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Heated Tubing and Insurance
#1
I underwent a sleep study about a month ago and was diagnosed with mild obsructive sleep apnea. I received my Philips Respironics System One REMstar Auto A-Flex with Heated Humidifier about two weeks ago and have been using it ever since with minimal problems except for some condensation inside the tubing. I was able to get rid of the condensation by wrapping the tube in a 66x90 inch microfleece blanket and securing it with velcro zip ties. It's kind of a pain to do that often and I don't know if that will stop condensation during the winter time. So, I'm looking into getting a heated tube for my CPAP.

My insurance completely covered my CPAP. I called the DME provider (Apria) and they said they needed a prescription. I called Kaiser's sleep clinic and they said Kaiser doesn't pay for that but they referred me to a local shop and said that I could order from the DME provider (Apria) but the local shop would be less expensive. I called the local shop and they said I could order the heated tube upgrade and that I would not need a prescription.

I was wondering if I could somehow get insurance to pay for the heated tube or if I should just take the sleep clinic's word for it and pay out of pocket?


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#2
If you have only had you machine and humidifier a month, you should be able to switch out the heated humidifier for a humidifier with heated hose. You will need to ask your doctor to give you another script stating a heated humidifier with heated hose. Don't know if your insurance would pay for it. You will have to call them.

The other option would be to order the heated hose upgrade, which is what I did.
Check the suppliers list above, it may be cheaper for you to buy that outright. I got a decent deal on mine, under $75.00. You get the humidifier replacement lid, heated hose, and an 80 watt power brick. It's easy to switch the lid, attach new hose and power brick.
OpalRose
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#3
I have been having issues with humidity since receiving my ResMed Airsense 10 a couple of weeks ago. I called a tech at the sleep study center and he said I could get a heated hose from them when the "office" opened on Monday. I went in today and they added the proper hose to my original CPAP system. All I had to do was sign the invoice. I haven't received a bill from the sleep center yet but I am willing to pay whatever it costs. I am down from 82 events per hour during the sleep study to an average of 7. I can sleep again.

I am hoping the heated hose will help with the dry mouth. I can't run the humidity setting above two without getting rained out.

I will post an update in a couple of days.

Jeff

PS. I was prepared to purchase the heated hose outright from either the local supplier or supplier # 10. The price was very reasonable.
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#4
Hi rx77310,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you with your CPAP therapy.
trish6hundred
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#5
My prescription was written for a heated hose, thankfully, because I don't think I could be compliant without it. Might need to get your Dr. to write a new prescription?

Dave
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#6
Fortunately, the DME was on her toes and made sure to order the heated hose when she ordered my Airsense. It came with the machine! Yay!! I only need the heated hose when we have the a/c on (like now) and maybe 3 weeks of winter. But I do need it then!
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#7
(06-22-2015, 06:42 PM)OpalRose Wrote: If you have only had you machine and humidifier a month, you should be able to switch out the heated humidifier for a humidifier with heated hose. You will need to ask your doctor to give you another script stating a heated humidifier with heated hose. Don't know if your insurance would pay for it. You will have to call them.

So, it sounds like I should ignore what the sleep clinic said about Kaiser not paying for a heated tube and just schedule an appointment with my doctor(primary care provider) and get a prescription directly from my doctor?

I received a letter with my CPAP saying I should contact the sleep clinic for any problems with the CPAP therapy, but I understand doctors don't necessarily need to work with the sleep clinic to write a prescription.

A local shop said I could order the heated tubing upgrade directly from them without a prescription, but I would like to investigate the possibility of going through Kaiser/ insurance/ DME provider (Apria) or other entity that eats cost for me to save money.
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#8
(06-22-2015, 06:19 PM)rx77310 Wrote: I underwent a sleep study about a month ago and was diagnosed with mild obsructive sleep apnea. I received my Philips Respironics System One REMstar Auto A-Flex with Heated Humidifier about two weeks ago and have been using it ever since with minimal problems except for some condensation inside the tubing. I was able to get rid of the condensation by wrapping the tube in a 66x90 inch microfleece blanket and securing it with velcro zip ties. It's kind of a pain to do that often and I don't know if that will stop condensation during the winter time. So, I'm looking into getting a heated tube for my CPAP.

My insurance completely covered my CPAP. I called the DME provider (Apria) and they said they needed a prescription. I called Kaiser's sleep clinic and they said Kaiser doesn't pay for that but they referred me to a local shop and said that I could order from the DME provider (Apria) but the local shop would be less expensive. I called the local shop and they said I could order the heated tube upgrade and that I would not need a prescription.

I was wondering if I could somehow get insurance to pay for the heated tube or if I should just take the sleep clinic's word for it and pay out of pocket?



If this were me, I would be calling my insurance company and get verification. I haven't heard of an insurance company that doesn't pay for the heated hose.
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#9
Update: I used the heated hose on the Airsense 10 last night set to auto. Big improvement. No condensation and dry mouth issue greatly reduced.

Jeff
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#10
Most insurance I have come across don't cover the heated hose unless there is a specific scrip for it (and even then it may be a fight).
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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