[Equipment] New vs. Used Equipment

[T.Hud]

My insurance is pretty good. Except for sleep apnea. After having sleep studies done for CPAP and later BiPap, I've ended up buying "opened box" new machines just to avoid the hassle of dealing with them. But after several years of CPAP I seem to have developed more and more CA's (no OA's) to the point where my AHI varies from 6 to 9 each night. The insurance company has just denied my doctor's request for an ASV titration (sleep study). I'm fairly confident an ASV machine will treat my CA's so I'm just going to get a prescription from my doctor and buy one.

ASV's are expensive so again I'm looking at buying a new "opened box" machine or a used one. Used will be less expensive but I'm wary. Is it possible that a Resmed ASV machine with just a few hours on it is defective in some way? Since I've never used an ASV machine, how would I know if it was working correctly or not? I guess my AHI dropping will be a big clue but does anyone out there know anything I should consider on a used machine purchase? I found one from a reputable re-seller with 10 hours on it.

[srlevine1]

My insurance is pretty good. Except for sleep apnea. After having sleep studies done for CPAP and later BiPap, I've ended up buying "opened box" new machines just to avoid the hassle of dealing with them. But after several years of CPAP I seem to have developed more and more CA's (no OA's) to the point where my AHI varies from 6 to 9 each night. The insurance company has just denied my doctor's request for an ASV titration (sleep study). I'm fairly confident an ASV machine will treat my CA's so I'm just going to get a prescription from my doctor and buy one.

ASV's are expensive so again I'm looking at buying a new "opened box" machine or a used one. Used will be less expensive but I'm wary. Is it possible that a Resmed ASV machine with just a few hours on it is defective in some way? Since I've never used an ASV machine, how would I know if it was working correctly or not? I guess my AHI dropping will be a big clue but does anyone out there know anything I should consider on a used machine purchase? I found one from a reputable re-seller with 10 hours on it.

With regard to questions about a used machine, you have essentially answered your own question by considering a purchase from a "reputable re-seller." Ask about warranty terms and conditions as well as "after" warranty service. Ask about temporary rental machines if your machine needs repair. And, ask about the vendor's access to repair parts from the manufacturer; as opposed to accessing parts from "cannibalized" machines.

With regard to a titration study, ask your doctor to challenge your insurance company, and as an ultimate threat, consider contacting an attorney to pursue an unfair denial in the clear evidence of medical necessity. If you have insurance through your company, ask your company's insurance agent to aggressively look at the claim. Insurance companies are afraid of losing a company's business, but will often abuse individuals with impunity.

Perhaps someone here could look at your Sleepyhead data from your current machine and make a recommendation for a safe starting point for an ASV machine that you could confirm with your own sleep doctor.

Hang in there -- and best of luck.

[Mosquitobait]

May I suggest that you file an appeal for an ASV titration? Some pencil pushers deny everything so that you provide evidence of need.

[PaulaO2]

If you deal with Supplier #2, you can always call them explain the situation, and they may be able to help you. They may "rent" you one for a short time or accept it back on return if it does not work out for you.

The insurance company probably turned down the ASV because that is what they do. Appeal it. They may want to fork out a ton of money for a sleep study first (which may not be a bad idea) then pay for it once it is justified. Either way, appeal their current decision as soon as possible. Don't let the time run out.

[Sleeprider]

A used ASV will be relatively hard to find, however they do come up occasionally due to a previous owner's intolerance of the breath timing and higher IPAP pressures. At least one forum member I'm aware of has purchased several PRS1 BiPAP AutoSV Model 960 machines used. There seems to be more Respironics and Resmed S9 VPAP Adapt machines available than newer Aircurve. I suppose it could happen that a defective machine would be sold, but most of the time it is just like any other CPAP or BPAP; it works fine but the seller wants cash, not treatment. For the lowest used prices I use a Craigslist search engine called SearchTempest. Obviously, there are risks to buying through Craigslist, especially if you can't do the transaction in person, but I have not seen this specialized machine as a scam target. For example there is a S9 VPAP Adapt listed in the Rochester, NY Craigslist that includes the sellers home address. I doubt that is a fraud. If I was interested in buying that machine listed at $495, I would contact them personally by phone before putting any money into it.

