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[Pressure] New rx for pressure setting
#21
RE: New rx for pressure setting
Yes it seems to be the norm with stubborn doctors and the insurance companies they serve!  That's the way they treated me as well.  I short circuited the process and purchased my own.  Now its up to me to navigate the medicare and insurance waters!  You could always look for a new doc, and hope you get a good one.
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#22
RE: New rx for pressure setting
It happens too often. Most central and complex apnea patients are miserable on ST. I know of one that was able to make it work, so the odds are not good. As far as it's "just the way they do things", I would be looking for a different practice that doesn't do it that way. Especially if you are responsible for copay or deductible costs. That is just stupid. Read the document I linked above. ST is the wrong therapy and even the manufacturer doesn't recommend it for central apnea. I would fight harder. I will tell you what policies like that do is to cause patients to go and buy out-of-pocket. It's just ridiculous that you would be denied the piece of DME intended to treat your condition, which is medically necessary, and hope the wrong equipment will fill the need. Who do these people work for? The insurance company or you? Do not accept the ST machine. Ask for an ASV titration test. There is no requirement that you must fail ST. The criteria to obtain ASV is that you fail CPAP and Bilevel without backup. You are then able to get the HCPCS Code #0471 which includes both ST and ASV, however as you know, they treat different conditions. If you have to push this to the wall, ask the doctor to print or cite any legitimate article showing ST is appropriate for central and complex apnea without pulmonary complications. When he fails to do so, you can print this NIH article and hand it to him. It compares efficacy of ASV with ST and finds considerably higher efficacy for ASV. Note the machines have advanced considerably since this article was written in 2014. https://pubmed.ncbi.nlm.nih.gov/25126031/

Also read Ron Poelesta's thread. We see this mistake nearly every week on the forum, and it gets incredibly frustrating. Also, take a look at Richfreher's thread using bilevel vs ASV. He also bought his own out of pocket. http://www.apneaboard.com/forums/Thread-...ASV-Charts?
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#23
RE: New rx for pressure setting
Just my opinion, but the path to get ASV in part depends on the knowledge the patient possesses. They say normal is a full fail of CPAP, BPAP without backup rate, and then ST, then ASV.

I failed BPAP without backup rate in a week by daily calls telling the quack how very bad it was. I didn't go to ST because I called them out on the high diagnosic report CA amounts. I armed with knowledge from Sleeprider, Gideon, and others on Apnea Board, educating me that CA needs ASV. So my knowledge helped me skip a step and caused a BPAP fail in 1 week.

If the therapy is a daily Trainwreck of Centrals, call them every single day and tell them it's TERRIBLE! And demand attention, answers, and that ResMed states Central treatment with ASV.
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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#24
RE: New rx for pressure setting
Comparison of Efficacy of ASVauto vs Bilevel ST. (Randomized Controlled TrialJ Clin Sleep Med 2014 Aug 15;10(8):855-61. doi: 10.5664/jcsm.3954.




. 2014 Aug 15;10(8):855-61.
doi: 10.5664/jcsm.3954.



[Image: jcsm.10.8.855a.jpg]
Sleeprider
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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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#25
RE: New rx for pressure setting
WOW. Thank all of you guys for the great info. I feel much more confident for my next round of talks with them.
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#26
RE: New rx for pressure setting
I was taken back by the first and only Oscar post with EPR of 0 apparently max pressure of 8.0 or so. All of the train wreck CAs were in periods where there was no flow limitations, I mean none - zero. That shocked me and made me wonder if the CAs were really SWJ even if they were long groups of them.

The titration study also seemed to show the bulk of CAs in the same rough time frame when the patient was transitioning between awake and N1 or N2 which sometimes can be quite light.

Can you all maybe look harder, or again through this?

Has OP sent a data file to one of the most trusted folks out there (I am thinking Gideon), for a better combing of details?

Thanks all, and especially the OP for wanting the best.

QAL
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#27
RE: New rx for pressure setting
My first thought is since we're dealing with the Trainwreck of Central Apnea, there's no airflow. No airflow means there's no chance for flow limitations.
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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#28
RE: New rx for pressure setting
I am definitely NOT an expert. From what I have read, the process is driven by insurance. The ASV machines are more expensive than the BIPAP machines, which are more expensive than CPAP/APAP machines. Therefore, to decrease insurance company costs, the patient has to first try a CPAP machine and fail at treatment, then try a BIPAP machine and fail at treatment, and finally get an ASV because the prior machines have not done the job. I don't agree with the strategy, but there it is.
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#29
RE: New rx for pressure setting
So the insurance pays for 3 progressively more expensive machines? Can't see how that reduces their cost.
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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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#30
RE: New rx for pressure setting
Melman it significantly lowers cost when you give up and quit CPAP altogether saying this will NEVER work.
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