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is this normal or is this Canada?
#11
(10-31-2015, 06:22 AM)cate1898 Wrote: Unless you have a crooked doctor who is willing to somehow fudge your sleep study results, if your results don't indicate APAP is medically necessary, you won't get one in Canada.
Out of interest, what 'medically necessary' suppose to mean?

ramblingasian wrote "The DME won't get the money from ADP if there's no evidence that you need a certain machine"
What sort of evidence, whether you need CPAP known as brick, CPAP fixed pressure data capable machine, or APAP (fixed and variable)?

Thanks

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#12
I imagine with Obamacare the US will be going the way of Canada, eventually. Sad
Sleep is worth the effort.
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#13
(10-31-2015, 06:37 PM)zonk Wrote:
(10-31-2015, 06:22 AM)cate1898 Wrote: Unless you have a crooked doctor who is willing to somehow fudge your sleep study results, if your results don't indicate APAP is medically necessary, you won't get one in Canada.
Out of interest, what 'medically necessary' suppose to mean?

ramblingasian wrote "The DME won't get the money from ADP if there's no evidence that you need a certain machine"
What sort of evidence, whether you need CPAP known as brick, CPAP fixed pressure data capable machine, or APAP (fixed and variable)?

Thanks

cate1898 posted the relevant documents below at 8:02 yesterday which I have posted for you in the past as well. Please read those documents. They contain the information that you need to answer your questions.

Like I said before, the findings of your in-lab titration is what will decide whether the ADP will fund a CPAP, APAP or BiPAP. The APAP and BiPAP have further requirements that need to be met, with the BiPAP requiring a BiPAP titration.

As for equipment, the Ontario government counts all CPAP machines (Data Capable or not) into one catagory.
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#14
(10-31-2015, 07:23 PM)foss Wrote: I imagine with Obamacare the US will be going the way of Canada, eventually. Sad

I'm not going to get into an argument with you about the semantics of public insurance, but I'm not sure why you're sad about a public insurance plan that is cheaper than any insurance plan in the US yet covers more and also has a higher life expectancy as well as standard of care.

As an example, I'm about to purchase a Resmed Aircurve 10 Auto VPAP machine. I'm only going to pay $330 CAD for it based on the ADP plan. Looking at the vendors in the supplier list, the cheapest the same machine brand new in the US that I can find is over $1700 USD, which is roughly $2200 CAD. I'll take the $330 all day.
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#15
(10-31-2015, 07:26 PM)ramblingasian Wrote: Like I said before, the findings of your in-lab titration is what will decide whether the ADP will fund a CPAP, APAP or BiPAP. The APAP and BiPAP have further requirements that need to be met, with the BiPAP requiring a BiPAP titration.
Thank for refreshing my memory, a senior moment for me
Please bear with for a second, I'm trying to learn and educate myself ... who said, you cannot teach an old dog new tricks

I've looked what you've said in the other thread but still don't fully understand the meaning and who sleep like that in the sleep lab, wouldn't that rule out everyone from getting APAP
[The individual must have polysomnographically documented OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more; and the change must occur between REM vs. NREM sleep or supine vs. sleeping on their side]



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#16
(10-31-2015, 08:24 PM)zonk Wrote:
(10-31-2015, 07:26 PM)ramblingasian Wrote: Like I said before, the findings of your in-lab titration is what will decide whether the ADP will fund a CPAP, APAP or BiPAP. The APAP and BiPAP have further requirements that need to be met, with the BiPAP requiring a BiPAP titration.
Thank for refreshing my memory, a senior moment for me
Please bear with for a second, I'm trying to learn and educate myself ... who said, you cannot teach an old dog new tricks

I've looked what you've said in the other thread but still don't fully understand the meaning and who sleep like that in the sleep lab, wouldn't that rule out everyone from getting APAP
[The individual must have polysomnographically documented OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more; and the change must occur between REM vs. NREM sleep or supine vs. sleeping on their side]

Basically the sleep lab records whether you're in REM vs Non REM and back vs side sleep. Because ADP requires a full night of titration, apparently those that do require an APAP get caught - apparently not many people do have a difference of at least 4cm though.

EDIT: I should be clear though, the DME can sell you an APAP even if you're only prescribed an CPAP. It's just that you can't use the ADP to cover the cost.
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#17
(10-31-2015, 06:08 PM)ramblingasian Wrote: +1. At least in Ontario, OHIP requires your titration scores from your sleep test to be included in the package that is sent to the ADP in order to get funding. The DME won't get the money from ADP if there's no evidence that you need a certain machine.

I frankly don't know if it's covered by the B.C. version of medicare. I was lucky enough to retire with a good private supplemental medical plan. Medicare covered the sleep study, but Blue Cross paid for the machine.

Ed Seedhouse
VA7SDH

Your brain is not the boss.

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#18
(10-31-2015, 09:32 PM)eseedhouse Wrote:
(10-31-2015, 06:08 PM)ramblingasian Wrote: +1. At least in Ontario, OHIP requires your titration scores from your sleep test to be included in the package that is sent to the ADP in order to get funding. The DME won't get the money from ADP if there's no evidence that you need a certain machine.

I frankly don't know if it's covered by the B.C. version of medicare. I was lucky enough to retire with a good private supplemental medical plan. Medicare covered the sleep study, but Blue Cross paid for the machine.

I believe that Ontario is one of the few provinces that covers the majority (75%) of the cost of a machine as long as you have a proper diagnosis. Most private insurance plans in Ontario then will cover a huge chunk (80-90%) of the remainder.
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#19
As someone mentioned, every province handles this differently.

Another example: in Saskatchewan my doc sent me for a test, took 2 weeks to get into a Sleep Center, failed the in-home test (small unit that reads breathing and oxygen levels) and was immediately given a S9 Apap to use for a 2 week trial. After the Sleep Center had the results from this trial they shared them with another gov't agency (SAIL - Sask. Aid for Independant Living). They sent me a free and new S9 Elite complete with new travel case. This delivery to the door took 2-3 weeks. Settings were based on Sleep Centers APAP tests. This gov't agency provides wheelchairs, walkers etc. to anybody that qualifies.

Humidifier and masks are purchased by me/us thru wife's work plan, everything fully covered. Nothing happened real fast but after x number of years with poor sleep I suppose this period is reasonable.
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#20
Napmeister how long did the whole process take from the time you originally spoke to your doc to receiving your own machine?
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