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[CPAP] How often new Machine? Sleep Study
#1
Question 
So its been 11-12 years since I did my first sleep study and came out with a CPAP set at 14.

I am very compliant, could count nights without machine on one hand in all that time. Wore out My REMStar, got a new Remstar Pro M? 5 years ago.. it started making high pitched whines that would affect me and the wife getting to sleep.

I rarely go to the DR for anything. Machine is working so why would I? Where I did sleep study closed down 2 years after I was there, Dr I moved to for new machine is now retired. There is no record of my original sleepstudy ANYWHERE. Got a new DR who talked to me, looked at my data from the machine and wrote me a new prescription.

My new Intellipap Auto (Love this machine, even if it looks very medical) first night with setting of 10-18 has me at 13.5 or below most of the night and I had an AHI of 8, normally below 5 on old machine. [But its the first night.. ]

BTW how quiet is this machine!! When I started it up.. My wife said "Wow, that's weird I hope I can sleep in all that silence" Smile

Insurance was telling me to cover the machine I would need a new sleep study which would cost me as much as the machine . That was upfront. I am going to send in the bill which is very low because I don't need or want a DME, so use trusted online retailer. I am going to submit anyway with copy of prescription and week of report data from new machine.

For a 340lb 52 yr old man I am very healthy. take no medication (stress sedatives about 60 times a year tops after family events ) But no other meds.. Just my CPAP.

Sorry for the rambling..
How often so people update their machines and how often do you do sleep studies to confirm the diagnosis again ?

thanks for any feedback.
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#2
I think I was told my insurance would cover a new machine every 5 years. I'm less than 6 months in, so I have a while before I have to worry. If we switch insurance I may try to get the new one to buy me another just so I have a backup.
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#3
Depending on your insurance, most do require a sleep study, but being you have a copy of script from doctor, it's possible they may reimburse you. Dont-know
OpalRose
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#4
My insurance said that they would only spring for a new machine when the current one no longer functions. Will probably be looking for a slightly used one for a back-up. Only had it for 3 months, so not too worried yet! Dont-know
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#5
Hi wordjoy,
WELCOME! to the forum.!
I think most insurance companies like to replace machines every 5 years. It's good to hear that you got a quiet machine.
Hang in there for more answers to your questions and much success to you as you continue your CPAP therapy.
trish6hundred
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#6
I have BC/BS. They only pay for CPAP once every five years. If mine ever gives out I will gladly purchase one online. The outright cost online is not much higher than my cost after deductible from the DME.

Good luck!

Jeff
Sleep is worth the effort.
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#7
Like everyone says, 5-6yrs is the usual, although more are leaning toward only replacing if it is dead or dying at that point.

If it has been 11yrs, and if you have a different insurance than 11yrs ago, that's why they are requesting the sleep study. Which is really frustrating. They'd never dare ask that a diabetic be re-diagnosed. Or a person with high blood pressure come off all meds and have a stress test to make sure they still have it. Yet we must dance this dance. And it is THEM who have to pay for it! Which further makes it frustrating! WHY!? Once that machine is paid for, the mask and supplies are minimal compared to what a diabetic's supplies are! Arrgghh!

But I digress. You could request an in-home sleep test. It is cheaper for them and easier for you.

I am on Medicare/Medicaid. When my S7 finally started dying, I went to my GP and she wrote the script for the next machine. I had no trouble getting it. Of course, I got an S9 Escape and believed the crap I was fed about data capable machines were not readily available and that Medicare wouldn't pay for it anyway. After I found this board and armed myself with knowledge and empowerment (and got over the bruising I gave myself for being an idiot), I purchased my own "gently used" Autoset out of pocket (I heart Supplier #2). I've had the Autoset now for about 2yrs and hope to get another 2 out of it. Since I bought it used, I'll be happy if I get that. I don't plan on letting it die before I have another one in the works, though. I may just continue to get them out of pocket, not sure. Sometimes it is easier to just empty my wallet than convince the DME I know their tricks.
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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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#8
I assume this is an issue because you have a high deductible. IF their rules allow you to apply your machine to the deductible and they refuse, simply appeal. Explain in your appeal that you have been using a cpap daily for x number of years. Also explain that auto machines will indicate if you have a dramatic change in your prescription need and your personal physician is able to prescribe that. If they give you crap, then accept that you have to pay for the machine. THEN, when you meet your deductible for something else, get a sleep study. It will be covered then and you won't have any difficulty. Use the opportunity to get a backup machine.

Your situation is why I rag on people to make sure to have a copy of all their medical records. Most places throw them away after 7 years. You never know when something that occurred a decade ago needs to be referred to. While I agree with Paula, diabetics don't get rediagnosed because they have continuing care. I have heard, but can't confirm, that Medicare will likely require a sleep study every 10 years from here on out.
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#9
(07-25-2015, 06:10 PM)Mosquitobait Wrote: I assume this is an issue because you have a high deductible. IF their rules allow you to apply your machine to the deductible and they refuse, simply appeal. Explain in your appeal that you have been using a cpap daily for x number of years. Also explain that auto machines will indicate if you have a dramatic change in your prescription need and your personal physician is able to prescribe that. If they give you crap, then accept that you have to pay for the machine. THEN, when you meet your deductible for something else, get a sleep study. It will be covered then and you won't have any difficulty. Use the opportunity to get a backup machine.

Your situation is why I rag on people to make sure to have a copy of all their medical records. Most places throw them away after 7 years. You never know when something that occurred a decade ago needs to be referred to. While I agree with Paula, diabetics don't get rediagnosed because they have continuing care. I have heard, but can't confirm, that Medicare will likely require a sleep study every 10 years from here on out.

That's the general plan.. Detectable is not that high and should have been fulfilled. I will send them a couple weeks report when I file it.

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#10
I'm not sure about insurance requirement but as its been 11 years, new sleep study is overdue
The Intellipap Auto report AHI but not the type of apnea, whether obstructive or central, PRS1 Auto and S9/A10 AutoSet does
Also they report additional data
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