What if Machine Assigned Wrong?

[Snorzz]

Waiting on sleep report review, but pretty sure it will be apnea.  Something is worrying me.  What if, say, I get assigned the $900 Autosense, but later find I really need the $1700 Vauto or the $3000 ASV?  Does the more expensive machine come out of my pocket, not insurance?  Or will they really, really know from the titration study which model I need?

[Walla Walla]

It would take too long to try to address all of the issues. The best thing you can do is call your insurance company and ask what their policy is.

Generally though if the machine is being rented it is returned and a new machine is issued providing the Doctor can justify the change.

[Snorzz]

So, best to rent the machine for a while?  If that option exists.

[silversnore]

Insurance and medicare have rules on how or what type of machine which you can qualify. IE, they want to spend the least amount of money possible for your treatment. If the machine that your insurance approves does not treat your apneas then you fail on that type of machine. Generally you have to go back to your doctor and eventually the insurance will approve another machine. The DME are under some sort of contract agreement with the insurance companies to help make your treatment work and the compliance issue. I would advise that you be very proactive with your treatment and machine that gets prescribed. When I first was prescribed my machine, I posted my sleep report and prescription to this forum. With the advice of some very knowledgeable people here, I approached my doctor and ended up with getting the machine that forum members advised. I have spent the last year with AHI averaging .5 or less. With help from a certain individual, I was able to set my own pressures. Get educated here and be proactive, it will save you a lot of time and heartache. Good luck!!

[Walla Walla]

So, best to rent the machine for a while?  If that option exists.

Usually it's a rent to own agreement. The reason is the insurance company doesn't want to buy it right away if your not compliant in using it. But it also helps in case you have to change machines.

Like I said before check with your insurance to see your options.

[Snorzz]

OK silversnore, ur making me feel better abt being such a worry wart.  However, I know that usually what can go wrong will go wrong, so I have been googling madly on this subject.  Abt 3 weeks ago I was demanding that my urologist remove my prostate to stop the constant peeing that was keeping me up all night.  Thankfully, he was honest and sent me in this direction.  Hope I have finally found the cause and can get some sleep.

[SarcasticDave94]

Most likely, you would have to follow a similar path to what happened to me, at least until you're issued the proper machine. I first was assigned a CPAP after a 2 night sleep study. Yours could be handled in one night which is called a split sleep study. Mine was supposed to be that way, but the tech failed to split the time between the 2 segments. My second night was focused on titration only, as was the following 2 sleep studies.

The CPAP I was given was set to 18 as I have severe sleep apnea. I failed that compliance, treatment failed also, and it was returned in the summer of 2015. I took 2016 off to pursue bariatric surgery for weight loss. In early '17 I took a new PSG for BiPAP, and was issued a DreamStation Auto BiPAP, which I also failed because of central apnea being in a very high concentration. I failed compliance and treatment again. Then I was off to the ASV.

This required another sleep study, a heart echo, and a follow-up consultation with a heart specialist to clear me of the possible issues between the heart and ASV treatment. I passed that hurdle. After some delays, I was finally issued an ASV by ResMed.

Each machine was on a 13 month rental agreement between the DME and insurance. And each machine's issuance was after a PSG sleep study to prove it was necessary.

[silversnore]

A good bit of the time, your prescribing doctor may not prescribe the best machine or his hands are tied by the insurance guidelines.  You have a legal right to your medical histories, get your studies and prescriptions.  Be pro-active by getting the knowledge to be able to help yourself get the machine you need and how and why it will work for you.  This forum is a great place to discover.  Understanding is the best preparation in positive treatment of your disease.   At any rate make sure that you get a data recording machine, preferably an auto.  Many people on this forum prefer the ResMed machines as they are more proactive in handling your treatment.  Good Luck!!

[Sleeprider]

Waiting on sleep report review, but pretty sure it will be apnea.  Something is worrying me.  What if, say, I get assigned the $900 Autosense, but later find I really need the $1700 Vauto or the $3000 ASV?  Does the more expensive machine come out of my pocket, not insurance?  Or will they really, really know from the titration study which model I need?

You really are getting ahead of yourself.  Focus on getting the best auto CPAP possible for now. If there is a problem, it will be sorted out.  The next step in your process is to get the prescription and review it and understand it.  If the diagnosis is obstructive sleep apnea, a CPAP will be prescribed unless there is a clear medical need for something else.  At this point you should be researching what DMEs are in your insurance network, and making a choice of which one is the best fit for you.  Call around and see who issues the Resmed Airsense 10 Autoset, and who dispenses dumb fixed CPAP.  Working with a supplier that normally dispenses the better equipment will generally provide a better experience.

Your insurance company will have a policy for DME purchase and rental.  Many will rent for 3-months and pay it off once you have demonstrated compliance, and had your physician follow-up.  Others will require new users to rent for up to 13 months.  Knowing what your insurance allows will help you avoid longer rental periods, which can be a problem for copays and deductibles since it usually spans two policy periods. Longer rentals are more profitable for the DME, so try to avoid that if possible by knowing what your insurance allows.

[SarcasticDave94]

Sleeprider is correct. Take this one step at a time. You have taken the sleep study. Now, contact your insurance customer service line to learn which Durable Medical Equipment (DME) providers are in-network with your insurance, and are near you. Also, you need to find out the guidelines from your insurance for the rental or purchase of a CPAP device and the parts needed to use it, such as the mask and replacement parts, etc.

Another thing to consider, is to learn here which machines are going to help you get proper treatment, such as avoiding brick CPAPs and obtaining one that will have data reporting capabilities. And also there's the action of you getting hard copies of the CPAP sleep study and prescription. Both of which you legally can obtain from the doctor who prescribed the CPAP.

Then, when assigned the CPAP machine, start using it, and posting reports, including the above-mentioned sleep study and prescription, making sure to redact/black out personal info that needs not be shared. What this does then is the knowledgeable guys N gals here can suggest pressure setting tweaks to assure you that your CPAP gives you the best therapy possible.

BTW