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+--- Thread: ASV and Insurance Question (/Thread-ASV-and-Insurance-Question)
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ASV and Insurance Question - rozenbob - 08-04-2016
I had an ASV titration completed Early June showing 0 Centrals.
But the Billing Dept wanted a BiPAP titration showing Centrals which was taken in late June
Now my Auto CPAP (set 8 / 12) has been replaced with an Auto BiPAP set at straight 16 /11 and I am having as many as 57 centrals with 8.39 ahi.
From experience, does anyone know how long this fiascal continues before the Billing Dept finally authorizes?
The authorization Dept said Yes over a month ago after the ASV titration and Echo cardio were complete, All before I had to take the additional BiPAP at my expense!
![[Image: 3KqR8J7l.png]](http://i.imgur.com/3KqR8J7l.png)
RE: ASV and Insurance Question - PoolQ - 08-04-2016
I can give you some numbers from my own experience:
1. report from the lab up to 3 weeks, can be done in a week if it is pushed by the Doctor
2. turnaround by the Doctor less than a week, couple of days for me
3. DME processing another week, pushed them and got 2 days
4. insurance approval standard is 10 days, DME can expedite for a 2 day turn. I got same day (heart issues)
5. getting the actual machine up to a week, I got it same day.
Nothing is fixed. Your AHI is low even though your total count looks high. BTW use the AHI number because that is what they are all used to, if you start talking about the total count you will just confuse them.
The problem is that the therapy itself can cause some centrals, the sleep/wake junk can cause some more-these are not real centrals which are caused by the brain stem.
You should be able to nicely "push" and get things done faster, but the numbers by themselves are not going to catch anyone on fire to get things done for you. Call them up and ask what the status is and if they have everything they need. I found that asking them for help worked well for me. "I am doing everything I can, using the machine every night, I just really need to get better sleep as it's effecting my job and I get worried about driving while being so tired all the time....".
I followed up on everything with everyone.
RE: ASV and Insurance Question - Sleeprider - 08-04-2016
How is it the BiPAP is at your expense? If you fail CPAP, it is rejected by insurance and returned (rental?). Same thing for BPAP. The insurance company wants to pay for the least expensive technology. That's why they spent a fortune repeatedly testing your and having to pay your doctor. (excuse the sarcasm).
RE: ASV and Insurance Question - richb - 08-04-2016
Hi rozenbob. It is difficult to get an ASV machine outright. There is a lot of resistance in the insurance community to giving them even though in your case it is shown to work. For many reasons mostly financial insurance including Medicare wants you to fail using standard CPAP and or BiPAP before they give you an ASV machine. It took me many months but it was worth it in the end.
Rich
RE: ASV and Insurance Question - rozenbob - 08-04-2016
I meant the BiPAP titration was $290 out of pocket after $290 for the ASV titration and another $290 for the Echo ALL in a One month period!
RE: ASV and Insurance Question - richb - 08-05-2016
(08-04-2016, 10:50 PM)rozenbob Wrote: I meant the BiPAP titration was $290 out of pocket after $290 for the ASV titration and another $290 for the Echo ALL in a One month period!
The BiPAP and ASV titrations could have been done in the same study. They set the machine on BiPAP to see and gather data to show BiPAP doesn't work. Then the machine is set to ASV and data is gathered to show that ASV works. That is the way they did it for me. Unfortunately I wound up getting 5 sleep studies on my way to an ASV machine.
Rich
RE: ASV and Insurance Question - natyprueba - 08-05-2016
rozenbob
-I hope that you got the machine that you need ASAP.
-Sir, I am a newbie in this CPAP machines stuff and don't got any medical education.
-I saw your graphics and I will analyze them as if they were mine.
1-The leak graphic shows way too high leaks.
In my case, if I saw that graphic with a leak as high as you got, NEVER got a low AHI.
I think that you must work to fix the high leak with this machine and with the next one.
Ralph.
RE: ASV and Insurance Question - jerrydaw - 08-05-2016
This is consistent with the advise from my doctor. I am scheduled to have a sleep test for a side by side comparison of a Bilevel type therapy with an ASV therapy. By showing that the ASV works on my central apnea issue, they satisfy Medicare concern of paying the high price for the ASV machine. My doctor said this test was necessary in order too obtain Medicare reimbursement.
RE: ASV and Insurance Question - Sleeprider - 08-05-2016
(08-05-2016, 07:01 AM)natyprueba Wrote: rozenbob
-I hope that you got the machine that you need ASAP.
-Sir, I am a newbie in this CPAP machines stuff and don't got any medical education.
-I saw your graphics and I will analyze them as if they were mine.
1-The leak graphic shows way too high leaks.
In my case, if I saw that graphic with a leak as high as you got, NEVER got a low AHI.
I think that you must work to fix the high leak with this machine and with the next one.
Ralph.
Natyprueba, the leak displays for your Resmed, and his Respironics machines are very different. Note that there are two lines on that leak graph. Respironics show both the total leak (Resmed does not show this), and the calculated excess leak. His leak data is excellent. That is part of the reason we ask members to put the machine data in their profile.
RE: ASV and Insurance Question - natyprueba - 08-05-2016
Sleeprider
.I don't want to argue about something that I don't know.
I am not discharging my lack of knowledge about all this stuff and the different ways that the reports are shown for different machines. I thought that these are standard reports with the same information. I was really wrong. In my post, I made the following disclaimer:
“I am a newbie in this CPAP machines stuff and don't got any medical education.
-I saw your graphics and I will analyze them as if they were mine. “
About your post:
1-If you watch his graphic, it got two very different things: total leaks & leaks rate. The graphic, is as almost all the graphics in Sleepyhead, doesn't has units and that lead to a mix up. For your post, I suppose that the bottom line is leak rate and the units are liters/minutes, if that is true, he is OK. The top line will be total leak and what will be the units? It will be very nice to know exactly what means total leaks and the units.