insurance route or not be insurance route - that is the question

[Mr. Van Winkle]

Here's my experience: 17 days with insurance

March 24 Family Doc suggested a sleep study
March 26 Appointment with Sleep Center Doctor
March 26 Sleep study part 1 in the lab
March 31 Sleep Study part 2 titration in the lab
April 2 Met with Sleep Center Doctor to review results
April 7 DME has the prescription and approval from insurance
April 10 Met the local in-network DME and purchased a machine

That was only 17 days from start to finish. May have helped that I was seeing the doc for months prior ruling out other things, so insurance probably had all the historical data they needed to make quick decisions. Also the docs were on the ball calling and coordinating insurance approvals.

Our insurance coverage is 80% of contracted rates for DME and supplies in-network, and 50% of reasonable and customary for out of network. Deductible (and out of pocket max) was already met so buying through the insurance was a no-brainer for us.

Also, felt fortunate that ins allowed us to pick out the machine we wanted and purchase it without a rent-for-compliance period.

I'm not sure about the question of how long until you settled on the equipment you were satisfied with.

- If you mean the machine .. In my case I'm sort of stuck with the machine I picked but I feel very good about what we bought (ResMed S10 Auto CPAP) based on what I learned here before ever meeting the DME. My prescription is fixed 10cm but I chose an auto machine based on advice I read here.

- If you mean the face mask.. the jury is still out. I opted for a F10 and after 4 nights I'm still trying to figure out how to adjust it properly and find a comfortable sleep position without massive air leaks.

First two nights I was uncomfortable from the air pressure but only had small leaks. I am getting accustomed to the air pressure but third night saw moderate leaks, and last night was off the charts. ResMed's eye in the sky is sending me emails an hour after I wake up each day with clever stuff like: Hey, bet you woke up with a dry mouth! Maybe you need to talk to someone about leaks.

Believe me I am not complaining... I don't feel wonderful yet but better is a good start and I get through the day without a nap.

saldus miegas

Wow! you sure had good experience .

[worn_out_in_lebanon]

Something that just came up in another conversation - if you buy on your own - nobody to answer to for usage related questions.
(how many days, how many hours per day, why are you changing your settings, etc.)

[OMyMyOHellYes]

For those who got their machine via insurance how long did it take until you were satisfied with the equipment you eventually settled upon.

I guess I'm asking on average how long does it take to run the insurance gauntlet?

I am useless at this point.

Question #2

Have you successfully filed a claim for reimbursement for a PAP machine?

No doubt I could search here for the info but there is that ADD thing. Oh that thread is shiny which leads to the next shiny thread and before I know it the day is over and I have learned much and accomplished nothing concrete.

How long did it take me to get satisfied with the equipment I was first issued? About five minutes after I turned off the light. That was an S-8 Elite that I never ever took data from, but had exceptionally good service from for at least six years (as I would gain weight and start feeling worse during the day, I would bump up the pressure .5 cm at a time. Upped from 9.0 to 11.0 over that time). Getting that unit took about a week or so from my third sleep study (first one washed out as I couldn't get to sleep in the industrial park sleep lab - then the diagnostic sleep study at the hospital followed a week later with the titration study). The sleep doc had to read it first, then sent the raw data over to my doc who then did his own interpretation and wrote the script to the DME of my choice (I'll admit it - it was Apria - I was young and dumb). I was lucky. Second mask I tried on in their office that day was the same one I wore for all six years on that machine (well, replaced occasionally with the same model - Respironics Comfort Classic).

Next was the S-9 Auto and I was very pleased. The sleep lab/DME practice where I did the second sleep study was real good about referring me to another DME when I told them that based on my satisfaction with the S-8 and the confidence it had inspired, I wanted the S-9 rather than the Respironics 550 Auto they were going to provide. They only distributed the Respironics machines and were very gracious about the referral. Was in no hurry then as I still had my trusty S-8, but I had it in like three days from the study.

Have never filed a claim for purchase of a machine - got two of them from in-network DME suppliers that did all the paperwork behind the scenes.

OMMOHY

[bwexler]

think my first machine was close to a month, the second about 2 weeks.
You may discover the squeaky wheel gets the grease. If a call can get some attention 2 to 5 calls a day can get some action. The folks may or may not like me now but I got what I wanted quickly. The girl at the sleep lab was always friendly and helpful, when I asked how quickly I could get my sleep report the day after I went home from the test here response was, do you have email? I had my copy before we hung up. Then I pushed for the insurance approval and talked to Crapria while I waited. It was about 2 weeks start to finish.

[distantdreamer]

Mine took a few weeks from the referral for the re-titration study (on a different insurance than previous study). But once approval came through I did the in lab study on a Friday. The next Friday I had follow up appt with my primary and he wrote my Rx for exactly what machine I wanted. The following week I started calling insurance and DME for cost info. No one would help so I took a chance and called the study center, who apparently also has a DME side to their business and they promptly ordered my machine on that Wednesday and I had it the very next Tuesday. It helped that they already had my insurance info and approvals on file. So just over two weeks from study to getting my machine. Granted I didnt have to go through the diagnosis study or it may have taken a bit longer.

It was pricey for me to go that route because of my high deductible, but being the beginning of the year I decided I was okay with it knowing that now for the rest of the year I have no more bills to pay medical wise.

[truetopath]

Mine was a two week process from start to finish. I guess I got lucky. My insurance DME coverage is 50/50 so I went that route.

[Mark Douglas]

My wife says I'm am obsessed with this forum and this subject. My reply is
1- I have been sick and tired for so long so yes I am highly motivated and
2- its an ADHD thing. You say obsession - I say hyper-focus. Tamahto tomato.

But she is correct inasmuch as I spend way too much time here.

Tues go to Doc and see what he has to offer re his other patients experiences good and bad.
If favorable do the sleep study and go to DME and see what they say. Anything less than an out the door bottom line I will take as an attempt to set me up for the slaughter. There will NO CC involvement. After reading the horror stories of so many other's I am not going to trust my credit rating to the vagaries of the "medical mafia"....
If DME co-pay costs are even close to outright purchase then I will simply buy my own and take my chances and not have "compliance" to deal with. I don't need to be threatened with "compliance" I am convinced of the need and highly motivated to get a good nights rest for the rest of my life.
If I go without insurance route and then experience with software indicates CSA events and need fancier machine can always go back to the ins treadmill if I must. Wife also IMHO has OSA so if I buy a machine that ultimately doesn't work out for me it may well work for her. If I wake up dead my problem solved and she can find a more stable guy.

So I will sign off and return to meat-space and report back when I have something worth reporting.

[PaulaO2]

Please do report back. We look forward to it!

[SaldusMiegas]

Mark,

I guess one other possibility is the doc could review the previous report and prescription, then simply write you a new prescription. If you haven't already done, it would be worth getting the previous sleep study report into your doctor's hands before the appt on Tuesday. We did this for my spouse who had an earlier sleep study that never got followed up on. We were actually at the doctor office when the doc suggested maybe doing a sleep study and we said hey you know she did have one last summer. Sitting in the doc office I called the sleep center and they faxed the report immediately. Doc read it and decided to write a script for the auto CPAP machine without a titration study.

I mention this to say you have a day to get the report faxed to your doc and maybe something similar could happen for you. When sending your medical records to another doc office, all they need is doc name and fax number.

good luck with this. Glad you are taking action this week.

saldus miegas

[trailrider]

At least take in Ebworth sleepiness test with you as benchmark.