Quest to diagnosis and start CPAP - some questions

[psm4610]

Hi Folks! Lurker for a few weeks and figured it' time to make my first post!

Over the past few years I have gained a decent amount of weight and noticed increasing daytime sleepiness. About a year ago after speaking with my doctor he recommended a sleep study but at the time my insurance wanted a large sum of money to satisfy my deductible. Fast forward and now after getting married and moving to my wifes insurance I was able to get an in home 3 night study for nothing out of pocket which I just recently completed. I am currently waiting on approval for a full night titration study in lab and recently had one of my doctors proscribe Provigil which has been helping immensely with daytime sleepiness and motivation. Hoping the light at the end of the tunnel is soon and I can start getting a normal nights sleep and start more effectively shedding some of these pounds.

After reading through the forums and doing research I do have a few questions for you folks though:

Does anyone have any experience with Cigna/CareCentrix especially in the Houston area? - I am particularly looking for answers here on how hard it will be to get them to provide a specific machine and how I will be able to do a mask fitting since I will most likely need a full face mask

For those of you with chronic nose stuffiness and sinus issues do you have any advice other than a full mask to allow mouth breathing? Has CPAP worsened or alleviated any of your issues?

I am specifically looking a a ResMed Airsense 10 Autoset or Aircurve (assuming I wont need BiPAP or ASV) specifically due to the data features and ability to self titrate as I see weight loss progress

I am also attaching the study results from the 3 night at home and would appreciate any insight you all may be able to provide. The sleep data can be found at:
drive.google.com/folderview?id=1EDFtCo1S4mBzR0Wa2d5O3TUkFs6BPkce
I do believe that the sleeping position data may be skewed and not represent the time I spend on my side and overestimate the time I spend sleeping supine but I could be wrong and will be confirming accuracy during the titration study

Any help you all can provide will be immensely appreciated!

[Sleeprider]

I don't have direct experience with your insurer, but generally they don't specify your machine unless they also issue it, like with Kaiser. Ask your insurer for a list of in-network DME providers, and then contact them. Choose the one that seems inclined to dispense the machine of your choice. I'll assume you will end up with CPAP, and will recommend the Resmed Airsense 10 Autoset as best in class. You could even self-titrate. All you need is the Rx for Auto-CPAP based on your diagnosis, and instruction to self titrate. The truth of titration is, it is rarely worth it, or accurate. It tries a series of pressures and finds a single best fixed pressure based on about 20 to 60 minutes of use, and a recommendation is made. Auto CPAP nearly always produces a better long-term result without the hassle of sleeping in a clinic. For a person willing to put in the effort to learn, APAP and self titration is the way to go. Even for the small percentage of patients that may need an alternative therapy like ASV, they are almost always dispensed CPAP first. So even the screening value of titration to identify complex apnea cases is negated by insurance policy to always try CPAP first.

I have chronic congestion, deviated septum and my adult daughter endlessly harasses me for the way I breathe at meals. I use the Resmed Airfit 10 nasal pillows, and it resolves the nasal congestion immediately. I have never used a full face mask in the 9 years I have used PAP. Don't discount the possibility that the expansion of your nasal passages with positive air pressure might be the most comfortable sensation you have ever enjoyed. Try nasal pillows first, and go to the bigger, heavier, hotter and leakier full face if necessary, not as a first choice.

Could not access your google drive without permissions. Good luck! Hope you enjoyed the unconventional advise of experience.

[psm4610]

Resmed Airsense 10 Autoset

I don't have direct experience with your insurer, but generally they don't specify your machine unless they also issue it, like with Kaiser.  Ask your insurer for a list of in-network DME providers, and then contact them. Choose the one that seems inclined to dispense the machine of your choice.  I'll assume you will end up with CPAP, and will recommend the Resmed Airsense 10 Autoset as best in class.  You could even self-titrate.  All you need is the Rx for Auto-CPAP based on your diagnosis, and instruction to self titrate.  The truth of titration is, it is rarely worth it, or accurate.  It tries a series of pressures and finds a single best fixed pressure based on about 20 to 60 minutes of use, and a recommendation is made.  Auto CPAP nearly always produces a better long-term result without the hassle of sleeping in a clinic.  For a person willing to put in the effort to learn, APAP and self titration is the way to go.  Even for the small percentage of patients that may need an alternative therapy like ASV, they are almost always dispensed CPAP first.  So even the screening value of titration to identify complex apnea cases is negated by insurance policy to always try CPAP first.

