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What should I do?
#1
Question 
Hello guys and gals,

Im new to this board and also to the apnea world I have been diagnosed and im to the point where im getting my machine. Here is my situation.

Im overweight and Im seriously in the process of loosing weight (30 pounds so far) and I know that if I loose weight my apnea will improve. I requested a auto cpap machine so that in the event the apnea gets better the auto cpap would auto adjust.

The lady said that my insurance approved me for the regular cpap machine and that they will need to go thru the hassle with getting a new prescription and a new insurance request to see if the insurance will approve the auto cpap.

She also stated that I can go to the doctor and calibrate my cpap if I need it.. ( I know I can do it myself)

My question is should I just go ahead and let her do the cpap machine setup or should I fight to get the autocpap? My insurance is united health care and could be a pain as i'm sure some of you know.

Any comments or suggestions are appreciated. Thanks
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#2
If the insurance company uses the same codes as Medicare, they will pay the supplier the same amount for the regular CPAP as they do an autoPAP since they both have the same code.

The supplier doesn't want to sell you an autoPAP because they lose money. I'd fight for it.

However, you could insist on a data capable machine so that you can view your own data and keep track of it yourself. You would know if the treatment pressure could go lower. She'll probably tell you that you can't view the data yourself and all that but you can.
http://www.apneaboard.com/wiki/index.php...ne_Choices
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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#3
I agree with Paula. Also advise shopping around with different suppliers -- you don't have to deal with these people. Also note that this board has a preferred supplier list and you can probably order whatever machine you want (get a data capable and APAP if you can) and get reimbursed from your ins. company. You'll be stuck with the machine for years, so best to get the one you want and especially the one you'll be excited to use (helps with compliance).

Call your insurance company to see what they cover. Note: some insurance companies require you to go through a "rental phase" first. And just beware that there are a lot of suppliers, some your ins. company will work with and others not. There are "shady suppliers" out there who are dishonest, so shop around.

Oh, and, Welcome to the forum!
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#4
yeah this supplier sounded kind of shady...She did not even know the brand or model of the cpap machine I was getting she said that the guy who did the setup had them. We will see what happens tomorrow I will throw a fit.

I should be able to get the prescription directly from the doctor and order online right? Will they be able to bill my insurance?
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#5
The prescription is yours, the doctor office should be able to give you a copy (the DME supplier will give you a copy to). The online suppliers will ship you a machine provided they have a copy of the prescription. I don't know if the online suppliers will bill your ins. company. That would likely be something you'd have to do yourself to get reimbursed (so call your ins. company first if you go that route) and you'll have to pay any "gap" since those suppliers don't have to abide by your insurance company's "negotiated rate".

If you don't know what mask you need, you'll probably want to work with a local supplier, and your insurance company should be able to provide you with the list of local in-network suppliers in your area.
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#6
If your Doc writes you a prescription for an "auto," then that is what the DME has to provide. So give a call to your Doc's office and ask if they would write a prescription for you specifying a "Resmed S9 Autoset" and you'll stop by and pick it up. They may say no, but there really isn't any compelling reason for them to say that.
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#7
My prescription just says APAP 9-17, with humidifier, masks and supplies for life. That prescription is good forever.

If your prescription strictly has the make/model of machine, then you are kinda screwed when the S10, S11, etc eventually come out... You'd need a new prescription after the current model is end-of-life'd.
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#8
(03-26-2014, 10:44 PM)c0reDump Wrote: My prescription just says APAP 9-17, with humidifier, masks and supplies for life. That prescription is good forever.

If your prescription strictly has the make/model of machine, then you are kinda screwed when the S10, S11, etc eventually come out... You'd need a new prescription after the current model is end-of-life'd.

Yes you would.... and the problem is??

My point is if someone is having trouble getting a DME to provide something better than what has been prescribed, then the best thing they could do is have a prescription for exactly what they want.

It would be like asking the pharmacist for the "name" brand drug when the prescription specifies "Generic."

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#9
Quote:Any comments or suggestions are appreciated.


I wish I had as much information about these machines as you already do. Enough to know the difference between them and to know to ask for the auto machine.
I didn't, and both myself and the hubby have been given the Resmed Escape which does not have the features you want, which I gather now everyone should have and I was too late into the process when people woke me up here about it.

I was advised to speak to different doctors and find out which one would give me that machine and that one would be the one to get my business.
If only I knew then.....don't make the mistake I made.

Fight for the Auto-Set.
Sounds as if you are American judging from your comments regarding Insurance. It seems easier from where I sit, in Toronto Canada, for Americans to get the Auto Set.

Good Luck
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#10
(03-26-2014, 10:48 PM)retired_guy Wrote:
(03-26-2014, 10:44 PM)c0reDump Wrote: My prescription just says APAP 9-17, with humidifier, masks and supplies for life. That prescription is good forever.

If your prescription strictly has the make/model of machine, then you are kinda screwed when the S10, S11, etc eventually come out... You'd need a new prescription after the current model is end-of-life'd.

Yes you would.... and the problem is??

My point is if someone is having trouble getting a DME to provide something better than what has been prescribed, then the best thing they could do is have a prescription for exactly what they want.

It would be like asking the pharmacist for the "name" brand drug when the prescription specifies "Generic."

Point is, my prescription cost $1,700+ -- significantly more than the machines. I'm not paying for another prescription again (it's a lifetime script).
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