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new DSX600, dramatic jump in AHI - ASV OMG!
#11
RE: new DSX600, dramatic jump in AHI
Do come back with the outcome Smile
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#12
RE: new DSX600, dramatic jump in AHI
I agree with Sleeprider.

This machine and that script is doomed to fail you big. It cannot be made to work effectively period, no matter how many edits are done and no matter how much you use it. Your central apneas can only be fixed effectively, and consistently, on an ASV. Specifically, the best machine choice is the ResMed AirCurve 10 ASV.

I will suggest that in some way you get the doctor to pay close attention to the area on your sleep study where the predominant CA was mentioned. You must be pointed in stating you are getting worse for using this dispensed BPAP. Hold no punches, tell the doc very firmly it is not working and cannot be accepted to continue. You can ask pointed questions about when do you get the ASV. Or make statements about the ResMed ASV, that you see for yourself ResMed describes the ASV as their only machine that is designed to treat these CA events.

I am not attempting to worry you, but I've been where you are, as in this scenario of being on a BPAP with high predominant CA. I felt very bad health wise, and yes in a dangerously bad way due specifically to the BPAP use. This needs the doctor's attention in an urgent way.
Dave

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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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#13
RE: new DSX600, dramatic jump in AHI
(03-30-2020, 09:33 AM)DrMike Wrote: THANKS ALL!

Am in Dr's waiting room now.

Excellent news! I hope you are successful in getting on the ASV path. Update us here please.
Dave

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Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#14
RE: new DSX600, dramatic jump in AHI
Attached is the 2-page report.

Per Dr visit this am,
1) the DX600 is going back; notified DME supplier this am but have not had a reply yet.
2) A new sleep study targeting ASV will be scheduled, date TBD
3) Using previous F&P Icon+ in the interim; it showed AHI of 15+ last night vs week average w/DX600's 65+/-
Next Dr appt scheduled for early May.

Some forum Q's:

1. I have a 20% co-pay with United Health Care for DME items. If I pay for an item myself, they will reimburse me at 80% of "Usual and customary Medicare reimbursements". Q is: Where do I find out what the "Usual and customary Medicare reimbursement" is for an "ASV" machine?
2. If the Rx doesn't specify a particular machine, just an "ASV", am I free to buy anything that meets the Rx ... i.e., specify the particular device I want?
3. What is the downside (other than having to wait for reimbursement) if I send the new (after the next sleep study) Rx to Supplier 2 or 33? I.e., are they then able to supply the consumables ... cushions, head gear, etc. ... associated with the Rx'ed machine?
4. Is there a downside other than a more limited warranty (6 months for an "open box" or "Gently used" machine, vs a new one at 2-3 years)?


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#15
RE: new DSX600, dramatic jump in AHI
I don't have a direct answer to question 1. I'd ask the insurance if they can tell you this.

If you have a script for an ASV, then you should be able to decide the brand. However, if going through a DME, they will likely try to give a Respironics. They seem to be less expensive to these DMEs. If you're buying it online, buy what you want/need. I still say work things so the ASV is ResMed.

The specific supplier would be able to answer that. If they are counted as your DME, that answer should be yes, they would be handling the supplies.

The only big thing I'd point out is you need to know how to get an accurate Hours Used reading. It needs to include machine and both parts of the power cord, which includes the power supply brick.
Dave

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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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#16
RE: new DSX600, dramatic jump in AHI
I highly recommend you consider Supplier #2 or Supplier #33. Both offer new and used ASV units at very comptitive prices. Supplier #2 is better with warranty support. I last checked prices of the Resmed Aircurve 10 ASV at Supplier #2 yesterday, and the gently used unit was $1390 as I recall, and the new one is $2149. I'm pretty sure that is far less than Medicare Usual and Customary, and if you call them, they will probably be able to tell you exactly what that is. In other words, I'm fairly certain that if you are reimbursed 80% of customary, you will pay less using these suppliers, than your DME.

You don't need titration. The Resmed Aircurve 10 ASV will automatically titrate to your needs, and we can help you to fine tune it better than any sleep study. I already posted the titration protocol and recommended starting settings in post 2 of this thread http://www.apneaboard.com/forums/Thread-...#pid342643 Congrats on having a responsive and knowledgeable doctor. He deserves a lot of recognition. I will suggest you copy the protocol, and if you decide to purchase a machine, you will have it before the end of the week. Tell your doctor your intention to use the Resmed Titration Protocol, send him a copy. I'm sure he will think that's a great idea.
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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#17
RE: new DSX600, dramatic jump in AHI
I did a quick search for the Medicare Reimbursement Rate for a HCPCS code E0471 which is a bilevel with backup rate. Resmed has the information and Medicare normally rents a machine for 13 months. The rate varies, and you can see what it was in 2019 here https://www.resmed.com/us/dam/documents/...F_RADs.pdf If you multiply those payments by 13, you have an idea of what the reimbursement could be. Additional links https://hcpcs.codes/e-codes/E0471/
Use search string: medicare reimbursement HCPCS E0471
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#18
RE: new DSX600, dramatic jump in AHI
GLITCH!  Turns out I can only be reimbursed 80% of the equipment cost if I buy through a Durable Medical Equipment supplier. Supposedly a Medicare requirement. Seems assinine that Medicare wouldn't like to spend less money, but it IS a government program.   Sad

Am checking with Suppliers 2 & 33 to see whether they fit that category but have not heard back yet.

Any enlightenment?
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#19
RE: new DSX600, dramatic jump in AHI
I think they are on Central time, so a phone call during business hours will get a better explanation. As you saw from the Medicare guidelines, you will endure a long delay, and multiple qualifying requirements with several denials along the way to get ASV from Medicare. Just saying, you are looking at 3 months, even assuming you can get in for a sleep test to demonstrate efficacy with ASV. With the severity of your problem, I might buy the used ASV unit, even a Resmed S9 Adapt Auto which is the older model with ASVauto mode, at Supplier #2, demonstrate efficacy by using the machine and being treated, and put in for the Medicare coverage. You would end up with treatment, a valid pressure, demonstration of efficacy, and a backup machine. It is a pretty big hit out of pocket, but the choice is to live with your central apnea for an indefinite amount of time. Medicare is designed to frustrate you and increase the cost and time of getting an advanced machine.

If you go the medicare route, you must use a Medicare Participating Provider. Start here to find one, call and ask them what you will need https://www.medicare.gov/supplierdirectory/search.html
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#20
RE: new DSX600, dramatic jump in AHI
Just a clarifiation, the S9 ASV model is the VPAP ADAPT. There are two versions, with only the later one having ASVAuto mode.
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