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Help with insurance justification for portable CPAP
#1
Help with insurance justification for portable CPAP
As suggested in the title, I am seeking a portable CPAP machine.  I have done a bit of research, but in many ways I am woefully ignorant regarding many facets of the CPAP world, especially insurance benefits.  I hope to change that by paying more attention on this forum.

I have been on CPAP therapy for so-called "mild" OSA for just over two years.  After hearing stories of DME providers offering up the least capable, highest profit machines to newbies, I think I lucked out and got something decent from day one.  Not only does it accomplish the needed task, but so far data needs have been met.  I have a Phillips Respironics DreamStation (not sure what nomenclature on the underside represents a model designation, but one possibility is this: DSXHCP).  It has a humidifier, which is very desirable here in the Desert Southwest.  

So far, I take the data card to my sleep doc for routine visits, and get a 30 day report.  I did get one six month report. In the future, I require a full one year compliance report in order to maintain medical certification for my job.  My doc (who I saw Friday) is going to analyze the recent download to see if a year is within reach.  If I have to do three or six month visits to gather data, that's fine.  But every month would not be manageable.  I expect at this point somebody reading this is thinking "learn to manage your own data and you'll be able to piece together a year, no problem."  Ok, point taken, and I will.  But the compliance data needed for my job will require a tight chain of custody, so I think anything provided outside of my doctor's hands would be called into question.  In other words, my compliance report must flow through official channels.  

In a few weeks, I will be traveling for my job with about 40% of my nights away from home.   I travel 100% carry-on; never a checked bag. The DreamStation is simply too big and heavy to hit the road with me.  Nor is it practical for me to sleep at home with my wife, and wake up for my normal crack-of-dawn departure, and then pack the DreamStation for travel.  Unplugging cords and hoses, emptying the tank, etc. would wake up the house, versus my normal stealthy departure.  I need something small and light, already packed and ready to go when I roll out of bed at home. These considerations are not a "want" or "luxury," but simply a mandate of my job.  

I am seeking guidance for presenting my case to insurance in a quest to get the portable unit covered by benefits.  Is this a futile attempt?  Stories from others in the same situation would be helpful.

Also, my doc suggests staying within the same brand family for a portable unit, to achieve data compatibility with the existing DreamStation.  This logic leads to the DreamStation Go.  I've read up on it, and it seems like a good unit.  Looks like I'll sacrifice a humidifier, which seems to be the case with most portables.  My travels will be at least half international, so access to data connection will by a mixed bag. Some sleep will be on 10 to 12 hour flights. I won't be able to rely on consistent data capture outside of the onboard memory card.  I guess I envision visiting my sleep doc with two cards in hand - one from the home machine and one from the traveler - with the hope that a merged report could be produced by their office.

I'm facing a bit of a learning curve here.  Any thoughts and suggestions will be much appreciated.

Thank you!
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#2
RE: Help with insurance justification for portable CPAP
From the reviews I have read, I would say that the Dreamstation Go is the only acceptable travel unit. It is small, and still has full data collection and is compatible with SleepyHead (for those of us who use it).
I have doubts about convincing an insurance company. You may have better luck convincing your company to pay for it - undoubtedly a taxable benefit, but better than paying full price yourself. The company benefit, of course, is that you arrive well rested and better able to take care of the company's business... you will know that situation better, of course.
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies. Monitors are also Advisory Members, just with Extra Work assigned.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#3
RE: Help with insurance justification for portable CPAP
OP,

Do you use your humidifier? The travel machines usually don’t have satisfactory humidifier options.

I travel with my Airsense Autoset, which is a full size unit. The travel bag is the size of a laptop bag. I don’t know how much room a travel machine saves as you still need to carry mask and tubing.
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#4
RE: Help with insurance justification for portable CPAP
(11-12-2018, 01:37 PM)zippinbye Wrote: I travel 100% carry-on; never a checked bag. The DreamStation is simply too big and heavy to hit the road with me.  Nor is it practical for me to sleep at home with my wife, and wake up for my normal crack-of-dawn departure, and then pack the DreamStation for travel.  Unplugging cords and hoses, emptying the tank, etc. would wake up the house, versus my normal stealthy departure.  I need something small and light, already packed and ready to go when I roll out of bed at home. These considerations are not a "want" or "luxury," but simply a mandate of my job.

Unfortunately, the "job mandates" you describe, such as not checking baggage and not wanting to pack up your home unit, do not seem to be matters of medical necessity. So I think you may just need to buy the unit you need on your own. But if you can get the insurance to swing for it it would be awesome. Alternately, if you could bill it as a travel expense to your company, since they are the reason you'd need it.

I'm not sure if I've ever read of someone getting insurance to pay for a travel-type unit. As a matter of policy they do not, but I'd think that if someone had limited mobility to carry one or some other medical reason for needing the travel unit there would be more hope for an exception.