I have chronic congestion, deviated septum and my adult daughter endlessly harasses me for the way I breathe at meals.  I use the Resmed Airfit 10 nasal pillows, and it resolves the nasal congestion immediately.  I have never used a full face mask in the 9 years I have used PAP.  Don't discount the possibility that the expansion of your nasal passages with positive air pressure might be the most comfortable sensation you have ever enjoyed.  Try nasal pillows first, and go to the bigger, heavier, hotter and leakier full face if necessary, not as a first choice.

Could not access your google drive without permissions.  Good luck!  Hope you enjoyed the unconventional advise of experience.

 Thanks for the info Sleeprider! unfortunately the 3rd party billing/authorization fo Cigna (Carecentrix) is basically unwilling to provide information on their in network DME providers.

Very interesting information on your experience with nasal pillows so I may have to give them a try.

Google Drive access should now be fixed.

I called and spoke to Carecentrix for the 5th time today about the authorization and they finally came back and denied in lab full night titration stating not enough evidence of comorbidity. I've already contacted my GP and requested an appeal which may or may not be necessary. I've also asked them to dispense a prescription for a Resmed Airsense 10 Autoset For Her (might as well get the extra algorithm if insurance will still cover it). Since I have a pretty decent GP that respects my opinion and self research I hae fingers crossed I can get a machine soon!

Would be curious to see what others think about the data I linked to on google drive. I am 6ft and 288lbs currently and also have been diagnosed with low Testosterone.

[dmeRT]

no need to fight so hard for an in lab titration study. that's just a waste of money at this point so i'm not surprised insurance is denying coverage.

you had the home sleep study. this shows moderate OSA (ahi 17.1). Now you just need your dr. to write a prescription for the auto cpap (specify the resmed airsense 10 if you'd like). If the auto cpap doesn't fix your apnea, then an in lab study would be warranted.

Call the number on your Cigna insurance card and ask them for a list of in-network providers in your area. Or call some DME's and ask if they par with your insurance.

[Mosquitobait]

If you don't have to pay for it, the lab titration can sometimes identify other problems that the home study didn't pick up. Otherwise, an apap is really all you need and adjustments can be made after the first couple of days. Tell your doctor to put on your prescription the specific machine that you want. The DME has to provide that machine. That will eliminate a lot of your hassles.

Contact your insurer and find out the details. We've had some members surprised that they never actually own their machines, others who could have had it paid for right away vs. a rental and stuff. Find out the actual deal for your coverage in advance.

[psm4610]

If you don't have to pay for it, the lab titration can sometimes identify other problems that the home study didn't pick up.  Otherwise, an apap is really all you need and adjustments can be made after the first couple of days.  Tell your doctor to put on your prescription the specific machine that you want.  The DME has to provide that machine. That will eliminate a lot of your hassles.

Contact your insurer and find out the details.  We've had some members surprised that they never actually own their machines, others who could have had it paid for right away vs. a rental and stuff. Find out the actual deal for your coverage in advance.

This is sort of what of what I was thinking as well since I have no out of pocket responsibility.
I have already sent the doctor specific wording for the prescription taken from the APAP template found on the wiki here.
Still dealing with the nightmare of finding out the fine print of my policy since all tge policy docs say is 100% coverage. They do not specify anything about rental/own, compliance or anything else.

[SarcasticDave94]

Welcome to the Dentist Board. When dealing with insurance and the DME, we get to pull teeth to get the answer you seek. Seriously, best wishes going forward.

Dave

[Sleeprider]

This is exactly what I was saying in my first post, that in-lab titration is a waste and a royal pain in the ...

You will do great on Auto CPAP with the help of the forum. Wherever you go for service, request the Resmed Airsense 10 Autoset. This will be a full data machine that is the most responsive and has the best comfort features. Nothing wrong with the Philips Respironics Dreamstation Auto, but it does need to be more fine-tuned in minimum pressure. The forum will help you to optimize whatever you get. Do not take a non-data machine, and try to avoid the BMC Apex and other Chinese APAP machines that are cheap and becoming more common. Resmed or Philips, and you can't go wrong.

[dsmith14469]

I have Cigna but in Rochester NY. If you can log into Cigna and create an account on MyCigna there is a option somewhere to search for doctors, labs and DME that are in network.

[trish6hundred]

Hi psm4610,
WELCOME! to the forum.!
I wish you good luck on your CPAP journey.