Insurance and Cpap
I just finished my sleep study and am waiting for the DME to contact me regarding the equipment. I've got BCBS and was told by the staff that the machine is rented for a few months and then at some point it becomes mine. Other things I heard that I need to be compliant (certain number of hours, certain percentage) or they could take the machine away. Since I don't get a lot of sleep on a regular basis (5-6 hrs/night), I'm somewhat concerned that all this could be for naught. Any thoughts on this one?
Also, I'm slated for an Airsense 10 (so I was told) and I've researched the different models and expect them to give me the cheapest model. Any thoughts on how to 'push' them to a better machine if they want to 'cheap out'?
Finally, I was told that 8psi was the sweet spot for my apnia. Would this mean that 8psi would be the maximum pressure set on the machine?
Lots of questions, I know. Newbie here, so thanks for all your help.
RE: Insurance and Cpap
Hi SD50 and welcome to the forum. It sounds like your insurance does the typical "try before you buy" thing and sets you up with a rental to see if a) CPAP therapy works for you and 2) that you'll work with CPAP therapy before they outlay the cash to actually buy you a machine. That is typical.
At 5-6 hours a night, you'll be over their magic 4 hours a night for compliance...assuming you use the machine the full time when you sleep.
About pushing for something other than a non-data recording (we often call them "bricks") CPAP machine, others may have better advice to give. I'd say that you should get a copy of your prescription and see what it specifies. If it is very limiting (i.e. only one pressure), then try to talk to your doctor about getting a prescription that has more flexibility (like a range or pressure, and if you have a great doc, have the prescription for "data capable")....it'll usually give you room to push/force the durable medical equipment supplier (we shorten it to "DME") for a better machine.
Your pressure of 8 cm H20 (centimeters of water) is in a fairly common range for treatment (especially compared to 8 psi, which is massive pressure in comparison and would give you no end of grief  ). Depending on the machine, they may set up up with a constant pressure of 8 cm H20 or they may have a range (i.e. an auto adjusting machine with a range of 6-20). You'll find out when you get your machine which way it is set up.
Again, welcome and hopefully someone else will chime in with some key phrases and tactics to help you avoid getting stuck with a brick.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Insurance and Cpap
8 psi = 562 cm-H2O. It would blow you apart!
RE: Insurance and Cpap
Thanks for the comments. My units of measurement are clearly off, so thanks of the clarification.
RE: Insurance and Cpap
Here is the machine I recommend
AirSense™ 10 AutoSet For Her CPAP Machine with HumidAir™ Heated Humidifier
With heated hose option.
Most insurance companies pay a flat rate for an XPAP machine, weather a brick or top of the line. So know what you want, know what it looks like, if they offer you anything less, don't walk out with it. Insist on what you want and be ready to go down the street if they won't provide it.
RE: Insurance and Cpap
regarding compliance, if you have problems getting more than 4 hrs with the machine for whatever reason, wear it for a few hrs in the evening while awake in addition. Some people tear the mask off in their sleep, and if that is you, you will want to get in the compliance period, however you can. If you are unable to use it for the full sleep time, revisit mask choice. Your DME will be motivated to get you a mask that can help you be compliant, because it sucks for them if the Insurance won't pay. (although my DME had a paper to sign that if I dont comply and insurance doesnt pay they can bill me for the full inflated amt, so watch what they give you to sign and do it with eyes open)
Auto adjusting with a range is absolutely the best, and data capable is IMO indispensable. *someone* should be monitoring that data and tweaking to get best results. You, an RT, a sleep doc..... best if it is you
Humidifier and climateline hose are also indispensable unless you have leather lined sinuses
Mask choice is hard, and I don't know about your DME but mine did not have a place to try it out laying down. (bad) Don't take it for granted that you will mouth breathe even if you always have and try everything they have before deciding. Pay attention to how hard the air vents out of the mask, some masks have a more diffuse output than others and are better for both the wearer and any bed sharer. A mask that works for you will be the difference between therapy that works and therapy that won't.
RE: Insurance and Cpap
Cannot stress enough that the "sweet spot" they have come up with is probably wrong. Get with your doc and insist the machine be set to auto mode with a range of maybe 8 to 11 to start with.
If you dont need more than 8 which is very low great. But youll likely need a bit more on alot of nights. If set to auto with a max of 11 the machine has some room to raise pressure to deal with your needs. If you dont need it it wont go higher than 8.
Setting a auto machine to run straight cpap is like having a Ferrari and only running it in first gear all the time. Senseless.
You need to be on the machine at least 4 hours a night 70 percent of nights in the first 90 days. The machine cant tell if your asleep or not but it can tell if its actually on a person. As already stated if you get 5 to 6 hrs of bed time a night your above the curve already.
12-18-2014, 02:16 PM
(This post was last modified: 12-18-2014, 02:16 PM by Amie87.)
RE: Insurance and Cpap
(12-18-2014, 01:48 PM)bwexler Wrote: Here is the machine I recommend
AirSense™ 10 AutoSet For Her CPAP Machine with HumidAir™ Heated Humidifier
With heated hose option.
Most insurance companies pay a flat rate for an XPAP machine, weather a brick or top of the line. So know what you want, know what it looks like, if they offer you anything less, don't walk out with it. Insist on what you want and be ready to go down the street if they won't provide it.
'For Her'? Don't you mean 'For Him'? 
RE: Insurance and Cpap
(12-18-2014, 02:16 PM)Amie87 Wrote: 'For Her'? Don't you mean 'For Him'?
The dudes are liking the "For Her" algorithm - and the reporting of RERAs
12-18-2014, 02:24 PM
(This post was last modified: 12-18-2014, 02:28 PM by Ghost1958.)
RE: Insurance and Cpap
Some recommend the Resmed Airsense but dont overlook the Respironics PRS1 Series Sixty (model 560) with heated hose.
Several reasons wife and I both choose that brand of machine. One its more battery friendly with no inverters etc needed. It will run off a plain old generator with modified sine wave according to the tech I spoke with at the factory instead of needing pure sine wave power.
Respironics also has a full 2 yr warranty on their machines and are very good to honor it. However the choice of machine is yours to make.
Insurance pays by Medicare codes even if its not medicare. The code for a brick or a top of the line auto machine is the same so the DME gets paid the same either way. And makes a tidy profit regardless of which machine they give you auto or brick of whatever brand.
Get your doc to prescribe an auto machine then pick what you want of the top of the line autos. If that DME doesnt want to do it find another. Your not locked to a particular DME, you can go any one of em you choose.
If the first one tries to say they can only get a brick machine they ARE lying to you and your better off to go somewhere else. Get a hard copy of your prescription and dont let them hang you with a sub standard machine. Usually if they know you know they get paid the same up front they are easier to work with.
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