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APAP Denied by insurance co
(10-13-2012, 08:42 PM)Moriarty Wrote: We don't have that problem in Australia - the Insurance companies pay $500 flat refund towards whatever machine is bought... and nothing toward mask, hose etc... and they even quibbled about that when I lodged my claim...
I've not lodged a claim for the machine but when did for the mask ... they said NO
and when asked about changing from extra cover to full cover... they said have to pay some penalty set by the government (loading which did not understood) on top for not taking it sooner. I,m going to cancel ... its cheaper to buy online and glasses much cheaper too

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I haven't had health insurance since I was in my 20s and am happy that I didn't have to get a machine according to my prescription, as it said to supply a fixed pressure cpap machine without humidifier. It is me who has to use it and be happy with it so I ignored most of my prescription except for the pressure setting and mask and chin strap, both of which were the same as the ones I used during my sleep study.
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You have to walk before you can run. When we are talking our doctors into things sometimes it just doesn't work. It's pretty standard that you fail CPAP before being prescribed AUTO (used to be- folks are getting more enlightened and going with the CPAP is a perfectly good way to start. Especially since you don't know if you will even stick with therapy.
In any event I wish you luck, and an AUTO if your heart is set on that, which I totally understand. I didn't rest- it took me four years- but I finally got an ASV which is the only machine that works for me.
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You need to emphasize that CPAP machines that are made for "Entry Level" patients do not have the ability to handle your changing needs over the next 5 years. Also point out to the insurance company that the price between a ResMed Escape (straight CPAP) and a ResMed AutoSet which can be used as a straight CPAP but available for Auto use if the time arises, is less than 100.00 difference in price! And even offer to pay the difference as you are not only concerned about your future needs but want a machine where your therapy can be monitored with the data available from the S9 ResMed AutoSet where the Straight CPAP cannot which in the long run may actually cost the insurance company more from new Sleep Studies etc. Also ask your Doctor, not the DME to write the prescription for "S9 ResMed AutoSet" and "DAW" dispense as written! I would also point out to the insurance company that some DME's are known to advocate for straight CPAP's as they know under the E0601 insurance code the Autopap is covered and can be used as a CPAP until your needs change and the DME gets to pocket the difference at your potential health risks if they convince the insurance company to only allow straight CPAP machine! Hope this helps. I wouldn't give up, as to speak to a supervisor at your insurance company and keep these notes in front of you when making the call! Hope it works out well for you, don't give up!
Finger Lakes Region, NY
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