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+--- Thread: when is a prescription not a prescription? (/Thread-when-is-a-prescription-not-a-prescription)
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when is a prescription not a prescription? - xxyzx - 05-01-2017
when is a prescription not a prescription?
apparently when the doctor works for a sleep lab and they want to make more money off you.
I have an Rx in my hot little hand for an ASV.
my EX DME says they cant fill it without calling the doctor.
They claim the doctor says I need yet another titration study.
They did one for a bipap less than a month ago.
This is total BS.
Apparently an Rx is not an Rx unless the doctors sleep lab gets paid yet again.
Sorry but I have had way too many studies that I can't afford.
And the DME had earlier said I would need more of them for every change in settings they made.
Well that wont happen either.
When , not if, I get my ASV then I will be doing my own settings from sleepyhead data.
Of course I will follow up with the doctor if insurance requires it or if I still have problems using the machine.
But no more studies !!!!!
RE: when is a prescription not a prescription? - jtravel - 05-02-2017
(05-01-2017, 12:09 PM)xxyzx Wrote: when is a prescription not a prescription?
apparently when the doctor works for a sleep lab and they want to make more money off you.
I have an Rx in my hot little hand for an ASV.
my EX DME says they cant fill it without calling the doctor.
They claim the doctor says I need yet another titration study.
They did one for a bipap less than a month ago.
This is total BS.
Apparently an Rx is not an Rx unless the doctors sleep lab gets paid yet again.
Sorry but I have had way too many studies that I can't afford.
And the DME had earlier said I would need more of them for every change in settings they made.
Well that wont happen either.
When , not if, I get my ASV then I will be doing my own settings from sleepyhead data.
Of course I will follow up with the doctor if insurance requires it or if I still have problems using the machine.
But no more studies !!!!!
The Doctor may not have written the Prescription correctly.
The Prescription needs to state the Machines type and pressure settings so the DME can order and set it up correctly.
When you get a prescription for a Bi-level Or ASV you have more pressure settings that need to be specified by the Doctor than a standard Cpap or Pressure range on a Auto. They can't just hand you a ASV machine and let you set it up on your own.
RE: when is a prescription not a prescription? - kwhenrykerr - 05-02-2017
Send up the Rx with your name blacked out. It may help us to understand and suggest something.
RE: when is a prescription not a prescription? - C0mbe - 05-02-2017
I don't know the specifics of your prescription, but this sounds like you are not complying with your insurance carriers rules, not that the prescription isnt valid.
The only time there are no strings attached with an xPAP prescription is when you are paying out of pocket. When you expect an insurance carrier to pay there are additional hoops you must go through.
For instance, you have to show failure on other devices first, and even when you've proved that they may want to know whether ASV will treat you effectively before spending $3500 on the Aircurve.
The sad truth is that insurance is a business, and a profitable one at that. Just because the doc wrote a script for a certain machine does not mean that insurance will automatically cover it. If that was true, the ins companies would all be bankrupt and we would all be using auto-bilevels and ASV machines because (imo) they are more comfortable and more effective.
I would suggest you take your prescription to Supplier #2 and see if they have any open box new Aircurve ASV, otherwise you will most likely have to go through the titration test.
Regarding more tests after you have the machine to optimize settings: this board can help you optimize your settings with no cost to you. There are some very knowledgeable members regarding ASV machines! Plus, the Aircurve 10 ASV is an incredible machine when given the room to work.
RE: when is a prescription not a prescription? - Sleeprider - 05-02-2017
You might try asking the doctor to write the prescription to the default settings recommended by Resmed for the ASV. This usually provides very good treatment, and minor improvements can usually be made based on the machine data. This should actually be equal or better than a lab titration study. It puts the doctor in the position of defending the need for another study, and might get you the complete prescription you want.
Default recommended settings on page 40 of this document might get you moving https://www.resmed.com/us/dam/documents/products/titration/s9-vpap-tx/user-guide/1013904r3_s9-vpap-tx-sleep-lab-titration_user-guide_glo_eng.pdf
Lots of other good information there as well, but for ASV auto mode, EPAP min 5.0, PS min 3.0, PS max 15.0. The recommendations for the VPAP Adapt are the same as the Aircurve 10 ASV.
RE: when is a prescription not a prescription? - xxyzx - 05-02-2017
(05-02-2017, 08:38 AM)C0mbe Wrote: I don't know the specifics of your prescription, but this sounds like you are not complying with your insurance carriers rules, not that the prescription isnt valid.
The only time there are no strings attached with an xPAP prescription is when you are paying out of pocket. When you expect an insurance carrier to pay there are additional hoops you must go through.
For instance, you have to show failure on other devices first, and even when you've proved that they may want to know whether ASV will treat you effectively before spending $3500 on the Aircurve.
The sad truth is that insurance is a business, and a profitable one at that. Just because the doc wrote a script for a certain machine does not mean that insurance will automatically cover it. If that was true, the ins companies would all be bankrupt and we would all be using auto-bilevels and ASV machines because (imo) they are more comfortable and more effective.
