Purchasing a CPAP/APAP

[StudentDoc17]

Hey everyone,

I got back from my first consultation yesterday with my Dr. I was told my AHI was 48 on my side and 105 on my back. I go back on Monday night for a titration study. It seems that I may actually end up with an APAP over a CPAP just from my AHI but won't know until next week.

Now, here is my question. I am unfamiliar with the costs of the machine and how the ADP works. I've been reading around on multiple forums, and gather that OHIP will pay 75% of their approved cost of $860 or $1020 depending on which device I need. Does this mean that all DME's can only charge that amount, or are they allowed to charge above and beyond that price for the same machines listed on the ADP list? I currently don't have any insurance, so anything aside from OHIP will be out of pocket expense for me.

My sleep clinic gave me a list of a few DME's in the GTA, but was wondering if anyone had any particular suggestions? I live in Burlington, and hoping for something in the area. I'm planning on visiting my Shoppers Home Health today to see what they have to say and how I feel with them.

Any input is greatly appreciated!!

Thanks everyone! =)

[StudentDoc17]

Sorry, forgot to ask about machines as well. Any machine in particular you'd recommend?

Thanks again!

[ramblingasian]

Basically it depends on the prescription that your doctor says you need. He/She will need to be able to show what you need in order for you to be covered by the ADP.

The base price you listed above is for the machine, a humidifier, a bag, a regular hose and a plain mask. If you want a heated hose or a better mask you will have to pay more.

[ChicagoGranny]

Sorry, forgot to ask about machines as well. Any machine in particular you'd recommend?

Thanks again!

We need to wait to know the titrated pressure before recommending a machine. Also, can you confirm that you have obstructive sleep apnea?

You will have a better time navigating the forum if you register and log in each time you post.

[D.H.]

For all those who don't know OHIP is "Ontario Health Insurance Plan." It is a "single payer" plan.

I have a DreamStation Auto PAP, which runs about US$750 or so if you pay out-of-pocket. Presumably, those in Canada who are destitute can get additional financial help. Hopefully, that's not your case.

Here is my review of that machine, the good and the bad.


The Phillips Respironics Dream Station Auto CPAP is my fourth machine since 1999; the others were all “bricks.”


Advantages:
• Automatic means that it will raise the pressure as needed when it senses distress. I think I fell more refreshed than before.
• Good statistics are generated, so you can see how you slept, and make adjustments as needed. In addition, stats are good for your doctor to see how you are doing.
• Machine is very quiet.
• Heated hose is very good, never had rainout despite full setting on humidity.
• Automatic altitude adjustment (good for travel).
• Leak compensation.
• Auto/on and auto/off can be activated and deactivated separately.
• Puts out the prescribed pressure more precisely than my old machine (yes, I verified this).


Disadvantages:
• Machine is a bit larger than the major competing machine.
• Sometimes, there is a burning smell, especially after a potty break. I’m pretty sure it’s harmless.
• Frequently, the water does not last the whole night. I generally wake up at least once overnight, so I refill it at that time. This might not work for everybody.
• Some have complained about the brightness of the display when you turn it off and back on, such as for a potty break. I don’t find this a problem. In fact, I use the light to reattach my mask to the hose.
• The power cord has a proprietary signal, so you cannot use a different cord, even if the voltage, wattage, amperage, and fitting are all identical. This means that if you need a replacement cord (or a spare cord), you have to get the cord specific to Dream Stations. If you want to use a battery (such as for camping and electrical outages), you have to buy an $80 proprietary device to generate this signal.

[Hose_Head]

Hey everyone,

I got back from my first consultation yesterday with my Dr. I was told my AHI was 48 on my side and 105 on my back. I go back on Monday night for a titration study. It seems that I may actually end up with an APAP over a CPAP just from my AHI but won't know until next week.

Now, here is my question. I am unfamiliar with the costs of the machine and how the ADP works. I've been reading around on multiple forums, and gather that OHIP will pay 75% of their approved cost of $860 or $1020 depending on which device I need. Does this mean that all DME's can only charge that amount, or are they allowed to charge above and beyond that price for the same machines listed on the ADP list? I currently don't have any insurance, so anything aside from OHIP will be out of pocket expense for me.

My sleep clinic gave me a list of a few DME's in the GTA, but was wondering if anyone had any particular suggestions? I live in Burlington, and hoping for something in the area. I'm planning on visiting my Shoppers Home Health today to see what they have to say and how I feel with them.

Any input is greatly appreciated!!

Thanks everyone! =)

Google "Ontario Assistive Devices Program" and you'll get to this result:

http://www.health.gov.on.ca/en/pro/prog ... tions.aspx

From that page you can click on any of the various policy manuals under the ADP program. Two are of interest: "Policies and Procedures Manual for the Assistive Devices Program" and "respiratory equipment and supplies": the links will download PDF's of these manuals.

In section 305 of the "Policies and Procedures Manual for the Assistive Devices Program" you'll find this:

"... Fixed price: the ADP pays 75% of an ADP Approved Price. Where the Ministry pays 75% of the cost of the Device, the Client’s portion must be at least 25% of the cost of the Device. The Vendor cannot charge the Client more than the ADP Approved Price..."

