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Any British Columbia, Canada Cpap'ers?
#1
Hi,

This is my second post - and I 'd like to start by thanking everyone for their responses to my first post. My pressure was increased to 10, and I tried some nasal pillows at the DME and found one that fit (I have a small head), but it was not comfortable, so I'm back to my F&P Eson.

I live in Vancouver, BC where CPAP equipment is not covered under BC Medical. My extended coverage is through Blue Cross, and although most of this coverage is excellent, for CPAP i have $2300 lifetime for a machine (once every 5 years), and $325 for supplies (I'm not sure on the frequency of this - need to call them tomorrow).

I did my sleep study at home through the DME as getting into a sleep lab here has at least a 6 month wait. So the DME paid to have the study read by a doctor in Alberta, and if I understand it correctly, they make their $ selling the equipment.

So here's my problem - I'm know they want me to buy the equipment from them (and they sent in the pre approvals to Blue Cross). However, now that I realize how crappy my coverage is for the machine ($2300 lifetime), I think my very first machine will eat up the $2300 if i buy through them. I've seen similar equipment for half the price so I could potentially get 2 machines in 10 years instead of 1 in 5 covered. Seems like a no brainer to me financially, but the therapists have been very helpful, and if I don't buy my machine from them, I will be managing my therapy by myself I guess? Sorry, I'm so new to this, I'm not sure what my options are - I'm sure my GP can't help me through this - could I get referred to a specialist?

Sorry for the rambling, but I'm hoping others have been through this and have suggestions.

Karen
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#2
I'd say you have it figured out about right as to how the DME is making their money. I'm not necessarily opposed to that sort of thing if they are being honest in their evaluations. But the tendency might be to make sure everyone has sleep apnea, and that's not a good thing. I would be more comfortable if they would provide the results to your GP for his evaluation even if he isn't a sleep doc pro. He could then write you a prescription that could be filled at a very economical price at one of our on-line suppliers. Your cost getting in would probably be less than $1000, and your insurance could be billed. Once the supplier has your prescription, they can provide whatever masks or other supplies you would need.

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#3
Thanks Retired Guy

I do have a copy of the report from the doctor who read my study, and I understand that was sent to my GP and then they asked my GP to provide a prescription to Blue Cross....so, I am sure I have sleep apnea (severe AHI 53). I know my GP would give me the prescription if asked.

From reading the forum it seems a lot of people are managing their therapy themselves, using this forum, sleepyhead, etc., so I guess I could too. Now I just need to figure out if I'm using the best machine - seems like most people here are using the Resmed S9 - Perhaps I should go that route instead of the System One.....ARGHGHHH!
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#4
I'm not an expert on the Remstar product line but they do have quality models. If you can get a new script from you doc, I would ask for one that specifies the new "Resmed A10 Autoset for Her." It's the top of the line and the "for her" version has options that are not even available on the regular models.
Also ask to have the prescription state "masks and supplies as per patients requests," or some such thing so you can decide what kind of mask you wish to use.

Then I'd research the on-line suppliers listed in this forum to see who would like to make you a good deal, ship to Canada, and bill your insurance or at least help you in getting that done.

As far as managing your own therapy, many of us do, but it's really nice to have a doc to fall back on. It sounds like your GP could fill that role.

But with your prescription you definitely can set up the machine at the appropriate pressures and begin monitoring your therapy.

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#5
We have some Canadians on the forum. They'll know better how to answer.
From reading some of their prior posts, it seems the Canadian NHS varies by province.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
(09-10-2014, 10:40 PM)zoecat5 Wrote: Hi,

This is my second post - and I 'd like to start by thanking everyone for their responses to my first post. My pressure was increased to 10, and I tried some nasal pillows at the DME and found one that fit (I have a small head), but it was not comfortable, so I'm back to my F&P Eson.

I live in Vancouver, BC where CPAP equipment is not covered under BC Medical. My extended coverage is through Blue Cross, and although most of this coverage is excellent, for CPAP i have $2300 lifetime for a machine (once every 5 years), and $325 for supplies (I'm not sure on the frequency of this - need to call them tomorrow).

I did my sleep study at home through the DME as getting into a sleep lab here has at least a 6 month wait. So the DME paid to have the study read by a doctor in Alberta, and if I understand it correctly, they make their $ selling the equipment.

So here's my problem - I'm know they want me to buy the equipment from them (and they sent in the pre approvals to Blue Cross). However, now that I realize how crappy my coverage is for the machine ($2300 lifetime), I think my very first machine will eat up the $2300 if i buy through them. I've seen similar equipment for half the price so I could potentially get 2 machines in 10 years instead of 1 in 5 covered. Seems like a no brainer to me financially, but the therapists have been very helpful, and if I don't buy my machine from them, I will be managing my therapy by myself I guess? Sorry, I'm so new to this, I'm not sure what my options are - I'm sure my GP can't help me through this - could I get referred to a specialist?