I would suggest you take your prescription to Supplier #2 and see if they have any open box new Aircurve ASV, otherwise you will most likely have to go through the titration test.
Regarding more tests after you have the machine to optimize settings: this board can help you optimize your settings with no cost to you. There are some very knowledgeable members regarding ASV machines! Plus, the Aircurve 10 ASV is an incredible machine when given the room to work.
unless the doctor is screwing with me
the Rx is valid
I *have* the Rx in my hand
would he write an Rx that was not valid?
and make a big deal out of it when he handed it to me and said to come back in one month
he expected me to get the machine that day the way he talked
i am in compliance with insurance rules that they have made up so far
still waiting to see all their rules in writing which i had requested
it is the DME that wont honor the Rx without another titration study
i just had one for another bipap a few weeks ago
they are both E0471
another study is a waste of money and time
if the DME keeps stonewalling i may have to make an appointment to see the doctor again
insurance is another issue
i am working against them to get their written rules
i have done all the things they verbally told me were required
insurance keeps talking to the DME that feeds them a pile of crap
then i have to shovel it away and focus my insurance rep on their rules not what the DME says
i expect the sleepyhead data and help here will do far better than the sleep lab or doctors guessing by looking at the data
RE: when is a prescription not a prescription? - xxyzx - 05-02-2017
(05-02-2017, 07:17 AM)kwhenrykerr Wrote: Send up the Rx with your name blacked out. It may help us to understand and suggest something.
its bureaucrats and greedy DMEs
i am slowly working my way through their hoops and over their hurdles
when push comes to shove i will bring johnny law into help
that threat got the DME to let me return the useless machine they said i had to use 21 straight days to prove i had failed
sorry but that machine kept me from sleeping
the doctor said it was a fail
then the DME tried to talk insurance into changing the Rx and making me also fail an S/T
the Rx was specific about ASV so i got the insurance to not believe that attempt by the DME was valid
i feel like insurance is on the DME side not mine
RE: when is a prescription not a prescription? - xxyzx - 05-02-2017
(05-02-2017, 07:17 AM)kwhenrykerr Wrote: Send up the Rx with your name blacked out. It may help us to understand and suggest something.
doctors pad with fancy security paper name address etc
script number
says ASV
has two G codes for the diagnosis
Dx G47.33/G47.31
his signature
really nothing special to help with the bureuacrats ignorance and DME greed
RE: when is a prescription not a prescription? - xxyzx - 05-02-2017
(05-02-2017, 12:06 AM)jtravel Wrote:(05-01-2017, 12:09 PM)xxyzx Wrote: when is a prescription not a prescription?
apparently when the doctor works for a sleep lab and they want to make more money off you.
I have an Rx in my hot little hand for an ASV.
my EX DME says they cant fill it without calling the doctor.
They claim the doctor says I need yet another titration study.
They did one for a bipap less than a month ago.
This is total BS.
Apparently an Rx is not an Rx unless the doctors sleep lab gets paid yet again.
Sorry but I have had way too many studies that I can't afford.
And the DME had earlier said I would need more of them for every change in settings they made.
Well that wont happen either.
When , not if, I get my ASV then I will be doing my own settings from sleepyhead data.
Of course I will follow up with the doctor if insurance requires it or if I still have problems using the machine.
But no more studies !!!!!
The Doctor may not have written the Prescription correctly.
The Prescription needs to state the Machines type and pressure settings so the DME can order and set it up correctly.
When you get a prescription for a Bi-level Or ASV you have more pressure settings that need to be specified by the Doctor than a standard Cpap or Pressure range on a Auto. They can't just hand you a ASV machine and let you set it up on your own.
i have the settings
11/14
i just had a titration a few weeks ago for the failed bipap machine
the pressures wont change that fast
any other changes should be handled by the AUTO part of SV
RE: when is a prescription not a prescription? - xxyzx - 05-02-2017
(05-02-2017, 09:19 AM)Sleeprider Wrote: You might try asking the doctor to write the prescription to the default settings recommended by Resmed for the ASV. This usually provides very good treatment, and minor improvements can usually be made based on the machine data. This should actually be equal or better than a lab titration study. It puts the doctor in the position of defending the need for another study, and might get you the complete prescription you want.
Default recommended settings on page 40 of this document might get you moving https://www.resmed.com/us/dam/documents/products/titration/s9-vpap-tx/user-guide/1013904r3_s9-vpap-tx-sleep-lab-titration_user-guide_glo_eng.pdf
Lots of other good information there as well, but for ASV auto mode, EPAP min 5.0, PS min 3.0, PS max 15.0. The recommendations for the VPAP Adapt are the same as the Aircurve 10 ASV.
i ahve settings
they titrated me few weeks ago
11/14
that is the starting point to be used for another bipap E0471 class device