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Seeking advice on how to deal with health insurance company
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Bosmer Offline

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Posts: 1
Joined: Jun 2015

Machine: ResMed Compact S8
Mask Type: Full face mask
Mask Make & Model: unsure
Humidifier: HumidAire 3i
CPAP Pressure: unsure
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #1
Seeking advice on how to deal with health insurance company
I was diagnosed with severe sleep apnea 7 to 8 years ago. My health insurance at that time paid for sleep study, cpap, mask etc.

Over the years I saw the doctor once, or twice, when I needed a new mask or tubes etc.

I have used the same machine since day 1 with no problems. I use it every single night.

Now, the machine is not functioning properly. The previous doctor does not take my new health insurance.

The new doctor is dealing with new insurer and won't send somebody to look at the machine or to have a new sleep study done. Instead they want me to do an at home test. In order to do this I can't use my cpap for the night. I think it is a terrible idea.

The doctor recommends me to call the health insurance company and complain.

Anybody have any tips? success stories?

Thank you!
06-24-2015 10:13 AM
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Sleeprider Offline
Wiki Editor
Advisory Members

Posts: 3,400
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #2
RE: Seeking advice on how to deal with health insurance company
The qualification for reimbursement comes from the insurance company. If you have old prescriptions or a copy of your original sleep study, it should be no problem to be approved for a new machine. Call them and find out what they need to qualify you for reimbursement or coverage.

An at home sleep study is not the end of the world. I think I have missed very few nights on the CPAP since I started in 2008. Once was last year when I left home without the power supply and was 300 miles away when I realized it. It was not a great night sleep, but I survived, and so will you. The priority is getting a machine ASAP. You might want to check Craigslist and see if someone nearby is selling one at a reasonable price. It's never a bad idea to have a backup, and you should not have waited this long to replace or backup your old S8.

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06-24-2015 10:30 AM
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justMongo Offline

Monitors

Posts: 3,857
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #3
RE: Seeking advice on how to deal with health insurance company
It's probably something the doc has no control over. It's the insurance company.
They don't want to issue a new CPAP without proof of necessity.

Since your present CPAP is not functioning properly; why not do a home sturdy w/o CPAP?

An option, if you have the former prescription is to buy online -- I bought my second machine from Supplier #2 on the list (top of page.)
You'll get a good deal; but your insurance will not reimburse.

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.
(This post was last modified: 06-24-2015 10:34 AM by justMongo.)
06-24-2015 10:33 AM
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trish6hundred Offline

Advisory Members

Posts: 6,453
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #4
RE: Seeking advice on how to deal with health insurance company
Hi Bosmer,
WELCOME! to the forum.!
Hang in there for more responses to your post and good luck getting your CPAP machine situation straightened out so you can get back to good therapy.

trish6hundred
06-24-2015 01:33 PM
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Mosquitobait Offline

Advisory Members

Posts: 749
Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #5
RE: Seeking advice on how to deal with health insurance company
Call your insurance company and ask them how old the study can be for them to accept it. In addition, ask them if you buy something from another supplier, if they reimburse out-of-network (you still need the study and the doc script). You will get your machine much cheaper this way. If your study falls into that guideline, go to your old doctor and get a copy of your original study. Then, get a new script from your doctor to get an auto-machine. At that point, he can decide whether he wants to add an oximeter and then make adjustments based on your automachine/oxygen levels.

If the insurance company does not accept your old study, then I would suggest you get a backup machine because it may take a month or longer (in my case 4 months) before you have a new machine. You can buy used or your doctor can choose to write you a script. There are some good, lower cost machines at some of our suppliers. The DevilBliss Intellipaper is a good one to choose from. Doesn't have all the bells and whistles of the top two, but it's a good machine with a long warranty.

If you decide you don't have the cash and want the insurance to cover it, you don't have a choice - make an appointment for a home study and suck it up. You need that machine and delays will simply make it that much longer without a machine. You want someone else to pay for something, you have to go through their hoops. I AGREE that once you have sleep apnea, you aren't likely to be cured and you can show from the run hours of your machine that you were a regular user. However, lots of things changed about 3 years ago when studies came out showing that half of patients never use their cpaps after a few months, so more hoops.
06-24-2015 02:27 PM
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