Buy CPAP Or Wait Possibly Months For Insurance?
Hi all,
Brand new to the board, so this is my first post! I've been dealing with what I now know is sleep apnea for probably the past 8 years of my life. I finally got a sleep study and was confirmed to have sleep apnea - I believe the doctor said I stopped breathing around 50x? After being told I could get a CPAP, I jumped at the opportunity only to release I need to have a follow-up sleep study to calibrate the machine, and then wait another week for the follow-up appointment in which they would "schedule a time for me to pick-up your CPAP". The earliest appointment I could get was just over a month from now. God knows how long after that I have to wait to get it.
I read the Wiki and see that I should specify which machine I want. I checked with my insurance and they do cover it, but I'm not sure if I can wait an entire month or more with these symptoms. I feel like they're getting worse.
My question: Should I rent in the meantime until I can get one from insurance? Should I just bite the bullet and buy the gold standard? I have been on their ass about trying to move my appointment up but they won't budge. I'm sure you all can understand how frustrating this is.
Thanks for all the help!
RE: Buy CPAP Or Wait Possibly Months For Insurance?
I would go into your regular Dr with any documentation you have showing you have apnea and ask for a RX. I have never had a problem getting a RX and with that in hand you should be sble to get the machine.
You could buy the machine out of pocket and submit the RX and bill to your insurance for durable medical equipment. I did that the last time I got a machine and the supplier said I could not get one yet because I only had it for 5 years.
RE: Buy CPAP Or Wait Possibly Months For Insurance?
Almost anyone can self titrate with an auto-CPAP machine. With the delays of obtaining a titration test, you should request that your doctor prescribe Auto CPAP and self-titration using a Resmed Airsense 10 Autoset. The Autoset series of machines are particularly well-suited to self-titration because they provide full data and are very responsive to your needs. Although you will likely start at near default settings of 4-20, I would suggest it be set to a minimum pressure of 8.0 with EPR (exhale pressure relief) at 3. This will be a starting pressure of 8.0/5.0 (inhale/exhale), with a maximum pressure of 20.0, and will quickly adapt to your needs if you require higher pressure. For masks, the minimal nasal pillows masks are the best to start with, then move to full face only if needed to resolve mouth leaks if you have that problem. The Resmed Airfit P10 is a great starter and one I have used for many years. The less mask you use, the easier it is to seal and wear. A titration test is lucrative for the doctor and clinic, but generally unnecessary, and only provides a snapshot of your therapy needs. People almost always do better with auto CPAP and self-titration. You should be able to get this self-titration Rx without any further delay or appointments.
Your sleep doctor does not have to be your prescriber. With your diagnosis complete, your regular physician can make this prescription and manage your care. Get away from the specialist as soon as possible. It is the exception for them to be helpful. Meanwhile, research the durable medical equipment (DME) providers that are in-network for your insurance, then call and be sure they dispense Resmed, and how long they will take to dispense upon receiving a prescription. Don't just let a doctor refer you to their preferred DME without doing your own research, and especially don't buy from directly from your doctor.
RE: Buy CPAP Or Wait Possibly Months For Insurance?
(09-27-2021, 10:53 AM)staceyburke Wrote: I would go into your regular Dr with any documentation you have showing you have apnea and ask for a RX. I have never had a problem getting a RX and with that in hand you should be sble to get the machine.
You could buy the machine out of pocket and submit the RX and bill to your insurance for durable medical equipment. I did that the last time I got a machine and the supplier said I could not get one yet because I only had it for 5 years.
Hi Stacey, I will take your advice and get the RX to take matters into my own hands. Thanks so much!
(09-27-2021, 11:03 AM)Sleeprider Wrote: Almost anyone can self titrate with an auto-CPAP machine. With the delays of obtaining a titration test, you should request that your doctor prescribe Auto CPAP and self-titration using a Resmed Airsense 10 Autoset. The Autoset series of machines are particularly well-suited to self-titration because they provide full data and are very responsive to your needs. Although you will likely start at near default settings of 4-20, I would suggest it be set to a minimum pressure of 8.0 with EPR (exhale pressure relief) at 3. This will be a starting pressure of 8.0/5.0 (inhale/exhale), with a maximum pressure of 20.0, and will quickly adapt to your needs if you require higher pressure. For masks, the minimal nasal pillows masks are the best to start with, then move to full face only if needed to resolve mouth leaks if you have that problem. The Resmed Airfit P10 is a great starter and one I have used for many years. The less mask you use, the easier it is to seal and wear. A titration test is lucrative for the doctor and clinic, but generally unnecessary, and only provides a snapshot of your therapy needs. People almost always do better with auto CPAP and self-titration. You should be able to get this self-titration Rx without any further delay or appointments.
Your sleep doctor does not have to be your prescriber. With your diagnosis complete, your regular physician can make this prescription and manage your care. Get away from the specialist as soon as possible. It is the exception for them to be helpful. Meanwhile, research the durable medical equipment (DME) providers that are in-network for your insurance, then call and be sure they dispense Resmed, and how long they will take to dispense upon receiving a prescription. Don't just let a doctor refer you to their preferred DME without doing your own research, and especially don't buy from directly from your doctor.
Hi Sleeprider, good idea as I just mentioned my doctor confirming that I was diagnosed with sleep apnea and that I would like the prescription/be prescribed an auto CPAP particularly the Resmed Airsense 10 Autoset. Thanks!
RE: Buy CPAP Or Wait Possibly Months For Insurance?
It is your right as a patient to decline any test or procedure, and to pursue a more efficient and effective alternative. There is simply no good reason to do clinical titration when today's machines offer such efficacy and data right out of the box.
RE: Buy CPAP Or Wait Possibly Months For Insurance?
(09-27-2021, 12:06 PM)Sleeprider Wrote: It is your right as a patient to decline any test or procedure, and to pursue a more efficient and effective alternative. There is simply no good reason to do clinical titration when today's machines offer such efficacy and data right out of the box.
Agreed! It's insane to me that they are taking their time when this is obviously a serious issue... Thanks to you guys, I'm actually getting help.
