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Ontario question...Understand ADP Rules?
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CHanlon Offline

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Posts: 292
Joined: Mar 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: ResMed Activa LT
Humidifier: ResMed Hi5
CPAP Pressure: 12 -20
CPAP Software: ResScan SleepyHead

Other Comments: Mirage Activa LT nasal mask

Sex: Male
Location: Ontario, Canada

Post: #11
RE: Ontario question...Understand ADP Rules?
(12-17-2015 06:03 PM)cate1898 Wrote:  
(12-17-2015 04:15 PM)GPSMapNut Wrote:  http://www.health.gov.on.ca/en/pro/progr...manual.pdf
CPAP is a fixed price device so;
page 27 (PARA 305) makes it very clear.
 Fixed price: the ADP pays 75% of an ADP Approved Price. Where
the Ministry pays 75% of the cost of the Device, the Client’s portion
must be at least 25% of the cost of the Device. The Vendor cannot
charge the Client more than the ADP Approved Price;

I skim read thru the entire 98 pages and couldn't find anything telling me that CPAP devices fall under the 'Fixed Price" category. Where did you find that? EDIT: Found it on this document at 600.01: http://health.gov.on.ca/en/pro/programs/...manual.pdf


Also, I'm going to go to the DME that verbally told me on the phone that they'd sell the A10 Elite + basic mask + hose, etc with all my paperwork in hand. I'll also bring my loaner with me in case I am successful in purchasing thru the new DME and go home with the new equipment. Then I'll return my loaner tomorrow to the original DME. Do you think they can then charge me for the loaner machine, mask etc??

Also, look at that document 515.01 " ...vendors may differ in device options, service plans, and in some instances, price" ?? Looks like a legal loophole to me.

Cate, I'm from Ontario too, check your PM's - I'll send you some information.
12-17-2015 06:29 PM
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cate1898 Offline

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Machine: PR System One 560BT Auto
Mask Type: Nasal pillows
Mask Make & Model: P10's/backup-DreamWear
Humidifier: PR attached
CPAP Pressure: 8.5 - 13. A-Flex 3
CPAP Software: SleepyHead

Other Comments: Began CPAP Therapy Sept. 11, 2015. Hx Hypertension, Post Graves Disease, chronic migraines.

Sex: Female
Location: Southern Ontario//SW Florida

Post: #12
RE: Ontario question...Understand ADP Rules?
No. I'm not trying to get the A10 Auto For Her. Their device code number is the same. Just because they put it in the wrong column doesn't mean it will go thru as an $860 ADP eligible device.

I just want to get my A10 Elite without being gouged for an extra $275.


EDIT: @CHanlon Thanks, will do.

APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
(This post was last modified: 12-17-2015 06:31 PM by cate1898.)
12-17-2015 06:29 PM
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GPSMapNut Offline

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Machine: DreamStation Auto
Mask Type: Nasal pillows
Mask Make & Model: Resmed AirFit P10 and PR DreamWear
Humidifier: DreamStation + heated hose
CPAP Pressure: 9-16
CPAP Software: SleepyHead EncorePro Other Software

Other Comments: Used Respironics REMstar Pro with C-Flex for 11 years and ResMed S9 Elite loaner for 3 months

Sex: Male
Location: Mississauga, ON, Canada

Post: #13
RE: Ontario question...Understand ADP Rules?
(12-17-2015 06:03 PM)cate1898 Wrote:  EDIT: Found it on this document at 600.01: http://health.gov.on.ca/en/pro/programs/...manual.pdf

Thanks, you saved me some searching Wink

(12-17-2015 06:03 PM)cate1898 Wrote:  Also, look at that document 515.01 " ...vendors may differ in device options, service plans, and in some instances, price" ?? Looks like a legal loophole to me.

You have to read whole paragraph from
http://www.health.gov.on.ca/en/pro/progr...manual.pdf

515.01 Authorizers are expected to advise Clients to consider and compare more than
one Vendor and to explain to Clients that Vendors may differ in Device
options, service plans and in some instances, price.

In essence, it doesn't say that anybody can sell you a CPAP system at any different but a set price but, and "authoriser" shall tall you that different vendors may offer different warranties, may not be selling all the options or brands of machines or masks that You may like or charge different prices for upgraded masks, supplies, warranties etc . The price of the base XPAP machine + mask + heated humidifier and few other things are set somewhere else and there is no loophole or budging on that. Anything outside of what ADP pays for, is a free game and "buyer beware" and uncontrolled.

