I am new here and to Apnea in general. Just finished my second sleep study (titration) and I will be visiting the doctor this week to get the results and the script (hopefully).
I apparently have both OSA and CSA and during the titration study the technical was unable to tune out all the Centrals, and tried to find a balance (She asked me not to tell the doctor she said so because it is not her place to interpret the study, but she said I was throwing a LOT of CSAs). The doctors comment after the first study was that I had severe OSD. I trust him.
Now, I am trying to prepare for the next meeting where I am assuming the CPAP machine will be in my future and I have a few questions before I meet with him.
I am 66 and have Humana Medicare Gold PPO, which apparently pays 80/20 with 0 deductible (if I am reading the plan correctly) for the DME if the equipment is purchase from an in network DME supplier which it will be - the closest to me is Apria. In my titration study we settled on the AirFit F10 and BiLevel CPAP at high pressure (as high as she could get it without the F10 leaking too much) or a CPAP at lower levels, she wasn't sure which way the doctor was going to lean, it was a balancing act between OSAs and CSAs.
I also understand (I think) that there will be a 30 day compliance test, where I use a device for 30 days and then the doctor determines if I used it and if it was helping. If both are true, I will then get a pre-authorization to buy or rent a machine. That is what I think is suppose to happen, am I right?
So, my questions are (these questions are "in general" I understand "it all depends" and things can be different for special cases.)
1. Is the machine that I use for the compliance test the one I will eventually rent/buy - the actual machine, not the same model. Or will this machine normally be a "loaner" machine with the same abilities/functions?
2. If it is a loaner machine would it normally be the same model as the one I would end up buying or renting or is it just some similar device?
(the first two questions don't really matter, I am just curious since I have read so much about how different people react differently to different machines)
3. Does Medicare prefer that I buy or rent? (whatever prefer means, easier, pays more/less, etc) In other words, is it easier to get approval for renting vs buying.
4. Since I have both CSA's and OSA's, and I don't have any symptoms of heart failure or left ventricle flow reduction, my research would indicate that the ResMed AirCurve 10 ASV machine would be the "best" for my case? It is also one of the most expensive by twice the next model down. Does medicare/Humana care? Or if the doctor writes the script for the ASV will they simply rubber stamp it?
5. If the ASV machine is likely to not be approved initially, what is the best second choice to ask for - AirCurve 10 S or VAuto would seem to be the BPAPs from MedRes that would be used in my case (BiLevel worked best in the titration).
6. Assuming I get a machine and it doesn't work out for whatever reason, how hard is it to get Medicare/Humana to replace it with an alternative or am I stuck with that one until some time elapses (years?) and they approve a replacement? (This obviously would impact I hard I push for my choice vs a doctor recommendation that might be different)
7. Do doctors in general script for function and leave the specific vendor and model up to you?
8. The ResMed seems to be more expensive than many alternatives but are highly reviewed in general, I prefer quality over cost, but my concern is that medicare may prefer cost over quality, do you have any advice on getting the high priced spread approved?
9. Are there any advantages to renting the CPAP machine for 13 months and then owning it according to medicare, as compared to simply buying the machine up front by paying my 20% - cost, warranty, etc. Is one option easier to get approved than the other?
10. I am fairly certain I will want a humidifier and the climate control hose regardless of if the doctor wants to add those to the script (I don't even know if they do that) so, I assume I will have to buy those separately and get reimbursed by Humana for the part they may cover, is that true? Or do I pay less out of pocket if the doctor puts those items on the script?
11. Any other options you would recommend for the ResMed AirCurve machines?
Thanks in advance for any information or advice in how to move forward from here. I am excited to possibly solve my constantly being tired and want to do everything I can to expedite this process.