Titration study needed?

[Pearson28]

I'm supposed to go in for my titration visit tomorrow night.

My sleep clinician said to me today "if insurance companies all specified APAP machines I'd be out of a job". So why should I bother paying $600 out of pocket for the titration when an APAP will auto adjust pressure?

Am I getting set up for a rip off or did I misunderstand?

Thanks.

[yaconsult]

It is the way it is normally done. If a patient has severe apnea, they will often do the titration during the second half of the night of the sleep test. But many doctors and sleep labs and insurance companies have a certain protocol that they need to follow. The advantage of the titration is that a trained technician will determine the range of pressures that you need and this may get you closer to the ideal setting for you compared to getting a machine that is set "wide open" at the default range of 4-20.

The doctor may or may not be willing to prescribe a machine without a titration study - it's up to him. That's a terribly high co-pay, unfortunately. You could call and ask the doctor if he is willing to prescribe an auto-adjusting cpap machine with full data so that you can monitor your progress and have adjustments made as necessary. But it's his call if he is willing to that or not. Explain to him that the high copay is a problem for you.

Did you check the prices on cpap.com? Also, give them a call and ask for the best price on a particular machine. Often, the manufacturers do not allow them to list prices lower than the official list prices but better prices are available on request.

The bottom line is to talk to your insurance company and find out exactly how much you will have to pay out of pocket. If you can buy it for cheaper than that yourself, then do so! Unless there are other reasons, like the need to meet a deductible for the year or something like that. Lightly used machines with a warranty are available for even cheaper from secondwindcpap.com.

[Pearson28]

Thanks for all the information. Once I get the titration done, I'll call the insurance company. If I get involved now, I'm afraid it will set me back even further.

My sleep center has been calling my Insurance Co. to get my titration authorization but has had no luck so far. I did the overnight home study back in the first week of September so I'm frustrated this is taking so long. Now I'm on standby, waiting on my insurance approval and a cancellation at the sleep center so they can squeeze me in.

Rant over.

[ChicagoGranny]

Now I'm on standby, waiting on my insurance approval and a cancellation at the sleep center so they can squeeze me in.

Rant over.

The sleep industry has a very poor and outdated supply chain model for delivering services and products to patients.

[Sleeprider]

You have a Dx for obstructive sleep apnea, and the patient right to decline any procedure or test. Request the Rx for an auto-cpap. Insurance will probably allow it with the sleep study and doctor Rx, however, failing that, you could still buy a Dreamstation Auto with heated hose on Amazon for about $400 and be a few hundred $$ ahead.

You are the patient / customer. It is entirely up to you to understand the process and to assert your rights. Get a full copy of the sleep study for your records. Ask for the APAP / self-titration prescription. If your sleep doctor won't write the script, get it from your primary. Self-titration with an APAP is an accepted, medically effective approach for simple diagnosed OSA. If you had complex or central apnea, get the titration.

[Pearson28]

Just a quick update...after many, many phone calls, the insurance company finally denied the titration overnighter last week and issued orders for an APAP. I'm well into my 3rd month on this journey. Another week until I see the original doctor who ordered the sleep study again. I am guessing he will simply write the script for the APAP and turn me loose. Time to go study some of the info. you've all provided so I'm armed before I go in there because he's a general practicing physician and he won't know the first thing about any of this.

[jtravel]

Just a quick update...after many, many phone calls, the insurance company finally denied the titration overnighter last week and issued orders for an APAP. I'm well into my 3rd month on this journey. Another week until I see the original doctor who ordered the sleep study again. I am guessing he will simply write the script for the APAP and turn me loose. Time to go study some of the info. you've all provided so I'm armed before I go in there because he's a general practicing physician and he won't know the first thing about any of this.

This is the same thing that happened to me. DR requested Split-night sleep study May 2016 with Titration but was denied. They only allowed a Home sleep study.
I purchased a used Apap from private party on this Forum as I was suffering extreme OSA symptoms and had been on treatment over the last couple of decades off and on.
Home sleep study completed July 2016 with overall AHI of 29, % time < 90% SPO2 36%
Sleep study recommended titration or Apap and the option of MAS.
I told the DR I could not wait for Insurance decisions any longer and Wanted a Prescription written for the APAP so I could purchase on my own. he complied and also
requested a Titration study but again denied and APAP approved OCT 2016.
Request sent to DMA to provide Apap Nov 2016

The DMA will rent the Apap Machine to me for 3 months and during that time I have to show that I'm using it 70% of the time.
Once that is completed I will have the option to continue renting or Purchase the equipment.
Costs are really high compared to what i can find available on my own so I declined to use the DMA at this point and investigating options on my own for now.
I have a Machine that I'm currently using so I can take my time.