IN one other post you asked about whether you have to pay the other DME for the loaner. AFAIK, it all depends on the contract you entered with them when you rented the machine. Carefully read the paper you got with it. If it doesn't stipulate a rental charge and you didn't sign anything else, you can simply drop the machine at their doorstep and tell them to fly a kite unless they are prepared to deal with you on YOUR terms!
12-17-2015 09:25 PM
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GPSMapNut Offline

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Posts: 175
Joined: Nov 2015

Machine: DreamStation Auto
Mask Type: Nasal pillows
Mask Make & Model: Resmed AirFit P10 and PR DreamWear
Humidifier: DreamStation + heated hose
CPAP Pressure: 9-16
CPAP Software: SleepyHead EncorePro Other Software

Other Comments: Used Respironics REMstar Pro with C-Flex for 11 years and ResMed S9 Elite loaner for 3 months

Sex: Male
Location: Mississauga, ON, Canada

Post: #14
RE: Ontario question...Understand ADP Rules?
(12-17-2015 04:24 PM)pholynyk Wrote:  @cate1898 - Did you notice that the AirSense 10 Autoset for Her is listed along with all the CPAP machines? It's the first item in the ResMed CPAP list. I'm sure it's an error, but you might try to talk them into it... Smile
>>>>

Fat chance ! For one thing, it's an APAP so, even if it's priced (by mistake) in a different category, a person with a CPAP prescription is not eligible to get it.
Secondly, DMEs know better than that and even if you insist, thy are not obligated to carry (for you) that particular model.

The funny thing is; a (data capable) CPAP and APAP machines are exactly the same hardware. The difference is in the firmware / software only. Even funnier; (I'm not sure about ResMed) in case of PR it's the CPAP that requires extra program lines which can block APAP functionality. Yup, the functionality is there! It can be enabled for up to 30 days but, the extra lines in code will block it after that...
12-17-2015 09:35 PM
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player Offline

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Posts: 412
Joined: Feb 2015

Machine: Resmed A10 Autoset For Her
Mask Type: Nasal pillows
Mask Make & Model: Resmed A10
Humidifier: Resmed A10 Autosset
CPAP Pressure: 11-16
CPAP Software: SleepyHead

Other Comments: It's a... mad world...

Sex: Male
Location: Canada

Post: #15
RE: Ontario question...Understand ADP Rules?
I bought in Ontario. If you have prescription for CPAP it's $215 for the A10 Elite. I had that but my doctor gave me an upgrade to APAP and I got the A10 for her for a bit more... $255 or $270 I forget.

You will want to buy a better mask, but not from them. They like to charge $270 for something you can get online for under $100 cad. I recommend the The ResMed AirFit™ P10 nasal pillows mask if you are not a mouth breather. I tried a bunch and it is the least intrusive, the most comfortable, and the quietest. Buy some Lanolin from No Frills Pharmacy and put the smallest amount around the edge of each nostril so they don't get raw. Be gentle when removing the mask in the morning.

The business of CPAP in Ontario is a big scam. The first dme I went to sold them in bronze, silver and gold packages. Bronze was a brick for $215. For $700 you got a bit less of a brick, but the gave you extras like a free air filter and they would look at your machine at the 1 year mark. The gold was $1,400 and they gave you free filters and a couple of adjustments, plus 3 yearly checks.

When I learned that all the cpap machines were $215 by order of the Ontario govt, they said if I got the gold machine which did reporting for $215 not $1,400, I would be getting a brick, as it would not come with the card. The finally admitted after a couple of times that it was a standard card I could buy anywhere, but 2 or 3 times they lied about it. Another lie they told me was without them checking my machine once a year it would void the warranty from the factory. Total lie. No manufacturer has this requirement on their warranty. And the big lie was telling me it was against the law and a criminal act for me to adjust the settings myself. F*cking liars.

Be sure to get your own copy of your prescription SIGNED by your doctor and keep it on file. Most of the online places will require it before they will sell to you. That was another way they jerked me around...







.
(This post was last modified: 12-18-2015 02:49 AM by player.)
12-18-2015 02:17 AM
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cate1898 Offline

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Machine: PR System One 560BT Auto
Mask Type: Nasal pillows
Mask Make & Model: P10's/backup-DreamWear
Humidifier: PR attached
CPAP Pressure: 8.5 - 13. A-Flex 3
CPAP Software: SleepyHead

Other Comments: Began CPAP Therapy Sept. 11, 2015. Hx Hypertension, Post Graves Disease, chronic migraines.

