(04-28-2017, 07:04 PM)PollCat Wrote: Did your sleep doc give you script for the ASV machine? The DME can only give you a machine that is prescribed by your doctor.
I have an Rx for an ASV machine.
I have a write up justifying it.
My DME is trying to snow my insurance rep saying i have to fail the first bipap for 21 days
then fail on an S/T machine before I can get an ASV.
Initially my insurance rep said all that my plan required was medically necessary and the doctor say bipap failed.
I got that justification and the Rx.
Now the DME is feeding them medicrap procedures or trying to impose their own DME rules onto my insurance plan.
The insurance rep was asked for the rules in writing and two different ones told me that there were no written rules for compliance and that
all I needed was for it to be medically necessary and justified which the board cert sleep doctor did.
Now they are finally saying their medical department will give me the written rules.
I wonder if they will agree with what the two service reps told me.
Now they are listening to the DME and say they won't pay for it without another sleep test with yet another machine and who knows how many more hoops and roadblocks they will try. I hope that is a bluff. When I see the real rules I suspect that I will get the ASV unless they are totally different from what I had been told before.
The bipap was a TOTAL FAIL. It either kept me from sleeping at all, else when I got so tired and fell asleep anyway it jolted me awake as if I was slammed into a brick wall and the air had been sucked out of the mask. I had to breathe through mouth until I can relax enough to try RAD again and as soon as I fall asleep the brick wall torture is repeated. NO mas!! 3 strikes and that machine is out. Not being tortured for some bureaucrats rule.
I will do without anything before I use that device gain.
Now I may not be the brightest person but I am not about to be tortured and get no sleep for 4 hours 21 days in a row to prove that machine failed.
THE DOCTOR SAID IT FAILED. I have complex/central apnea. His Rx said to use an ASV not an S/T.
My question is there anything but an ASV that can treat complex/central that they could justifiably ask me to try first.