Please Help, Newly Diagnosed!

[BP]

I just returned from my follow-up appointment to my second sleep study. The numbers are stated below. Please let me know if you need any more info.:

Time in Bed: 407.5 min
Total sleep time: 326.0 min
Total sleep time nrem: 306.0
Total sleep time rem: 20.0
Arousals: count=146, index=26.9
Awakenings: count=3, index=.6
Total Apneas: 160
Total Hypopneas: 166
AHI: 60
RDI: 61
SaO2 Minimum: 80%
Titration Pressure: 10.0

Today my doctor wrote my prescription for my CPAP machine. After doing much research at this site, and the fact that I live alone, I suggested one of the newer auto cpaps with c-flex, and software. He stated that my insurance carrier Cigna, would not agree to any of the new fancy options like c-flex, auto, or software etc. He said in a week to ten days they would drop ship me a basic machine, with the only option being a humidifier and an RT to help me set-up. He also stated that he didn’t trust the software anyway, and that it was a waste of money.

Obviously, I have a few questions:

1. Does anyone have any experience with Cigna?
2. Would it be prudent or a waste of time, to call Cigna, or their dme, and twist some arms?
3. Or, should I just see how I do with the machine they send?

Also, the doctor mentioned that if I decided to buy my own machine that it would cost me at least $1,500 for the machine I was suggesting. I said that I have seen them online for just over $750. He said, who would set it up for you? I didn’t have an answer for that. Can I do the setup myself? Does a setup really cost $650?

Any help would be greatly appreciated,

BP

[TXKajun]

Hi, BP and welcome to this wonderfully informative and supportive board. First off, let me assure you, you're feelings and questions are totally normal for someone who has just been diagnosed. You did real good posting all of your information. Heck, you did real good just to walk out of your doctor's office with the information!!

The really good news is you are in EXACTLY the right place at just the right time to get some valuable knowledge and information that will save you tons of worry, time and probably quite a few $$$$. As you get to be more familiar with the board, you will find you can do searches on topics that you've just asked about. In all likelihood, someone real darn soon will post direct links that will answer all your questions, though.

I've been a "hosehead" for a little over 8 months now. It was scary at first, made me mad as heck, cost me quite a few $$$, bothered my wife, scared my son, just to mention a few of the less-than-desirable issues. On the other hand, having been diagnosed with OSA and started treatment has given me back my life! I'm not falling asleep at my desk anymore, I have enough energy to be awake past 6PM, my temper is a whole lot longer, heck, my wife is even back in bed with me! WOO HOO!

What I'm trying to say is this therapy WORKS! For some of us, it works almost immediately, for others it takes a while to kick in. The main thing is, you're not alone in this. ok? Feel free to ask questions, gather information, spout off about almost anything, heck, even come post about being angry if you're angry! Welcome to the board....and our world. It's all about you for now.

[ehusen]

Sigh. You're Doctor is being a dufus. "You don't want any of the newfangled auto-pap stuff. And I wouldn't trust it anyway." Yeesh. I'm sorry but that's just plain bad advice. Read this forum, you will see bunches of people who had great success managing/monitoring their own care.

I don't know anything about Cigna, but giving them a call certainly wouldn't hurt. What have you got to lose? The worst that happens is you get the setup they are going to give you anyway. Staight CPAP which many people use quite successfully. But in my case, IMHO, an APAP machine is better, if just for comfort reasons. I like the fact that the machine is responding to my needs, as needed, instead of just being inflated constantly.

As for being able to set it up yourself. You would need to know how to setup the pressures and such. Plus understand about hooking up the tubes/mask and cleaning. Cpap.com will usually send you a manual for it. I would rate it about less difficult than setting up a home theatre. Heck, the thing is pretty much a glorified air compressor.

I'm certain many here would be glad to help you with any questions. I think the mask is probably the biggest issue. You've got to find one that you can tolerate. And that might not be the 1st, 2nd, or even 3rd you try. You can look in this forum for recommendations.

[johnnygoodman]

Howdy and welcome. You've come to the right place.

I'm Johnny, I admin this board and also run websites that help people get high end CPAP equipment in the most cost effective ways possible.

Your options in terms of equipment are:

#1. Take whatever Cigna decides you should have.

#2. Buy what you'd like to buy for cash on cpap.com.

#3. Work with BillMyInsurance.com to get Cigna to get you the good stuff and pick up the majority of the tab.

I suggest trying #3 first and working backwards. BillMyInsurance's toll free number is 1-800-266-1575.

