Nursing Home, Sister in Law needs help!

[deerhound]

My sister in law is living in a nursing home. She is incapable of walking and is so obese that they use a lift to take her out of bed for a shower. Last year she was hospitalized for extremely low SPo2 levels. She spent a week in ICU on a Trilogy machine that allowed her to get much better. The hospital sent her back to the nursing home with the Trilogy which she is using at night to stay alive. Humana, her Medicare managing insurance company Humana, has so graciously now decided not to pay for machine rental after a year of use and payment. The DME is wanting $1000.00 a month to continue to provide the Trilogy.

The only thing I can see on her prescription that is different from normal Bilevel treatment is that she is using AVAPS. While we are fighting the insurance company, I am thinking that maybe I should get her a more consumer type of machine that provides AVAPS as a treatment. Which Resmed machines would be applicable? I know that the Aircurve 10 ST-A can do this. How about the Aircurve 10 AVS, would that also work? I see that Palerider has some ASV machines for sale and I am thinking of getting one for her. She will die without breathing assistance while sleeping.

Thanks for you help
Dale.

[Pugsy]

I don't think the ASV model will do what is needed for targeted volume issues that the Trilogy or AVAPS can address but then I don't understand all those features anyway.

Send Palerider a PM and just ask him because he has a much better understanding of what each setting in those other machine does or needs to do for people with very special needs than I have.

[ChicagoGranny]

Humana, her Medicare managing insurance company Humana, has so graciously now decided not to pay for machine rental after a year of use and payment.

Have you discussed this with a supervisor at Humana? This could be a billing coding issue. Or maybe, the Trilogy is over-prescribed?

[deerhound]

Thanks, we are constantly on the phone with Humana and fighting the battle. I am just worried that it might take too long and am pursuing an alternative route because I am not going to let her die.
Dale

[ChicagoGranny]

we are constantly on the phone with Humana and fighting the battle.

What does her doctor have to say about the insurance battle? A good doctor will help overcome the insurance crap.

[deerhound]

Her doctor has provided all information asked for. I really think the problem is that she has been over prescrobed and that Humana doesn't want to pay for that. I was just told that she will need to do a sleep test at a hospital since she is so immobile. Stuff just takes time when dealing with the unreasonable.

[ChicagoGranny]

Yep.

[palerider]

I don't think the ASV model will do what is needed for targeted volume issues that the Trilogy or AVAPS can address but then I don't understand all those features anyway.

Send Palerider a PM and just ask him because he has a much better understanding of what each setting in those other machine does or needs to do for people with very special needs than I have.

So, here's what I PMd deerhound.

No, it can't. VAPS means "Volume Assured Pressure Support" (if I remember right). Resmed's version is called iVAPS (for Intelligent ....) while Philips is called AVAPS (advanced, I think).

ASV works by monitoring your breathing and providing supplemental ventilation when your breathing effort decreases or ceases, it is programmed to maintain something like 80% of your tidal volume, but that means over time the ventilation on an ASV can drop further and further.

VAPS has a couple of different modes where you can program a lung volume, (one way on Resmeds is to put in the person's height) and it will make sure that they are taking at least the programmed amount of ventilation, so you set something on VAPS, ASV figures it out as it goes.

The big advantage of that is that ASV let's you breathe on your own when you don't need the intermittent assistance, hot hammering you with the big pressures until you need them, whereas VAPS isn't as automatic. Sorry.

.......

So, the S9 VPAP ST-A and the AirCurve 10 ST-A are the same machine, just shaped differently. they provide the iVAPS. Now, whether your SIL *needs* VAPS or not, is another question, that's usually reserved for people with lung diseases, like COPD, etc, where they can't breathe on their own.

If she has central sleep apnea, then an ASV or regular ST (Timed backup rate) would be appropriate, however, with the obesity, she probably has OHV, Obesity HypoVentilation which is a condition where the extra weight on the stomach and chest makes it hard to take a deep enough breath, so people hypoventilate, and the typical treatment for that is more pressure support than the ASV may be able to provide at it's max 'normal' setting (when it's not doing it's magic).

That's probably why they had her on the trilogy, but it's a very very expensive machine. If you can find out more about *why* they had her on a trilogy, then I can offer some better advice. It's possible that a plain VAuto might be plenty enough of a machine for her, and you can buy one of those new for not a lot more than they want to charge to rent a trilogy... and probably buy one or two used ones (I've bought a lot of used CPAPs) for less than the rental price.

[chunkyfrog]

Humana and United Heathcare are on my permanent crappy insurance list.
My union lobbied to get rid of UHC because of their dirty tricks.