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Over the counter CPAP comment from doctor
#31
RE: Over the counter CPAP comment from doctor
(10-01-2018, 08:35 AM)DaveL Wrote: Prices are too high here in the Ontario area; I bought my last machine used without a prescription.

Prices in Ontario are regulated by the Provincial Government.  CPAP $860 Cdn ($660 US) and APAP $1,020 Cdn ($785 US).  Then the government run ADP program program subsidizes 75% of the cost.  And a new machine every 5 years if you want.

Considering we are a different country with a substantially smaller population and a different currency,  these prices are not out of line.

No other province in the Country offers a better price or subsidy.

People pay more for their iPhones or other assorted tech.
Sleep-well
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#32
RE: Over the counter CPAP comment from doctor
Thanks for your comment.
However, I have found the price excessive. I found the choices to be restrictive, and with no concern about sleep quality. There is a high failure rate amongst new users. Many people refuse to do cpap therapy because they chose not to wear the mask and use the equipment.

Finally the method excludes more effective and more comfortable equipment that would improve my care. There is a market for imported machines from other countries, and there is a market for used equipment that needs to be used well.
I can't afford an iPhone and don't have a cellular phone.
DaveL
compliant for 35 years /// Still trying!

I'm just a cpap user like you. I don't give medical advice. Seek the advice of a physician before seeking treatment for medical conditions including sleep apnea. Sleep-well

http://www.apneaboard.com/wiki/index.php..._The_Guide

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#33
RE: Over the counter CPAP comment from doctor
(08-06-2018, 10:40 AM)CHanlon Wrote: It's a shame for my sleep dr.  I never went back after the first annual checkup.  At which point I walked in with a years worth of ResMed reports showing that my opinion was correct and I met the criteria for an APAP prescription.  Pretty sure he never looked at it.  So I really don't know how he could possibly comment on my compliance.

I have 8 years worth of data now... I look forward to the conversation about compliance, one day. :-) ROFL.

The docs don't care about compliance (nor are they supposed to) except as it affects your medical condition: if you're evading the treatment for any reason, then obviously that needs to be corrected or else there's no point and everyone might as well go home. The compliance b.s. is all between the insurers, who I assume came up with the stupid idea in the first place, and the DMEs, who rely on the insurers as their cash cows and do the compliance-checking from the machines' data. (That cellular modem basically calls your DME, not your doctor.) And "cash cow" is putting it mildly; the whole thing is a huge boondoggle, worth I don't know how many zillions of dollars per year.

Anyone who thinks that his or her 30-day or 90-day private-insurance compliance period is a PITA should ask a Medicaid victim about the ten-month CPAP compliance period for Medicaid that our wunnerful dumb-ass U.S. Congressdroids came up with however many years ago. What a crock that is.

CPAP equipment should be just like eyeglasses as far as the acquisition of it is concerned. Sure, an Rx is required, but it's not a Certificate of Authenticity with an RFID embedded in it, issued by a Central Scrutinizer; it's merely a set of specifications for the optician to use when making the lenses, and sometimes when you buy from an online retailer you can just type in the numbers and not bother to send a scan of the paper.

For the various bureaucracies to treat CPAP equipment as if it were radioactive is absurd and stupid. (Hey, a smoke detector is radioactive, and that's sold OTC. What is wrong with this picture?)

As for insurance not covering OTC items, yes, that's a concern, but I'm convinced that the only reason a basic, lower-tier CPAP machine has a list price of $900 now (also absurd) is that the manufacturers know that relatively few patients buy their own. So that's another boondoggle in which the corporate attitude is "Hey, no problem; our customers, the insurers, have super-deep pockets!" So that needs to change also. And, as with eyeglasses, more competition and more knock-off copies (all the way down to made-in-China trash sold at Walmart) would be a good thing in general for us consumerdroids. Not that I want to wear cheapie glasses or use a cheapie CPAP machine, but we need some kind of change from this captive-consumer situation.
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#34
RE: Over the counter CPAP comment from doctor
I would hope not.  Then we will all have to pay for our own machines and supplies.  Many of us cannot.  As soon as something is OTC, insurance won't cover.  Supplies are ridiculously expensive, especially masks.  Don't deprive so many that need insurance coverage.  Those that want to buy without prescription already can buying a barely used machine from many sources.
Everyone has a bad hair day once in a while.  Same with a night on xPAP.
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#35
RE: Over the counter CPAP comment from doctor
(11-07-2018, 10:17 AM)zzzlessinMS Wrote: I would hope not.  Then we will all have to pay for our own machines and supplies.  Many of us cannot.  As soon as something is OTC, insurance won't cover.  Supplies are ridiculously expensive, especially masks.

CPAP equipment is artificially expensive because the deep-pockets insurers pay for it. An improvement in that situation seems desirable. Whether it's ever going to be politically & economically feasible is a different question, and I suspect that the answer is no. So I don't think you have anything to worry about in that regard.