Also, many people carry-on their CPAP in a dedicated bag in addition to their normal carry on. In the US the CPAP bag does not count against your carry-on limit, but overseas that can vary.
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#5
RE: Help with insurance justification for portable CPAP
Insurance provides a replacement CPAP no sooner than every five years, and may do something sooner only if your machine is not functional and cannot be repaired. You got your dreamstation two years ago, and it is working well for you. In short, there is no justification that will cover a new machine because you travel, however this may be something your employer may cover as a travel expense...not likely. A new travel setup like the Air Mini Autoset costs $800. if it is that important, you are probably going to be out of pocket unless you employer chips in. How do you feel about requesting this accomodation to enable your frequent travel?

Remember your CPAP does not count against your carry-on allowance when flying, so this is really about a convenience.
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#6
RE: Help with insurance justification for portable CPAP
Good luck, because I think you'll need it. Insurance is likely to say "Howls of derisive laughter, Bruce!"

I would buy the thing out-of-pocket and, if necessary, filch some of the cash from my entertainment budget. For most people (not necessarily for me), that could include any, some, or all of: movies (in theaters) and buying video discs, book-buying & magazine subscriptions (use the public libraries instead), live music & other nightclubs, sports events, eating in restaurants, drinkin' in bars ... you get the idea. How much cash per month can the average American recover from all of those frivolous inessentials, just for a few months until the CPAP equipment is paid for?

But if it's for business trips, maybe you could get creative with the expense account? Naw, just kidding.

Edited to add: OK, books are not inessential (and if you want, leave that one off the list), but buying a lot of them can be, if there's a good public-library system available.
"I wanted to be a Boy Scout, but I had all the wrong qualities.  They were looking for kids who were trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean, and reverent.  Whereas I tended to be devious, fickle, obstructive, hostile, rude, mean, defiant, glum, extravagant, cowardly, dirty, and sacrilegious."  (George Carlin)
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#7
RE: Help with insurance justification for portable CPAP
everything considered, i would just travel with your present machine. don't overthink this. it's not that big of a deal to pack your machine in the morning and save the cost of buying a machine and aggravation of using 2 sd cards. when i pack mine up everything including mask and hose goes in the original resmed case. if yours doesn't you may want to look into a bigger bag.
First Diagnosed July 1990

MSgt (E-7) USAF
Retired 1968-1990
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#8
RE: Help with insurance justification for portable CPAP
I travel all the time between San Francisco and Europe with my Phillips Dreamstation Go which fits easily at the bottom of my carry-on computer bag. I breeze through TSA and Customs with the Go. The 12" hose is much smaller than the larger 15" hoses. Additionally, no brick. The Go works so well that I use it at home as well as in the air. Works perfectly in EU countries. I say Go for it.

Unfortunately, I can't help you with your Insurance company or your employer. My own sleep specialist did write a prescription that specified the provision of only the Go.
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#9
RE: Help with insurance justification for portable CPAP
Thanks for the thoughtful replies everybody.  I know, hilarity and laughter from the insurance company at the prospect of another machine just two years after my existing unit.  I'm still certain that I require a travel unit for the reasons mentioned, so self-funding, here I come!  Since this is totally out of pocket now, I will indeed be grateful for suggestions for locating the best non-insurance deal possible on a DreamStation Go.
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#10
RE: Help with insurance justification for portable CPAP
I hope you will post your experience once you get the portable unit and can compare it to your home setup. I am new to CPAP and my machine is a DreamStation like yours, but I have very serious concerns about traveling with something so large and heavy.

A lot of comments seem to trivialize this problem, but it is real to me. It sounds like you have similar goals to mine, if for your own reasons.

I would never suggest anyone else change how s/he chooses to travel, but I take ideas from ultralight backpacking and work very hard to reduce the bulk and weight of every item I carry. Some of this is due to another health condition. Instead of giving up travel, which I love, I gave up bringing most of my stuff to keep my belongings manageable for someone with a chronic condition.

My packed carry on--the only item I bring on a short trip--weighs about 9 lbs. That includes ~2 lbs for the bag itself. My DreamStation setup would add about 4.5 additional pounds (if the specs on a retailer website are accurate.) That's 50% of my TOTAL carrying weight.

I don't use a rolling suitcase because, at an average of ~6 lbs FOR THE BAG ITSELF, I fear being unable to hoist my own stuff into an overhead bin. Flight attendants are not supposed to do that for you and are not obliged to do so, though kind ones might. Kind passengers may also assist, but I can't feel safe traveling on my own (again, A JOY in my life!) without being able to manage my own possessions under normal circumstances.

I thought a visual aid might also help clarify for more average packers what a one bag traveler might carry instead. I'm attaching a photo of my fully packed nylon travel pack (18" x 12" x 7"/ 1512 cu in) next to  my new DreamStation CPAP in its case (15.25" x 9" x 6" / 823 cu in) or 54% of my current volume.


It's not that the airline won't let me have more stuff. I just can't physically handle any more stuff ON MY OWN if I'm at less than peak capacity. (And I can't predict when my illness will flare.) If I bring two bags, I will need to request an escort from check in to gate to plane, I'll have to stop taking public transit upon arrival, and--my real concern-- I won't be self sufficient.

Sorry I'm hijacking your thread. As I said, I'm new to CPAP and this board, and this is a major concern for me. It's been worrying me more than anything else since I got my diagnosis. I hate feeling disabled, and the machine (the object, not the act of using it) feels like a tremendous burden.


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