[T.Hud]

Thanks everyone. I have more information now than I did before and really appreciate it. After passing up two Resmed ASV machines on Craig's List in the last few months I ended up purchasing a used one from Supplier #2 today. I didn't know the supplier list on this forum existed until yesterday and it's very useful(I have no excuse, they make it very obvious at the top of the page!)

The supplier doesn't rent machines and they don't repair anything themselves. They do a check when they receive used machines to validate that the pressures are accurate and that it's from a non-smoking environment. They clean it and warranty it for one year (extended warranty for an additional year costs $50).

There are extenuating health issues that made me decide to get this ASAP. I don't think I can wait another month or two to engage Aetna and get them to do the right thing. I realize that by side-stepping insurance I've done exactly what they wanted me to do and I will eventually have to do this again in 5-7 years when the machine wears out.

[srlevine1]

Thanks everyone. I have more information now than I did before and really appreciate it. After passing up two Resmed ASV machines on Craig's List in the last few months I ended up purchasing a used one from Supplier #2 today. I didn't know the supplier list on this forum existed until yesterday and it's very useful(I have no excuse, they make it very obvious at the top of the page!)

The supplier doesn't rent machines and they don't repair anything themselves. They do a check when they receive used machines to validate that the pressures are accurate and that it's from a non-smoking environment. They clean it and warranty it for one year (extended warranty for an additional year costs $50).

There are extenuating health issues that made me decide to get this ASAP. I don't think I can wait another month or two to engage Aetna and get them to do the right thing. I realize that by side-stepping insurance I've done exactly what they wanted me to do and I will eventually have to do this again in 5-7 years when the machine wears out.

You may want to bring the device to your doctor's office and have him look it over just to sprinkle holy water on the transaction. You may also want to do your own 30-day compliance test and review with your doctor to make sure the settings are correct and therapy is working.

You may also want to continue to pursue the insurance claim to show that the device was medically necessary -- and seek reimbursement for your expenditure. The last thing you want on your insurance records is an affirmative denial without a challenge as this information may go to the big database in the sky that is shared among insurers and pre-condition the next decision.

[OpalRose]

Agree with srlevine1.
If you do not pursue the insurance claim, you wont even have a chance 5 to 7 years from now. They will have the denial on record and the fact you did not appeal it.

I would appeal the denial no matter how long it takes. It dosen't matter that you have now bought your own machine out of pocket. Go ahead and use it. If insurance does eventually approve your claim, then you will have a backup machine.

[Sleeprider]

This is pretty familiar territory, so my story might be relevant to you. I was issued my first M-Series machine in 2008 and insurance paid. I had high deductibles in 2013 and bought a PRS1 60 Series Auto used out of pocket, then a PRS1 60 Auto BiPAP in 2014. I worked with my physician documenting need for the bilevel and getting a new prescription. With better insurance I submitted a claim for a new auto bilevel in late 2015, which was denied, but an auto was approved, which I declined. We assembled the sleep study records from 2008 and a recommendation, including "intolerance of CPAP" and appeal for bilevel from my doctor, and the new machine was approved in Feb, 2016.

My thoughts are that this claim will be on record when I make my first Medicare claim (whenever), and it's important that I establish the need and insurance history now. So technically, my M-Series auto was "unrepairable" and replaced with an Aircurve 10 Vauto. Lots of work, but this illustrates don't let a denial go unappealed. I had great assistance from my doctor and the hand-picked DME I was going to buy the bilevel from.

Your challenge will be to work with your doctor and document the efficacy and need for ASV, assuming you get positive results. That should then translate into documentation of your compliance, need and a prescription. All of that can feed into an appeal of denial. The fact you buy your own machine is completely off the map for insurance, they will be looking for establishing medical necessity for the ASV as a new machine replacing your last insured Auto CPAP. You need to ensure his records include a diagnosis of central apnea that he recommends be treated for ASV. Be sure to Google insurance reimbursement rules for ASV. You will find Medicare Guidelines for ASV, http://www.medicareecodes.mobi/medicare-...s-for-asv/ and other good articles. YOU need to read these so you can assist your doctor. Insanity rules!

[trish6hundred]

Hi T.Hud,
Good luck with your new machine and dealing with your insurance.