A few years ago I was diagnosed with plantar fasciitis (routine) and had some expensive custom orthotic insoles made, which insurance paid for. Knowing nothing about p.f. or its treatment, I didn't think twice about it until those started to wear out, at which point I picked up a clue and thought "I wonder whether those off-the-shelf orthotics that I've seen would work just as well." The answer turned out to be yes: Powerstep or Superfeet (OTC) are just as good as Hersco (Rx) in my case, at a fraction of the cost. Wouldn't I rather have insurance buy 'em? Sure, but not at the expense of wasting a lot of time in podiatry clinics and then waiting for delivery. That's like going to a doctor and asking for a prescription for aspirin.

Most CPAP users, at least most of those who are not on bi-level or ASV, don't need the sleepydocs or the techs or the RTs or the prescriptions, except to figure out the correct pressure range. Everything else with basic CPAP you have to do yourself anyway.
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#36
RE: Over the counter CPAP comment from doctor
(10-03-2018, 11:57 AM)Cpapian Wrote: People pay more for their iPhones or other assorted tech.

I was thinking about that occasionally since reading it the other day, and at first it seemed irrelevant, but now I don't think so, because I suspect that a lot of folks have skewed priorities or expectations about home medical equipment in the larger context.

Although the prices of machines & masks are artificially inflated by the manufacturers and all the way down the line, just because that's what the market will bear based on the insurers being the usual customers, that's not the whole story.  People routinely pay many hundreds of dollars for a smartphone every couple of years, plus two figures per month for that service, plus low three figures per month for combined TV & Internet service at home from either a cable company or a former telco that has turned into a cable company.  Hardly any of that is essential; if just landline Internet service by itself, nothing else, were available in that raw form (it almost never is), a reasonable price that would let the telco recover its costs and make a small profit would be about US$20/month.  But the vast mass of consumers put up with paying the extortionate hundreds of dollars per month for their infotainment needs, and there's no end to that; it only gets worse.  (A clarification about Internet service:  If you have only that at home, you can add landline phone service via a third-party VoIP provider, including 911 emergency-response service, for, no kidding, $2/month more and maybe the local government's 911 surcharge.  For the same thing, a telco charges at least $25/month plus various bogus fees and pretends that its way of doing it is the only game in town.)

OK, to get back to CPAP hardware: it's an up-front investment of at most US$1000 for machine & mask, with an expected lifetime of five years except that, realistically, you'll need to buy a replacement mask about every year or so and occasionally a hose.  So say $1500 over five years, or $300/year, or $25/month.  My point is that not only is that a fairly low number, but it's an investment in the individual's health and well-being.  We need CPAP in order to function properly.  Isn't that worth some investment, even if it's not paid by insurance and you have to front the total cost?

So I guess the way I look at it is that although I resent the high prices and the locked-in nature of the rigged market and the insurance/DME scam as it now exists, I also shrug it off because the financial cost of going it alone doesn't seem unbearable ... considering the alternative of trying to sleep without CPAP!

Background, in case it matters:  I'm poor, my only insurance is Medicaid, and I have bought more than one machine and more than one mask out-of-pocket so far.  So, please, no accusations of rich man's snobbery or "Let them eat cake."  On the other hand, what makes me completely bizarre, a circus sideshow freak, is that I have no cellular phone and no idiot box.  So I evade paying that few hundred dollars per month to sleazy disgusting cable-and-wireless companies and Crapple.  (Aren't you envious?)
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#37
RE: Over the counter CPAP comment from doctor
(10-03-2018, 03:02 PM)DaveL Wrote: Finally the method excludes more effective and more comfortable equipment that would improve my care. There is a market for imported machines from other countries, and there is a market for used equipment that needs to be used well.

Is it unfeasible for Canadians to buy from U.S. online retailers because the import duty is prohibitive?  What does that amount to as a percentage of the transaction value?  And probably you'd also be paying sales tax or VAT, right?

(I'm not asking anyone to look it up in the rules & regs; I just thought maybe someone who has done that knows offhand.)
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#38
RE: Over the counter CPAP comment from doctor
"the ten-month CPAP compliance period for Medicaid" Fats Drywaller

Hmm, it must be different for various states/commonwealths. My compliance was standard 70% in 30 days out of a 90 day period. My insurance is a welfare issued combo United Healthcare Community/Medicaid package with the optional Obama phone plan.

Coffee
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#39
RE: Over the counter CPAP comment from doctor
(11-09-2018, 03:13 PM)SarcasticDave94 Wrote: "the ten-month CPAP compliance period for Medicaid" Fats Drywaller

Hmm, it must be different for various states/commonwealths.

Oh yeah, that's right. I think that was mentioned in another discussion a while back. Medicaid administration is up to the individual states. I knew that part, but had forgotten about it. In some places the system works better than in others.

So presumably it wasn't the U.S. Congresscritters who came up with that requirement. I stand corrected.
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#40
RE: Over the counter CPAP comment from doctor
Although I'm not much for advertising or marketing, it did occur to me to take that earlier calculation of mine one step further to come up with a kind of advertising-brochure slogan: If I spend US$1500 on a CPAP machine + supplies, lasting five years, and if I add in the cost of the electricity, then I'm paying something like $1.00 per night for the benefits of CPAP-assisted sleep. Not a bad deal! If I use the distilled water (as I do) that a lot of folks have just been saying is unnecessary, that makes it $1.10 per night.
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