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What does it take to get insurance to replace a machine after 5.5 years?
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Galactus Offline

Advisory Members

Posts: 1,384
Joined: Jan 2014

Machine: Phillips Respironics System One PRS1 DS760P Auto BiPAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: System One Heated Humidifier + Climate Line
CPAP Pressure: E/I 13/20 PS 4/7 BiFlex 3
CPAP Software: SleepyHead EncoreBasic

Other Comments: Sleep can be a good thing.

Sex: Male
Location: USA

Post: #11
RE: What does it take to get insurance to replace a machine after 5.5 years?
(11-06-2014 07:52 AM)Bubblace Wrote:  I truly appreciate the humor in these posts. You guys have made me feel a little better about my situation. Thank you!

Just remember, some of the truest things are said in jest.

I just recently had a similar situation with my sleep doc as I tries to get a climate line because I am cold. They grilled me like a hot dog about how long I had the machine why y I didn't mention it last year and all this baloney. They were nice and all but what's with the 3rd degree? i finally got irritated, and said - Look, I was diagnosed last year, and it was late in the season, I suffered all winter because I was stupid and didn't know there was a better option, and of course you guys didn't bother to tell me. Now it's cold again and when I mentioned it to my friends on the board they quickly educated me that there was a better way. So why are you giving me a hard time? Not like you're going to have to pay for the climate line, or miss a meal to get me one. All you have to do is write it down on a piece of paper and viola someone will get me one. And as if by magic they stopped asking stupid questions.

So just look at it this way, just because the unit may not be technically broken, doesn't mean you can't complain about the therapy you are getting to get them to change the machine. "broken" is so broad a spectrum. And you know they are also required to get you a unit that allows you to "comply with the therapy" so if for some reason that machine doesn't allow you to comply for whatever reason (it's noisy and keeps you up) they have an obligation to get you something that will allow you to comply.

I don't presume you came here to say that you wanted a new machine just because the new one was shiny. Because most of the time someone wants a newer something because the old one isn't doing what it needs to do. So fixate on that and make them change it.

If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
11-06-2014 05:15 PM
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Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #12
RE: What does it take to get insurance to replace a machine after 5.5 years?
(11-06-2014 07:52 AM)Bubblace Wrote:  I truly appreciate the humor in these posts. You guys have made me feel a little better about my situation. Thank you!

You must live near me. I could hear the bearing in the fan motor squealing in your machine all the way over here at my place .Bigwink

I even yanked on the wifes hose, woke her up and said, "You hear that? Thats Bubblace's old cpap machines fan bearing going out":oh-jeez:

She said it sounded horrible and your insurance should get you a new machine right away.SHa_biggrin5
11-06-2014 09:18 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #13
RE: What does it take to get insurance to replace a machine after 5.5 years?
Careful. Even in jest, some of this is on the border of insurance fraud. Yes, I am such a party pooper. But as moderator, I have to be since without this board, we would not be having this conversation. Understand?

So Bubbles, in my opinion, your best bet is to get a spiral bound notebook and some pens. Sit by the phone and call your insurance company. Write down the time and date. Write down who you spoke to and when. Write down what was said (basics, not an exact transcript but "discussed machine") and the conclusion. Be polite but firm.

Tell them the situation. Tell them the machine is 5.5yrs old. That the nurse was a nurse, not a machine tech. Tell them you'd be happy to take it to a supplier if only there were one near you. Tell them ANY problems with it. Not just that it is old, but that age means wear inside. Tell them the nurse did not hook it up to a manometer (tests the pressure coming out). Mention ANY noises it is making that is ANY different than when you first got it. And that noises usually means bad valves and bearings.

Remember, be polite. If they deny still, ask about the appeals process. Ask to have the denial in writing. Ask for it the denial to be emailed to you so you can take care of this quickly. Don't let them say "the information on the appeals will be on the letter we will send". Tell them you want the appeals process information now and to either tell you how to get it online or to email it to you.

Before you hang up, go back over the conclusion of the conversation "In conclusion, you have decided to further deny the purchase of this CPAP and you will email me the appeals process and the denial letter within the next hour, correct? And your name again was...?"

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
11-08-2014 09:55 PM
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