Sex: Female
Location: Southern Ontario//SW Florida

Post: #16
RE: Ontario question...Understand ADP Rules?
Player, wow you sure got the runaround worse than I'm getting! I agree the CPAP industry in Ontario is a scam. Also I can't for the life of me understand why I can't buy an Auto machine and pay the extra but use it in CPAP mode in case my needs change. Even if they were going to gouge me with $200-400 extra to do so. I'd be willing. But no, and my doc definitely does not prescribe them unless he has to.

I did get a signed photocopy of the script for a fixed CPAP. I'm a bit p!ssed off because the RT that told me I'd pay $475 over and above the ADP for the A10 Elite WITH the mask of my choice, told me on the phone yesterday that she would not have said that. BS. So I played phone tag with their manager, and I now await a call from her this morning. I'm really not happy about someone lying to me. If she had even said something like, "if I told you that, I'm sorry I was mistaken (or wrong etc)", I could understand.

I am going to take my prescription copy and all the ADP paperwork to the DME who told me over the phone that they'd sell me the A10 Elite for $860 and sounded like they were in stock. They said most masks are around $300, but I am planning to buy online and I guess I'll try and put up with the F&P Zest that apparently comes with the CPAP package. I am wanting the DreamWear and found it online at 2 different Cdn. retailers for $150 and $160 + tax and free shipping. I would also consider buying either the Swift FX for her, or the P10 for her masks if I can get them cheaper or faster than the DreamWear. I have to read all their fine print to decide which of the online retailers to buy from. I think one of them ships with Canada Post Expedited and if so I may use them. If anyone knows of somewhere cheaper and reliable with fast delivery I'd love to know about it! I know, I know-I'm asking for a lot!!

Definitely not looking forward to going back to original DME and returning equipment. I have read over the 'agreement' I signed and can't find anything there that says I am liable to pay a rental fee, or are obligated to purchase through them.

APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

-------------------------------------------------------------------------------------------------
EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
12-18-2015 07:27 AM
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player Offline

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Posts: 412
Joined: Feb 2015

Machine: Resmed A10 Autoset For Her
Mask Type: Nasal pillows
Mask Make & Model: Resmed A10
Humidifier: Resmed A10 Autosset
CPAP Pressure: 11-16
CPAP Software: SleepyHead

Other Comments: It's a... mad world...

Sex: Male
Location: Canada

Post: #17
RE: Ontario question...Understand ADP Rules?
When you say $860 you mean $215 right?

I set up an account at http://www.reship.com . It costs $5 USD (1 time fee) and this gives you an American street address. I then had the American supplier ship there for free. Reship charges $5 plus shipping costs to forward the package on to Canada. Here you can choose your preferred method, like USPS mail.

I also set up a USA PayPal account for USA sellers that won't sell outside USA.
12-18-2015 09:27 AM
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player Offline

Advisory Members

Posts: 412
Joined: Feb 2015

Machine: Resmed A10 Autoset For Her
Mask Type: Nasal pillows
Mask Make & Model: Resmed A10
Humidifier: Resmed A10 Autosset
CPAP Pressure: 11-16
CPAP Software: SleepyHead

Other Comments: It's a... mad world...

Sex: Male
Location: Canada

Post: #18
RE: Ontario question...Understand ADP Rules?
I did a return and switch, no charges.
12-18-2015 09:40 AM
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cate1898 Offline

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Posts: 784
Joined: Aug 2015

Machine: PR System One 560BT Auto
Mask Type: Nasal pillows
Mask Make & Model: P10's/backup-DreamWear
Humidifier: PR attached
CPAP Pressure: 8.5 - 13. A-Flex 3
CPAP Software: SleepyHead

Other Comments: Began CPAP Therapy Sept. 11, 2015. Hx Hypertension, Post Graves Disease, chronic migraines.

Sex: Female
Location: Southern Ontario//SW Florida

Post: #19
RE: Ontario question...Understand ADP Rules?
Yes I do mean $215. So that reship is interesting. Had heard about something like that but forgot. Must look into it in April when we get back home cause we're leaving in 2 weeks for 3.5 months in Florida. What is return and ship? Is that returning an item to an online seller for whatever reason?

APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

-------------------------------------------------------------------------------------------------
EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
12-18-2015 10:37 AM
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player Offline

Advisory Members

Posts: 412
Joined: Feb 2015

Machine: Resmed A10 Autoset For Her
Mask Type: Nasal pillows
Mask Make & Model: Resmed A10
Humidifier: Resmed A10 Autosset
CPAP Pressure: 11-16
CPAP Software: SleepyHead

Other Comments: It's a... mad world...

Sex: Male
Location: Canada

Post: #20
RE: Ontario question...Understand ADP Rules?
If you are going to Florida buy the mask in the USA while you are there. Free ground shipping.
12-18-2015 08:05 PM
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