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Supply coverage by Medicare
#1
If I purchased on my own an upgraded machine to replace my present  CPAP machine with a BIPAP or ASV machine , would Medicare cover the supplies for that self bought machine without a new sleep study and Rx? 

Would the DME even allow the supplies to be ordered in the first place knowing what my past order history and machine was?
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#2
Why do you think you may need an ASV machine, without confirmation from a sleep study? Why would you choose to pay for an ASV without going through the hassle of insurance?
Do you realize the cost of a new ASV machine?

Yes a DME will provide supplies for which ever xpap machine you have, although the same may not be true for an oxygen concentrator.
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#3
(05-21-2017, 08:36 PM)old82 Wrote: If I purchased on my own an upgraded machine to replace my present  CPAP machine with a BIPAP or ASV machine , would Medicare cover the supplies for that self bought machine without a new sleep study and Rx? 

Would the DME even allow the supplies to be ordered in the first place knowing what my past order history and machine was?
I simply mentioned machines that treated central apneas which is what my present CPAP machine read out says I'm having 99% of the time.  My sleep doctor claims my present machine, the resmed airsense 10 , isn't capable of determining central apneas from obstructive apneas but my readout from my SD card every morning indicates all are central. 
I would love to try a different machine that treats central to see if my terrible , fitful nights on my CPAP machine is any better without going through the long process of new sleep labs and other medical tests to prove I need something different.
Yes, I know the cost of a ASV is several thousand $ but that would be my last resort.
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#4
(05-21-2017, 08:36 PM)old82 Wrote: If I purchased on my own an upgraded machine to replace my present  CPAP machine with a BIPAP or ASV machine , would Medicare cover the supplies for that self bought machine without a new sleep study and Rx? 

Would the DME even allow the supplies to be ordered in the first place knowing what my past order history and machine was?

I don't know about the Medicare part, but my insurance covered it just fine when I did this. As long as the DME had a prescription from my doctor, they didn't care what machine I was using. When I called the DME to order supplies they asked me what machine I had and which supplies I needed.
Sleepster
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#5
(05-21-2017, 09:23 PM)old82 Wrote:
(05-21-2017, 08:36 PM)old82 Wrote: If I purchased on my own an upgraded machine to replace my present  CPAP machine with a BIPAP or ASV machine , would Medicare cover the supplies for that self bought machine without a new sleep study and Rx? 

Would the DME even allow the supplies to be ordered in the first place knowing what my past order history and machine was?
I simply mentioned machines that treated central apneas which is what my present CPAP machine read out says I'm having 99% of the time.  My sleep doctor claims my present machine, the resmed airsense 10 , isn't capable of determining central apneas from obstructive apneas but my readout from my SD card every morning indicates all are central. 
I would love to try a different machine that treats central to see if my terrible , fitful nights on my CPAP machine is any better without going through the long process of new sleep labs and other medical tests to prove I need something different.
Yes, I know the cost of a ASV is several thousand $ but that would be my last resort.

I think you may need to have a longer conversation with your Dr. The information he gets, if I read the Cliniton manual does not give him the CA/OA breakout. If I were you I would get a copy of Rescan and take some printouts along with your laptop is you have one to meet with the Dr. Although Dr cannot use Sleepyhead as a primary tool becasue its not been vetted as medical software, I think that Rescan has. If you are indeed having CA, that may convince hi/her.  Thre is a link to send an email under the adjust cpap pressure link on the main apneaboard.com page.
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#6
I believe to qualify for a higher level machine Medicare wants you to fail at using the standard xPAP machine. You have done that. It is up to the doctor to try and bump up to a machine that might help. Do you have heart problems? I think you need to have an ejection fraction of above 40 to get a VPAP. Under 40 is a very good start toward congestive heart failure.
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#7
(05-21-2017, 11:58 PM)SideSleeper Wrote: I believe to qualify for a higher level machine Medicare wants you to fail at using the standard xPAP machine.  You have done that.  It is up to the doctor to try and bump up to a machine that might help.  Do you have heart problems?  I think you need to have an ejection fraction of above 40 to get a VPAP.  Under 40 is a very good start toward congestive heart failure.

