a prescription for ASV, and locate the lowest online price, then work with your doctor to evaluate the machine data and make adjustments. ASV can work as a CPAP or bilevel, but it costs about twice as much as an auto bilevel machine. It is the only therapy that targets central apnea while resolving obstructive sleep apnea and RERA.
...Examples of these machines are Resmed Aircurve 10 ASV or Philips Respironics BiPAP autoSV Advanced.

The Philips Respironics BiPAP autoSV Advanced *can* act like ASV or fixed-pressure CPAP, APAP, bilevel or bilevel Auto, but the Resmed ASV models can only provide ASV or fixed-pressure CPAP.

I think it should have been clear from the number of Central Apneas in the original "diagnostic" study that neither CPAP, APAP, nor standard bilevel would be able to treat the large number of Central Apneas.

In my view, a good doctor should have requested insurance preauthorization for an ASV titration immediately after the diagnostic study, and, when the insurance company denied coverage (a virtual certainty) should have immediately appealed, and, when the insurance company denied the initial appeal (a virtual certainty) the doctor should have appealed a second time. I think the second appeal usually goes to a higher level of review where there is some hope that the insurance company would take a fresh look at the situation and possibly pre-approve a combined titration for standard bi-level with progression to ASV if needed, recognizing that paying for a standard CPAP or standard bilevel titration would be a waste of money.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 01-01-2016 09:23 PM by vsheline.)
01-01-2016 08:39 PM
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vsheline Online

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Posts: 1,908
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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #19
RE: Need advice
(12-31-2015 01:51 PM)Sleeprider Wrote:  Once you get a prescription for the ASV machine, the cost is going to be at least $3500 for ASV (or $1700 for BiPAP) with humidifier, hose and filters, plus the costs of mask and other supplies. This will be covered under your policy durable medical equipment coverage. You need to call the insurance company and find out what deductibles or co-pays apply to DME if any. Sometimes deductibles are not required for DME, but you need to know.

A "Gently Used Respironics System One BIPAP Auto SV Advanced DS960 Machine with Heated Humidifier" is $1,399.00 at Supplier #2. Excellent machine. In ASV mode it slowly automatically adjusts the exhale pressure EPAP (to help avoid obstructive events) and quickly adjusts the inhale pressure IPAP (breath-to-breath, to prevent apneas or hypopneas, whether central or obstructive).

A "Gently Used ResMed S9 VPAP/BIPAP Adapt SV Auto with Heated Humidifier - REF - 36037" is $1,249.00 at Supplier #2. The REF 36037 has the ASVAuto therapy mode which slowly automatically adjusts the exhale pressure EPAP (to help avoid obstructive events) and quickly adjusts the inhale pressure IPAP (breath-to-breath, to prevent apneas or hypopneas, whether central or obstructive). The cheaper REF 36007 has the older "ASV" therapy mode in which EPAP is manually adjusted and IPAP is automatically-adjusted quickly (breath-to-breath, to prevent apneas or hypopneas, whether central or obstructive).

(12-31-2015 01:51 PM)Sleeprider Wrote:  You do not really have the option to say "I don't have the money". Your condition is serious and will eventually compromise your long-term health and ability to make a living.

Right.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 01-01-2016 09:26 PM by vsheline.)
01-01-2016 08:48 PM
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Hornnumb2 Offline

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Posts: 32
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Machine: Respironics series 60 Bipap auto sv
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
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CPAP Pressure: none
CPAP Software: SleepyHead

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Sex: Male
Location: Baytown, TX

Post: #20
RE: Need advice
I am getting more confused each day, so far I have called my doctor and he is out till next week. I have emailed the sleep doctor to see about a appointment. My wifes has a friend that owns a sleep clinic and I asked his advice, after he looked at my studies he thinks that from all the events on my first study that it was botched. I have no clue who to believe.....Michael
01-04-2016 03:01 PM
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