Sorry for the rambling, but I'm hoping others have been through this and have suggestions.

Karen

Hi Karen,

I'm in Alberta and it is the same thing: Nothing provincially, just through insurance. Your coverage sounds about typical too...I get up to $2000 for a machine every 5 yrs (lifetime of the machine), but other than heated hoses (which my insurance doesn't cover) they've been pretty reasonable about replacement intervals for supplies (do check, though).

As you have noted, there are ways to get more value for your money (provided the insurance company will accept it...if you're going to an internet based supplier, just make sure your insurance will be okay with it). Depending on the DME, "going solo" might be for the best too....my original one started off great, but the revolving door of staff and some other issues sent me elsewhere.

My current DME understands that I'm actively involved in my treatment and, for the most part, they seem cool with it. If they see something out of whack, they generally let me know, but considering I've managed to drop my AHI an order of magnitude (as in 10x) lower than where DME1 said it was "great", and I'm consistent in those numbers, DME2 is perfectly fine letting me "at the helm" so to speak.

My advice: if you're going to be proactive or to "go it alone", start with what worked for you in terms of a mask and the initial recommended pressure(s). If you're feeling air starved, you may need to bump the initial pressure or alter the ramp settings a bit.

Once you've "gotten up and running" and have a good baseline (ideally 2-3 weeks where you have become comfortable with the mask and machine), then use the tools that are available like Sleepyhead or ResScan to see how your therapy is performing. If you feel that changes are needed, make them, but give yourself at least a week to see what the changes do for you. If better keep it, if worse go back and try something else Smile

It is an iterative process, most certainly, but I personally feel that where you end up is far better than where most DME's will say "good enough" and settle. Besides, there are lots of folks here to help you along the way. Big Grin
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#7
Hi Karen, I am in Vancouver, BC...

I have had a fairly average experience at the DME I went too. The technician I saw really just wanted to work with OSA, anything else
they ignored...I have what I think is Complex Apnea, a lovely mix of OAs and CAs...anyway..

I would not worry about not buying your equipment from your DME. As far as I can tell you will pay top dollar for the equipment and maybe you will get follow up visits. You have had some good advice from the previous, experienced folks above....

I was going to be charged $2600 for a system one with mask...I understand that is how they make their money, however there is no
sure way to tell how well they will monitor you. My DME prohibited me from doing any pressure adjustments, and would have stuck with that had I purchased the machine. Given the level of skill displayed by the tech, I chose to not buy in the end and will wait to see a sleep doc.

It is a hard decision to make for new apnea patients, we should not have to make these decisions, but we do, to get the best care we can. As you can see on this board, most have taken charge of their own therapy, with the help of an actual sleep doc. And there lies one of the challenges, we have few of those in BC, and only one actual sleep clinic at the University Of BC...As my GP said to me recently, we do have a problem here...

Anyway, take your time and read all you can, and ask lots of questions....

Story
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#8
Thanks so much Story....I appreciate your insight! It's so amazing to me that this is covered under medical in some provinces but not BC.

There is also a sleep lab in Fraser Health (my employer) but it's in Abbotsford, and the wait is 6 months i understand. I was going to be charged a similar amount so that's my challenge as well, considering my lifetime limit. If I can avoid paying out of pocket, that's the way I want to go.

Do you have your appointment soon? I'm guessing you've been waiting since July?

Mike - thanks to you as well. I just talked to Blue Cross, and unfortunately my $2300 is lifetime (as in mine), not the machine, unless the person I talked to was incorrect. I do get a reasonable amount for supplies (they were willing to pre approve the $325 the DME had submitted which would have just been a mask I think. Maybe I need to clarify further with Blue cross if it's my lifetime or the lifetime of the machine, as it talks about every 5 years. The wording is weird.

I guess worst case if I can't manage my therapy myself I can always continue until I can get a sleep study, then I've already go the equipment and just need a sleep doc for ongoing management of my care.

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#9
(09-11-2014, 08:16 PM)zoecat5 Wrote: I guess worst case if I can't manage my therapy myself I can always continue until I can get a sleep study, then I've already go the equipment and just need a sleep doc for ongoing management of my care.

If you have a good relationship with your GP, they can be awesome to work with too. No, they will not have as much experience as a sleep doc, but if you have a good one, they are willing to inquire of colleagues, learn along with you and help you where a DME might only be after the profit margin.

I don't have a specific sleep doc....they are pretty few and far between here too....but my current DME has a contact should I need it and my GP is following my treatment on a regular basis. My GP is an absolute jewel and, next to the forum, has probably been one of my best resources for managing my therapy.
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#10
i am from bc also and i bought two mc resmed 9 for under 1000 each delivered and this site asisted with programs to set up or change settings so far very good help i dont have any med assistance so its all out of oap
the information i have recieved is very accurate and very helpful
Thanks
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