[Equipment] Ontario Canada insurance strategy

[elwoodpdowd]

Cpapian,

I too have heard stories about travel CPAPs being noisy but this is not always the case.  Both my wife and I each picked up an Apex CPAP machine, mine is an Apex XT Auto W/humidifier and hers is an Apex Ich Auto.  The XT without the humidifier is about the size of cubed tissue box (sits in the palm of your hand), easy to pack in a suitcase/carryon or I can use the carrying case which is about the size of a lunch bag (with the humidifier, hose and mask inside).  The Ich is a bit larger but does not take a lot of table space and it fits into a lunch bag size carrier.  Both are extremely quite, portable and affordable. What I like about the XT v Ich is the power converter is internal (just a cord to plug in) where the Ich is like the ResMed where your adapter is external.

We got our machines while in Las Vegas this last February.  The store we went to is not on the supplier list (too bad about that) but are just off the strip.  All I will say these are affordable and didn't break the bank.

Our insurance won't cover these CPAPs because we already have our initial machines partially paid by the province of Manitoba and the rest by our insurance.  Our insurance won't entertain the thought of bypassing Manitoba's DMEs so the Apex machines were out of pocket.  Insurance companies love to have someone else pay before them but that's the way it goes.
 
The Apex brand is not as popular in Canada but some Canadian DMEs do carry them at a price.  They are available in the U.S. and the prices are not too bad if one is in the market for a travel CPAP.

The only thing is it is not Sleepyhead compatible so it might not be for everyone.

Sorry for the testimonial but wanted to emphasize I was able to find a suitable travel CPAP that is very quiet and compact.

[same2you]

I guess great minds think alike.  I came up with the same action plan, and came across this post when I was looking to see if anyone else has done it in the past.  I am currently in week one of a 2 month trial, and I'm already convinced of its effectiveness, so I'm now figuring out the final purchase.  I was a little confused that SunLife covers up to $2000 every 5 years, but will only allow one device in that time.  So I hit up the Sunlife chat service on their members site, and first verified the 1 device every 5 years thing... then I asked the question about purchasing my 1st device Out-Of-Pocket, leveraging the ADP (paying a couple of hundred of my own money), then submitting a claim for an AirMini through Insurance.  She had to check on some things, then came back saying that in that case I would be refunded the entire cost of the travel CPAP machine.

Now... I have not ACTUALLY done anything yet because my prescription is currently only for a trail, but I at least have my direction for when I have a script for my final device...  To find the lowest cost supplier for the AirSense 10 Auto...pay out of pocket and submit for ADP (or if the store does the ADP stuff on my behalf, even better).  Then I'll use the overpriced place that I am leveraging for the trial and have them complete the trial with an AirMini that I will pay for, then submit to Sunlife.  If I get any pushback from Sunlife, I at least have the chat conversation saved so that they can refer to it.

Cheers

[Phasenoise]

Thanks for all the feedback.

I flew to the US out of YOW last week, Air Canada (jazz). I succeeded in getting all three carryons on the plane, including the Airsense for her case. But I got pushback at the gate with the gate agent saying that the CPAP counts since it is not battery-powered. Their view is that the exemption is if you are actually using the machine in the cabin. They wanted me to skycheck a bag, but I was able to talk them out of it.

I am going to get a predetermination from the insurance company relative to the AirMini, will let you all know how it goes.

[same2you]

Alright... so the trick to get the most bang for your buck in Ontario is to purchase your first CPAP through ADP, and fork over the remaining co-pay out of pocket.  Then you can leverage your own medical insurance to pay for (in my case) 100% of the cost of the 2nd machine.  I was having issues with the machines communicating in my bedroom during my trial because of poor cell service, so I opted for the Dreamstation Expert APAP (New model...  includes a new P-Flex mode that I can't find any info on) and added the wifi adapter.  The cost of that unit was mainly covered by Ontario's ADP program.  

I have now also purchased and have had insurance reimburse 100% of a Dreamstation Go with the newly released humidifier that I will take while travelling... this will also function as a back-up machine if my primary one has issues. I went with the DSGo because I don't want to be locked into specific masks, I like the modular/integrated battery/humidifier, and I like that everything uploads to the same DreamMapper account (yes, I know.. Big Brother is watching/DreamMapper shows almost nothing, etc, etc).

To be certain ahead of purchasing the DSGo, I sent in an estimate to my insurance provider for pre-approval, and wrote on the estimate that ADP had already been leveraged for a unit in the past.. it was pre-approved within a week, so that cleared the runway for a purchase/claim.  The end result is that I now have 2 new machines (one for home and one for travel) and have paid approximately $200 out of pocket.  It would be nice if my insurance would also cover the DSGo battery, but apparently none of them do.

I'm not sure if this would be applicable in any other Province, but if you are starting PAP therapy in Ontario and have Private Medical Insurance... I would highly recommend that you look into it.  Hell, even if you only purchase the unit through ADP (paying the co-pay out of pocket), at least you can hold onto the ability to claim a 2nd machine through insurance at a later date.  If you leverage insurance to cover your ADP co-pay, then you can't claim another machine for 5 years.