CPAP Coming My Way..Need Guidance

[HalfAsleep]

I have qualified under AHI 18, rated "moderate" I have Medicare.

What happens next?

Presumably titration study via new sleep test.

Do I go home with the machine they use for the test? Or do they just use a standard machine and build a prescription?

At what point to I get to choose my own machine?

How do I get a prescription for a mask? How do I get to choose?

How do I get related stuff? Or is there any more stuff that goes with a prescription?

What do I have to budget for that isn't on a prescription?


I'm sure I'll have more questions, but I want to get my ducks in a row for any decisions that can't be reversed.


Thanks!

[Walla Walla]

Under Medicare you pay 20% of what Medicare pays. You'll get your machine from a DME. Normally you'll have a choice between a couple of them. Medicare rents the machine. Which machine you get depends on your sleep study and what brand the DME carries. Mask are included in the prescription that your Sleep Doctor will write after titration. The DME's also supply you with replacement parts at 20% from you. Read up on picking a machine and mask here on the board. Good Luck.

[Gideon]

I have qualified under AHI 18, rated "moderate" I have Medicare.

What happens next?

Presumably titration study via new sleep test.

Do I go home with the machine they use for the test? Or do they just use a standard machine and build a prescription?  
The machine they use is specialized for sleep labs, you will not get it.

At what point to I get to choose my own machine?
You will have to exercise some control and insistence here, many DMEs will give you the cheapest machine they can, and frequently one that, despite what they say, doesn't provide full efficacy data (detailed data, down to the ability to look at every breath you took at night in extreme detail).  Assuming that you do not need a more advanced machine (the sleep studies will give us insight into this) we typically recommend an Auto CPAP.  You need to communicate to your Dr that if you don't need a more advanced machine you want an Auto CPAP with a Heated Hose.  It gives more therapy choices and in Auto mode it's like getting a new Titration Study (not exactly) every night.

How do I get a prescription for a mask? How do I get to choose?
You NEED to try masks on, under pressure, every visit to a sleep lab or your DME!!!  Read the Mask Primer, it even includes a strategy for trying masks.

How do I get related stuff? Or is there any more stuff that goes with a prescription?  
Filters, new mask parts on a regular schedule, new masks, chin Strap.


What do I have to budget for that isn't on a prescription?
Don't worry about this right now, everything here may or may not be needed.     Anything needed for position management, possibly a specialized pillow, or a cervical collar ($10-15) to help prevent your mouth from opening


I'm sure I'll have more questions, but I want to get my ducks in a row for any decisions that can't be reversed.


Thanks!

Welcome to the Apnea Board,  you will find your answers here.

First get and post your first study here. It contains information that will help us to help you.  The second study when you get it too.   Same reason.

First an important link (also in my signature) New to Apnea? Helpful tips to ensure success
the second article will walk you thru the typical process



Hope this helps you



Fred

[Sleeprider]

The normal course of action upon diagnosis with sleep apnea is a sleep test to determine if CPAP can resolve events to an acceptable level. That is commonly called a titration study. The process can be shortcut by asking your primary care physician to prescribe an Auto CPAP with orders for self-titration, along with mask and supplies. If you feel you can do that (I did), then it saves a lot of money and time. The sleep specialists, clinics and DMEs aren't real big on that approach, but it's out there for those that like to control their own therapy. We can help.

If you follow the normal course with a second sleep study, you will be given a trial on CPAP with pressure controlled by a technician. That test will be scheduled about a month from now. Following the test, it will be about 2-3 weeks before you hear the results, then you will be issued a prescription that will be forwarded to an in-network DME to dispense the machine, train you in its use, and fit you with a mask. That is usually another 2-3 week delay. The DME will bill Medicare, and you will be responsible for 20% of the cost if you don't have Part B coverage that covers durable medical equipment. Typically Medicare rents the equipment for 13 months after which ownership reverts to you.

Or, you could spend $360 on Amazon and have a Dreamstation DSX500T11 auto CPAP at your house in less than a week. The point is, the medical system is going to run you around for at least 2-months, and over-charge you in the name of giving you complete professional care. Be ready for it. It is possible to use your primary care doctor to write the script, educate yourself here, and save a lot of time and money. The most important thing you can do now is get the results of your sleep test for your records and note the distribution of obstructive, central and hypopnea events. With mostly obstructive sleep apnea with hypopnea, you can probably treat this with an auto CPAP set to a pressure between 6-11 and 85% of people will be fully resolved. Most of the rest will need some refinement. A few will develop a central or complex apnea that needs a different approach, however your clinical titration study will not attempt to diagnose or identify that anyway. So there really is not much disadvantage to self titration with auto CPAP.

[HalfAsleep]

Thanks all and Bonjour. Exactly what I needed to get answers to!

[HalfAsleep]

Thanks Sleeprider. YOu guys are awesome.

Where do I find out which are my local DME's?

[Gideon]

I will add that the team here are at the "expert" level on therapy, and they can and will help you, all the way to recommending that you contact your Dr. to resolve some specific issues.

Fred

[trish6hundred]

Hi HalfAsleep,
WELCOME! to the forum.!
Good luck to you as you start your CPAP journey, hang in there for more answers to your questions.

[SarcasticDave94]

Thanks Sleeprider. YOu guys are awesome.

Where do I find out which are my local DME's?

For myself, to get that answer I called my health insurance customer service phone number. I asked them which DME suppliers were in-network.