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[CPAP] Newly diagnosed, need advice about providers and Insurance
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DEScott Offline

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Posts: 2
Joined: Apr 2016

Machine: none
Mask Type: Not using mask
Mask Make & Model: none
Humidifier: none
CPAP Pressure: none
CPAP Software: Not using software

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Sex: Male
Location:

Post: #1
Newly diagnosed, need advice about providers and Insurance
Hello,

I've been diagnosed with Apnea, and received a 'prescription'.

1. I was referred by my physician to a provider who, when I arrived had already selected a machine/mask/settings that they informed me I could not change. I walked. Am I not able to select my provider or the type of equipment.

2. How do I determine what my insurance (Blue Cross) will cover, and the long term costs?

Thank you.
04-28-2016 11:07 AM
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OpalRose Offline

Monitors

Posts: 3,181
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #2
RE: Newly diagnosed, need advice about providers and Insurance
Welcome to Apnea Board DEScott,
Glad you found us.

First, call Blue Cross and find out directly from them what they cover and your deductable if any.
Don't depend on a DME to get this information, because they often don't get it right. Also ask for a list of providers that they contract with.

Next, get a copy of script if you haven't done so already. Hopefully your script states an Auto Cpap.

And yes, you have a right to select your provider. There is a compliance period to meet, usually 90 days, so it's best to find a provider you can work with.

You also have a right as to what machine/brand you want.

Here is a link to help you in machine selection, and which ones to avoid.
http://www.apneaboard.com/wiki/index.php...ne_Choices

Good luck and check back with us.

OpalRose
(This post was last modified: 04-28-2016 11:24 AM by OpalRose.)
04-28-2016 11:22 AM
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PoolQ Offline

Advisory Members

Posts: 986
Joined: Jul 2015

Machine: AirCurve 10 VAUTO
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Integrated
CPAP Pressure: 6.2, 15, PS4.0
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Sillicon Valley

Post: #3
RE: Newly diagnosed, need advice about providers and Insurance
Yep, everything above already said. The DME, any of them, can only provide you what you prescription says. If it does not specify a specific machine or type, then many will provide the machine that gives them the most profit, we call these "bricks" because they have no data capability for you to monitor your progress.

Figure out whet your script says, and what machine you want that matches the basics of your treatment and if the script does not specify that machine, talk to your doctors office and ask them to change the script.

You need to understand what BS requires for compliance, including follow up doctor visits. Chances are good that they will provide a machine on a rent to own basis so if you don't use it they can take it back and stop payments (make sure you understand compliance so this does not happen). Costs for you will depend on your specific policy with BS, you should only trust them to tell you what this is. Check with them about in and out of network costs and requirements.

There are many on line suppliers listed above, some will submit insurance forms, but this does not mean that they are in network.

You have already taken control of your treatment just by posting here, good on you

The "settings" are based on your script and the DME cannot change those, they must set the machine to your script. Now what you do later is another story.
04-28-2016 11:58 AM
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DEScott Offline

New Members

Posts: 2
Joined: Apr 2016

Machine: none
Mask Type: Not using mask
Mask Make & Model: none
Humidifier: none
CPAP Pressure: none
CPAP Software: Not using software

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Sex: Male
Location:

Post: #4
RE: Newly diagnosed, need advice about providers and Insurance
Gee, I'm glad to have found this site and the nice folks here! Cheers and hugs.
04-28-2016 01:12 PM
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becker44a Offline

Advisory Members

Posts: 181
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus Lg
Humidifier: ResMed H5i
CPAP Pressure: Rx 10 - 20cm, Usually 10-14cm
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: NE Ohio, USA

Post: #5
RE: Newly diagnosed, need advice about providers and Insurance
(04-28-2016 11:07 AM)DEScott Wrote:  . . .
1. I was referred by my physician to a provider who, when I arrived had already selected a machine/mask/settings that they informed me I could not change. I walked. Am I not able to select my provider or the type of equipment.
. . .

Hi DEScott,
Welcome to the forum!

Re .1: Good move. Many DMEs seem to want to dictate everything, and thrive on patient ignorance.

Some recommendations:
(1) Get a hard copy of your CPAP prescription. This may not be easy - my GP would not give it to me - forced me to get a faxed copy from the DME.

(2) Make SURE the machine you get provides FULL data. This is critical. Review the link that OpalRose posted carefully before you settle on a machine.

(3) I recommend an APAP. All APAP units can be programmed to deliver a fixed pressure. A single pressure unit (CPAP) cannot operate like an APAP. So an APAP is like having 2 machines in one. The choice is easy before you accept delivery of a machine - it will be harder to change afterwards. The DME won't want to do this, because they then have a machine that can't be sold as new.

You don't say where you are from, so this might be different where you live, but in my case, I asked that my GP write the prescription for a pressure range. So the DME had to supply an APAP unit, as no fixed-pressure machine can meet the script.

(4) Be aggressive, or at least assertive. No one else has as much interest in your treatment and your health as you. Walking out of the DME's office was a good start. Keep it up.

(5) Ask any questions you like, of your Sleep Doc, or here, or both. Information is your friend.

Good luck on your PAP journey.

A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
04-28-2016 03:02 PM
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trish6hundred Offline

Advisory Members

Posts: 6,450
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #6
RE: Newly diagnosed, need advice about providers and Insurance
Hi DEScott,
WELCOME! to the forum.!
Much success to you as you start your CPAP journey.

trish6hundred
04-28-2016 06:40 PM
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DariaVader Offline
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Posts: 1,827
Joined: Nov 2014

Machine: Resmed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10 for Her
Humidifier: H5i humidifier with ClimateLine heated hose
CPAP Pressure: 8-15
CPAP Software: SleepyHead

Other Comments: diabetes II, Thyroidectomized, Primary Immune Deficiency, and the list goes on :P

Sex: Female
Location: Oregon

Post: #7
RE: Newly diagnosed, need advice about providers and Insurance
I have heard of a DME telling people they have no choice on machine (which is bs...) but never on the mask too. sounds like a dme to avoid! Good on you for calling them on it. They get away with this because their clientele is sleepy and bemused by new diagnosis... preying on the ignorant! If enough people did as you have, they could not remain in business!

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
04-28-2016 06:54 PM
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green wings Offline

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Posts: 548
Joined: Feb 2016

Machine: Respironics System One RemStar Pro (460)
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10
Humidifier: integrated humidifier
CPAP Pressure: 13.0 cm
CPAP Software: SleepyHead

Other Comments: using CPAP since Jan. 2016

Sex: Undisclosed
Location: US

Post: #8
RE: Newly diagnosed, need advice about providers and Insurance
**Applause** for you, DEScott!

In addition to what's been suggested above, I'd recommend asking your insurance to refer you to a written copy of their policies for coverage and costs/co-pays for xPAP machines,masks, and other supplies.

They should be able to provide you with a copy of their policy in addition to going over the details with you on the phone and answering questions for you.

If you live in the US, your insurance company is very likely to use the same definition of compliance (how much you have to use the machine in order for your insurance to continue paying coverage) that Medicare uses.

If you have access to a copy of your Employee Benefits Health Coverage Manual either online or in paper form, you may find details of coverage for xPAP equipment and supplies in there.
04-28-2016 07:23 PM
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