Approved prices are found in the product manuals (a link is included in the above link). A direct link :
http://www.health.gov.on.ca/en/pro/prog ... nuals.aspx


Note that Vendors can charge up to 100% for other services or products. I've not experienced this but have read on this board posts by others who have found DMEs who try to upsell those other services. You can refuse.

Let us know how you make out!

[D.H.]

It seem that my price was really close. The price in this link is CAD$1020, which equates to USD$755. This conversion is based on the live rate at the time I posted this message.

[Hose_Head]

It seem that my price was really close. The price in this link is CAD$1020, which equates to USD$755. This conversion is based on the live rate at the time I posted this message.

Whenever you have a question about OHIP and ADP, it's always necessary to look it up. They change things fairly often so old information very well could be wrong.

[LSAT]

Hey everyone,

I got back from my first consultation yesterday with my Dr. I was told my AHI was 48 on my side and 105 on my back. I go back on Monday night for a titration study. It seems that I may actually end up with an APAP over a CPAP just from my AHI but won't know until next week.

Now, here is my question. I am unfamiliar with the costs of the machine and how the ADP works. I've been reading around on multiple forums, and gather that OHIP will pay 75% of their approved cost of $860 or $1020 depending on which device I need. Does this mean that all DME's can only charge that amount, or are they allowed to charge above and beyond that price for the same machines listed on the ADP list? I currently don't have any insurance, so anything aside from OHIP will be out of pocket expense for me.

My sleep clinic gave me a list of a few DME's in the GTA, but was wondering if anyone had any particular suggestions? I live in Burlington, and hoping for something in the area. I'm planning on visiting my Shoppers Home Health today to see what they have to say and how I feel with them.

Any input is greatly appreciated!!

Thanks everyone! =)

============

auto is good fixed is bad

ONE SIZE FITS NOBODY

our pressure needs change constantly
so a machine that adjusts to you would be better than one that makes you adjust to it

Completely Wrong

[StudentDoc177]

Thanks for the replies everyone! I'm just currently waiting on being confirmed by and admin and I'll be registered! (This is OP, won't let me post with the same username right now)

Firstly, sorry about the confusion about OHIP and stuff, completely didn't even think about non-Ontario members!

I went into my local DME, and spoke with the registered CPAP nurse there very quickly. She informed me that they do the ResMed Airsense 10 Elite or Autoset. Mentioned that it would be $860, out of which 75% is covered. She did mention I would be paying around $500 as the mask isn't included, which the ADP states it should be so once I have my prescription I'll have to figure that out with them.

Thanks for the Dreamstation review DH! Definitely gives me something to think about as well. I guess I just have to wait for my prescription and my official meeting with the DME and then go from there.

I'll keep you all updated!

[Hose_Head]

Thanks for the replies everyone! I'm just currently waiting on being confirmed by and admin and I'll be registered! (This is OP, won't let me post with the same username right now)

Firstly, sorry about the confusion about OHIP and stuff, completely didn't even think about non-Ontario members!

I went into my local DME, and spoke with the registered CPAP nurse there very quickly. She informed me that they do the ResMed Airsense 10 Elite or Autoset. Mentioned that it would be $860, out of which 75% is covered. She did mention I would be paying around $500 as the mask isn't included, which the ADP states it should be so once I have my prescription I'll have to figure that out with them.

Thanks for the Dreamstation review DH! Definitely gives me something to think about as well. I guess I just have to wait for my prescription and my official meeting with the DME and then go from there.

I'll keep you all updated!

I don't know for certain but it's probable that ADP only pays for a basic mask. It won't be any mask that you'll care to use. Thus, you will be paying for the mask of your choice.

One other thing: make sure you get a written script from your sleep doctor for your equipment. If 's an auto, make sure that it says "auto" on it and shows a prescribed range of pressures. With that script you'll be able to buy supplies anywhere you choose, including a new xpap if you wish. Without the script you may be limited to buying only from the original DME at whatever outrageous charges they deem fit.

CPAP.com is a great place to buy. Helpful and prices cannot be beat. However, they are restricted from shipping Resmed and Philips-Respironics products to Canada so you'll need to find a Canadian online source for them. There are a number of good Canadian online suppliers; search the forum to find discussions about them.

[tedtomato]

I believe 1800CPAP.com will ship Resmed items abroad, and for a reasonable price.

[StudentDoc17]

So, just got back from my titration study.

NOT as pleasant as I had hoped it to be. I've read people talk about how annoying the mask and the pressure can be for the first little while, but honestly didn't think it would be that bad. Used a nasal pillow mask for most of the night, which wasn't too bad initially, but I kept waking up and the pressure was crazy. Tried a full face mask and that was even worse. Felt like it was just taking my breath away and I was suffocating. Went back to nasal for the last hour or so. Hoping I get used to it once I start!

[ChicagoGranny]

Hoping I get used to it once I start!

I would like to suggest a different tack. Instead of "getting use to it", take control of your therapy. Learn as much as you can. Learn all the "tricks" to wearing a mask. Learn the comfort tricks. Learn how to monitor and control your therapy. Learn to optimize your machine settings.

Most of this can be learned through the help of this forum.