How concerned should I be about the length of these Centrals?

[LookingForward]

So with those settings I should be getting a ResMed AirCurve ST-A instead of an ASV so that I have the back-up rate?

I assume the ST-A would control the centrals, but it didn't seem like LinCare was ordering an ST-A.

Since I have Myotonic Dystrophy type 2, do you think the ST-A is the best choice?


Does SleepyHead work with ST-A?

[Sleeprider]

The ST-A is an appropriate technology for your condition, and has more settings than the ASV. In this case, the ST-A can target tidal volume, provide a backup rate, and adaptively increase pressure support as needed. This machine is actually capable of more than the ASV, and is an option I mentioned very early in this thread.

[LookingForward]

How do I get Lincare to agree? I've been wondering for a while if the ST-A is a better option.

I don't think I can get my doctor to rewrite the prescription.

[Sleeprider]

All I know is there is no adjustment on the Dreamstation that can't be made with the Resmed. The Resmed flow smoothing with EasyBreathe is much easier to tolerate, and that is the class of machines you have been using. https://www.resmed.com/us/en/consumer/pr...0-sta.html

You can threaten to reject the Dreamstation and take your prescription elsewhere. That is the most leverage you have, is that you can be anyone's customer if they meet your needs. The Philips does not offer this suite of comfort features.

[LookingForward]

I've been looking at online options for buying out of network. I found Direct Home Medical. After online chatting they said they can sell me the machine. But they have the insurance code of E0472 needed for the ST-A. Wouldn't that be wrong and the code should be E0471? That's the code this prescription is written for.

Edit: Now I've found two online suppliers that say the medical code for the ST-A is E0472. I'll have to call ResMed tomorrow and directly ask them. If that's the case, I can't get it with my current prescription.

Edit 2: After looking up the insurance codes, I think those online sites are wrong about the medical code. Does anyone know for sure which is correct?

E0471 Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) 

E0472 Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)

[Sleeprider]

The correct code is E0471. This is a non-invasive positive pressure ventilator with backup rate. E0472 is specifically an invasive ventilator used with tracheostomy. This error by DMEs has been noted:

Recently during claims review it was noted that suppliers are billing HCPCS code E0472 (Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)) with non-invasive interfaces. This is not correct billing. As noted in the code descriptor, code E0472 is reserved for devices used with an invasive interface. Claims for E0472 must not be billed with any of the following non-invasive interfaces or accessories:

Idiots are everywhere, beware.

[Sleeprider]

If you are serious about going out of pocket, contact Supplier #2 and 33. Both will be far below retail.

[LookingForward]

Thanks for the suggestions. Unfortunately neither of those suppliers will work. Supplier #2 doesn't have the ST-A on their site. A few days ago I contacted Supplier #33 by email when my current DME was giving me a hard time. He said that he has the ASV but doesn't sell the ST-A at this time. Both of them would have likely had better prices though.

I'm going to call Apria tomorrow. My insurance didn't mention them as an in-network provider but I used them two years ago with this insurance so will at least ask them to check if they are still compatible with my insurance. The reason to call Apria, is at least two years ago, the supplier near me said that they only deal with ResMed.

[Sleeprider]

You are doing your part. What does your current DME say about the Resmed ST-A? They supplied your Aircurve 10, so have access to this machine. Maybe they just don't know about it. I think it may be reasonable to provide the Dreamstation alternative, but they need to give you an honest explanation. You should certainly take the Dreamstation under an insurance coverage before paying out of pocket for the Resmed. I have my opinions mainly based on reviews of comfort by others, and the fact I like the data feedback, but these are rare and expensive machines. You have won by getting either one.

[LookingForward]

I haven't talked to my current DME since last week. They were offended that I requested an AirCurve ASV (the machine I thought I went to the sleep study for) and that I didn't what the DreamStation. That's when I got the run-around about the need for the DreamStation based on my prescription and the wording about the Tidal Volume. They didn't like it that I knew ResMed could do the same thing.

So at the beginning of this week I called LinCare back to ask which machine was ordered. I was told the person that I needed to talk to was in a meeting but she would be given a message to call me. She still hasn't called back, so I figured out how to get my own prescription and sleep study results. After studying the results and posting on here, I felt that SleepRider had the two best possible solutions for which machine to get. 

After researching possibilities on how to get one of the machines, I remembered that Apria only sells ResMed products. So this morning I called my insurance first too see if the E0471 has been approved or where it is in the process. I was told that they haven't received a request for that. Even though my prescription says URGENT on it, Lincare is mad enough to not even submit it yet for approval. I then asked my insurance if I could switch to Apria and was told yes.

I then took by prescription and sleep study titration directly to Apria's office. I talked to the lady and told her what was going on and told her that Lincare also has the results but has dropped the ball. I also told her that I have educated myself a bit in this process and that I use a program called SleepyHead and that I learn a lot from online research and forums. I also told her that I knew that Apria only deals with ResMed and that once the insurance code for E0471 was approved that my insurance didn't care if I got the AirCurve ST, AirCurve ST-A or the AirCurve ASV. All three have the exact same negotiated rate. I told her that based on the wording of my prescription, the need for a backup rate and that I have Muscular Dystrophy with a weakening diaphragm muscle, I felt that the ST-A was the best choice for me over the course of the next 5 years of owning the machine. 

She was quite surprised that I knew all that. She said that in the 27 years that she's worked there, I'm the first person that understood the insurance end and the differences in the machines. She said that it was a wonderful thing that I've taken the time to learn. Since I gave her everything she needed to start the prescription process and submitting it to the insurance she was going to start on it today and get it submitted to my insurance. Unfortunately the respiratory therapist is on vacation until Monday but she was going forward with it all anyway and will have as much of it processed as she could by then. She told me to expect a call on Monday. She also made copies of all my documents, including the brochure for the AirCurve ST-A. She attached it all together with my reasoning behind getting that machine.

So hopefully I'll know Monday if Apria agrees with the ST-A.

I haven't decided yet when I'm going to tell Lincare no to bother. I don't really know how that works if two companies end up sending in for approval about the same time. I think that either on Dec 8 or 9 my monthly lease for my current machine renews. So it looks like for one month I'll be paying the rental cost on the old and new machine. But hopefully that also gives me until January 8 to return my current machine since I will have already paid for the rental. I will have two machines for a short time to give me the space to learn to adjust to the new machine.

It's not a victory yet. But I have a different route to take to try to get the ST-A through a different in-network provider.

I can't thank everyone enough on here for helping me. All of you are invaluable!