Thank you Sidesleeper...could you expound a little about "ejection fraction".  What is the name of the test that gives the number.? I'm not clear about what you said about being above or below 40. If someone has congestive heart failure symptoms would the ejection fraction number likely be above or below 40? I've not been diagnosed with heart problems but due believe my heart has something to do with my problem.
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#8
(05-21-2017, 10:54 PM)TASmart Wrote:
(05-21-2017, 09:23 PM)old82 Wrote:
(05-21-2017, 08:36 PM)old82 Wrote: I Have Rescan and have brought my laptop in and shown the doctor the colored coded graph showing central apneas and she dismisses the information and sticks with her  beliefs that my machine isn't capable of determining centrals so I am at a dead end with her. 
Is is there anyone out there with the same machine...resmed airsense 10 auto...that uses Rescan and is seeing it showing predominantly central apneas and is being believed by their doctor?


I think you may need to have a longer conversation with your Dr. The information he gets, if I read the Cliniton manual does not give him the CA/OA breakout. If I were you I would get a copy of Rescan and take some printouts along with your laptop is you have one to meet with the Dr. Although Dr cannot use Sleepyhead as a primary tool becasue its not been vetted as medical software, I think that Rescan has. If you are indeed having CA, that may convince hi/her.  Thre is a link to send an email under the adjust cpap pressure link on the main apneaboard.com page.
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#9
Old82, what is your CAI, or events per hour of central apnea. Can you show us a graph for a typical night?  There might be some information there we can help with to help communicate with your doctor.

This whole thing about congestive heart failure and ASV arose out of a Resmed Study [commercial link removed, instead, search for "Special Safety Notice: ASV therapy for central sleep apnea patients with heart failure"] which found an increased risk of sudden cardiac death among patients using ASV with a left ventricular ejection factor (LVEF) less than 40%.  This risk was high enough that Resmed issued a warning.  This warning has now been blown way out of proportion and caused everyone receiving ASV to be evaluated for CHF and LVEF.  Here is an explanation: [commercial link removed, instead search for "heart association Ejection Fraction Heart Failure Measurement"]






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#10
(05-22-2017, 08:22 AM)old82 Wrote:
(05-21-2017, 10:54 PM)TASmart. // side sleeper// sleep riderTo all who responded .....thank you for your inputs. Try as I may I am unable to provide screen shots of examples from my machine.sleeprider provided excellent links explaining ejection fraction and I was able to better understand the numbers. In fact I remembered I had a test 2 years ago prior to back surgery that showed my EF number to be "55-60" which looks ok but may be lower now after 2 years.  I\m 84 so it wouldn't surprise me.  I'm in the process of selling my house and moving to a different state and when I get settled I'll see about getting an update of my EF number.sidesleeper...disregard my request for clarification of EF since the links provided by sleeprider were very explanatory.Since I've managed to get my total AHI below 5.0 most nights it appears doctors treat that as being treated appropriately by my CPAP and don't wish to spend time looking further into symptoms of poor sleep even tho my central AI in all cases is 5 or 4.9.  Appreciate all the good info from you all. I just need a new sleep doctor who cares and when I move I intend to find one.old 82 (now 84) Wrote:
(05-21-2017, 09:23 PM)old82 Wrote: I think you may need to have a longer conversation with your Dr. The information he gets, if I read the Cliniton manual does not give him the CA/OA breakout. If I were you I would get a copy of Rescan and take some printouts along with your laptop is you have one to meet with the Dr. Although Dr cannot use Sleepyhead as a primary tool becasue its not been vetted as medical software, I think that Rescan has. If you are indeed having CA, that may convince hi/her.  Thre is a link to send an email under the adjust cpap pressure link on the main apneaboard.com page.
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