[th]

#3. Work with BillMyInsurance.com to get Cigna to get you the good stuff and pick up the majority of the tab

Johnny, I took your advice and filled out the application to BillMyInsurance.com I am due 1 mask now..........Good Luck with my insurance co both of them my Insurance co & my DME or a PIA....... th

When its time for an APAP if you can get them(Insurance Co) to do it........I ready to try the 420E My prescription is on file with you now

[Wulfman]

BP,

Make sure your doctor gives YOU the prescription for the machine so you can choose your own supplier. Try to get him to at least add "CFLEX" to the prescription....even if he just wants you to run straight CPAP. The CFLEX will help with your breathing. I don't know CIGNA, but most insurance carriers will usually go along with what the doctor prescribes. If he's arranging for "somebody" to deliver it to you, then that would indicate that he's got a "cozy" relationship with a DME supplier. If you can read.....you can set up your machine, mask, etc. I'm sure the $1500 price tag he's quoting is from what the local DME's probably charge.....(that's about typical of this area, too.)

Good luck and welcome to this forum of CPAP information.

Den

[BP]

Thanks for the replies. I just contacted BillMyInsurance.com to see if they can do anything. Hopefully they are reputable.

Concerning C-Flex, my doc said Cigna would not authorize it. I asked him specifically about this. I certainly don't mind paying part of the price to get what I want. We'll see. I'll keep you posted.

Thanks,
BP

[morphy]

BP

I have CIGNA - but PLEASE don't take anything I say as being set in concrete - it's just MY experience - your mileage may vary.

CIGNA puts ALL requests thru a Co. called Gentiva for approvals on CPAP machines. Bare bones machine with heated humidifier.

Sent me a "Rem Star Plus (Domestic)" CPAP machine with heated humidifier and an Ultra Mirage II nasal mask in the mail(!). The stuff came from a Co. called Sleep Central. Setup is a snap. There's a phone # for help if needed.

My AHI is 85, machine set at 12. I'm one of the lucky ones, it seems to be doing the job. I got the stuff on 8/5/05 so I'm still new at it all.

You're definitely in the right place on this board - ask away and you will get the info you need. These folks are great (even if they do look wierd when sleeping).

[ufo13]

BP: Wulfman's advice is right on the money in my opinion! go to the bank with what he says!!!


Best to you and welcome!


steve,
ufo13

[rested gal]

Can I do the setup myself?

With the help of good people on the message board, you certainly can.

[BP]

Here's an update on my saga. Unfortunately, CIGNA refused to work with Billmyinsurance.com. Johnny and everyone there tried very hard for me, and I appreciate the effort.

I'm going to give CIGNA a call next week and see if I can do anything, I don't have a lot of faith in that. I'm sure they'll send me a decent basic machine. And anyway, it's about that time of year where I choose my insurance company, I'll see if anything better than CIGNA is available.

If anyone has any additional advice, please pass it my way.

Thanks,
BP

[TXKajun]

BP, do you have a "Flex fund" account? (If you don't know what I'm talking about, then chances are you don't.) If you do, call your flex provider and/or HR person and see if you have enough to cover a purchase from johnny & co at cpap.com!! That way you can get the machine you want and will be reimbursed. Yep, it'll cost you out of pocket for the purchase, but cpap.com sends great receipts (I know, it worked for me with no problems!!) for sending in for reimbursement.

Good luck and, BP, it is DEFINITELY worth getting a top of the line machine at the start!!!!

This therapy WORKS!!!

[loonlvr]

I have Blue Cross/Blue Shied. I got a prescription from my reg doc(sleep doc refused) and bought it online. I would consider asking your personal doc if he would write the rx. Since it was out of provider, they re-emburshed at 60% instead of 80%. But online was way cheaper, so I saved some money. You just have to pay for it yourself first, then submit the form to them, which takes awhile. Always get a written ok from insurance co first and keep the rx.Feel free to ask more questions since i ve been through the hoops, at least with BCBS.

[Wulfman]

loonlvr,

Since it was out of provider, they re-emburshed at 60% instead of 80%


My insurance (service) provider (the state is self-insured but contracts with a company to handle the claims) tried to do that to me, too.....(a clerical error no doubt).....and I corrected them to the fact that they were reimbursing ME, and I'm not "out of provider". They then issued another check for the difference.

My point is, if YOU paid for it out of pocket, they should re-imburse YOU at the 80% rate because YOU are the provider at this point.

Just my thoughts about this,

Den

[loonlvr]

But I am not on their list of eligable provider Dme's.