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[Treatment] BS or legitimate?
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CountGlottula Offline

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Joined: Dec 2012

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Post: #1
BS or legitimate?
Hi all. First post here and maybe not my last. Need a little help on what to do about my sleep apnea.

Background: I am a 25 year old male with no complications associated with or derived from sleep apnea. Got tested a bit ago and came back with mild to moderate apnea.

Problem: I have an appointment tomorrow to do some more tests or whatever but the problem is that my health insurance company wants to charge me 1k to do this test, which apparently is a test to tell me what air pressure I need for a CPAP.

Now, 1k is a lot of money or what I deem a crap piece of knowledge that I could otherwise invest in a good piece DME and tune myself, ostensibly with built-in software on the CPAP or just using a pulse occimeter for calibration. However, if the appointment tomorrow will include the CPAP machine that I need to get on with my life, then I am OK with spending the 1k. Either way, I am canceling it until I get some answers from my insurance company.

Does anyone have any insight into these matters? Would it be better for me to get assessed by an independent facility? Can I pull it off myself? Anyone else think the same way?

Any help is appreciated.
12-04-2012 02:30 AM
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JJJ Offline

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CPAP Pressure: 17-20
CPAP Software: SleepyHead

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Sex: Male
Location: USA 97217

Post: #2
RE: BS or legitimate?
(12-04-2012 02:30 AM)CountGlottula Wrote:  Hi all. First post here and maybe not my last. Need a little help on what to do about my sleep apnea.

Background: I am a 25 year old male with no complications associated with or derived from sleep apnea. Got tested a bit ago and came back with mild to moderate apnea.

Problem: I have an appointment tomorrow to do some more tests or whatever but the problem is that my health insurance company wants to charge me 1k to do this test, which apparently is a test to tell me what air pressure I need for a CPAP.

Now, 1k is a lot of money or what I deem a crap piece of knowledge that I could otherwise invest in a good piece DME and tune myself, ostensibly with built-in software on the CPAP or just using a pulse occimeter for calibration. However, if the appointment tomorrow will include the CPAP machine that I need to get on with my life, then I am OK with spending the 1k. Either way, I am canceling it until I get some answers from my insurance company.

Does anyone have any insight into these matters? Would it be better for me to get assessed by an independent facility? Can I pull it off myself? Anyone else think the same way?


First, you need treatment, but if you don't get it for a week or so it's not going to be life threatening. You've survived for some time with this condition and a few more days won't make that much difference.

As to insurance companies, they all employ claims adjusters whose job is to figure out some way to deny coverage and/or get the patient to pay for it. It's quite possible that your insurance company is blowing smoke.

And yes, you can figure out what kind of therapy you need and buy the equipment to do so yourself, and for less than $1,000. But plan on spending several months in trial and error and learning about how this equipment works. Note, however, that if you are in the US you cannot buy the equipment without a prescription, so you need a doctor willing to write one.
(This post was last modified: 12-04-2012 02:49 AM by JJJ.)
12-04-2012 02:47 AM
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zonk Offline

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Post: #3
RE: BS or legitimate?
Hi CountGlottula ... welcome to the board
I don,t know much how insurance system works but if you need advice on what machine to get
check archangle machine recommendations before seeing your DME
http://www.apneaboard.com/wiki/index.php...ne_Choices
12-04-2012 04:56 AM
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archangle Offline
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Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #4
RE: BS or legitimate?
It's unlikely it will include a CPAP in the $1000 fee. Insurance probably won't pay for a CPAP machine or CPAP related expenses without an in-lab CPAP test.

You also may be bit in the backside by starting a new deductible at the end of the year if it's relevant to your insurance. The doctors and insurance can also be infuriatingly slow at getting things done, too.

See part of why I refer to the medical mafia as the medical mafia?

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
12-04-2012 07:31 AM
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archangle Offline
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Advisory Members

Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #5
RE: BS or legitimate?
BTW, yes, the sleep study is the way to do it for most people. It's not really do it yourself type of treatment.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
12-04-2012 07:35 AM
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trish6hundred Offline

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Machine: Resmed S9 AutoSet for Her
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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: #6
RE: BS or legitimate?
Hi CountGlottula and WELCOME! to the forum.!
What everyone has said so far.
Best of luck to you.

trish6hundred
12-04-2012 11:50 AM
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2Tim215 Offline

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Mask Make & Model: Swift FX Nasal Pillow - Medium
Humidifier: ResMed H5i w/Climate Hose
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CPAP Software: ResScan SleepyHead

Other Comments: OSA, Fibromyalgia, Rheumatoid Arthritis, Osteoarthritis, Gout, PTSD, & Meralgia paresthetica.

Sex: Male
Location: Finger Lakes Region, NY

Post: #7
RE: BS or legitimate?
Hi CountGlottula, I am surprised that the first study would not have a pressure indication to determine that you had mild to moderate sleep apnea. I would start by getting a copy of that initial test to see how they determined your apnea and what criteria was used to make a diagnosis of mild to moderate. You may find the information there. Was it an overnight test? If you cannot learn any pressures used for the first test it is important to have an adequate test done to see where you should start your therapy. Unfortunately insurance is an issue for a lot of us. I hope things work out for you. Glad to see you found this Board, you will find a lot of answers here related to sleep disorders!Welcome

Tim
Finger Lakes Region, NY
12-04-2012 03:21 PM
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