Getting CPAP on Missouri Medicaid insurance

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
SewTired
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Re: Getting CPAP on Missouri Medicaid insurance

Post by SewTired » Thu Jul 16, 2015 2:58 pm

Krelvin wrote:
pettyfan45 wrote:Because I am 23 my doctor might just do it by a yearly basis for a while and see if it improves and if possible see about a multi year prescription if able.
What improves? OSA is controlled by treatment using CPAP, but doesn't improve itself.
I completely agree with you Krelvin, but the OP is young and we don't know what his issues are. Is he overweight and hopes to lose a lot of weight? Is he on some med that is required now and not maybe in a year that is causing apnea? But, yes, I agree that chances are, a year from now, two years from now, 10 years from now, he will still have apnea. How often you see the doc depends. Many board members never see the doc again. I have a medical problem that will probably require me to see the sleep doc at least every other year since my main problem is not apneas.

A fair number of people under 30 getting gastric bypass, for instance, no longer need cpap after they've lost a bunch of weight. Of course, nowhere near 100%, but age has some to do with it. My sister had surgery for a deviated septum and she was one of those fortunate ones where it had a side effect of eliminating her apnea. She hasn't had need for a machine now for 10 years or so. So, live in hope, but don't get too excited.

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pettyfan45
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Re: Getting CPAP on Missouri Medicaid insurance

Post by pettyfan45 » Thu Jul 16, 2015 3:14 pm

SewTired wrote:
Krelvin wrote:
pettyfan45 wrote:Because I am 23 my doctor might just do it by a yearly basis for a while and see if it improves and if possible see about a multi year prescription if able.
What improves? OSA is controlled by treatment using CPAP, but doesn't improve itself.
I completely agree with you Krelvin, but the OP is young and we don't know what his issues are. Is he overweight and hopes to lose a lot of weight? Is he on some med that is required now and not maybe in a year that is causing apnea? But, yes, I agree that chances are, a year from now, two years from now, 10 years from now, he will still have apnea. How often you see the doc depends. Many board members never see the doc again. I have a medical problem that will probably require me to see the sleep doc at least every other year since my main problem is not apneas.

A fair number of people under 30 getting gastric bypass, for instance, no longer need cpap after they've lost a bunch of weight. Of course, nowhere near 100%, but age has some to do with it. My sister had surgery for a deviated septum and she was one of those fortunate ones where it had a side effect of eliminating her apnea. She hasn't had need for a machine now for 10 years or so. So, live in hope, but don't get too excited.
My first post here has all my issues viewtopic/t106744/viewtopic.php?t=106672

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SewTired
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Re: Getting CPAP on Missouri Medicaid insurance

Post by SewTired » Thu Jul 16, 2015 5:53 pm

That's why everybody likes you to keep your stuff to one thread. Thanks for the link.

Here are my thoughts. You still have weight to lose. I don't know enough about cerebral palsy, but if it affects muscles, it certainly is reasonable to assume that it affects apnea. You are or you are not on a machine? If not, you need to advocate for yourself. Talk to the sleep doctor or your doctor. There is no reason for you to continue to suffer month after month. Change docs if you have to. You already have the data from the sleep study - they should be using it, not bumping you along for nothing. You have more than enough data for Medicare - it should be enough for your insurance company as well. If you are buying out of pocket, then really hassle them. No reason for you to keep waiting as you only need a prescription and don't need any kind of compliance data.

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pettyfan45
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Re: Getting CPAP on Missouri Medicaid insurance

Post by pettyfan45 » Thu Jul 16, 2015 6:24 pm

SewTired wrote:That's why everybody likes you to keep your stuff to one thread. Thanks for the link.

Here are my thoughts. You still have weight to lose. I don't know enough about cerebral palsy, but if it affects muscles, it certainly is reasonable to assume that it affects apnea. You are or you are not on a machine? If not, you need to advocate for yourself. Talk to the sleep doctor or your doctor. There is no reason for you to continue to suffer month after month. Change docs if you have to. You already have the data from the sleep study - they should be using it, not bumping you along for nothing. You have more than enough data for Medicare - it should be enough for your insurance company as well. If you are buying out of pocket, then really hassle them. No reason for you to keep waiting as you only need a prescription and don't need any kind of compliance data.
On the weight lose right now I have been suck around 224lbs for about 2 weeks. cerebral palsy affects the nervous system in general, my twin sister has CP ( it shouldn't be genetic we just have horrible luck) from a stroke at birth and her right arm and leg are messed up because of it, her CP is worse than my seeing how I just have leg pain a muscle weakness. I am not on a machine at this time. As for doctors I am done with my current doctor and I have an apportionment with a nurse practitioner tomorrow (July 17th) to see about starting treatment of my apnea and maybe have her be my new GP. I just hope she doesn't try and tell it is hospital policy not to treat mild sleep apnea because that would be an issue for me seeing how the next closest hospital to is about an hour one way.

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Last edited by pettyfan45 on Thu Jul 16, 2015 7:22 pm, edited 1 time in total.

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chunkyfrog
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Re: Getting CPAP on Missouri Medicaid insurance

Post by chunkyfrog » Thu Jul 16, 2015 7:21 pm

"Co morbidities" tend to lower the hurdles some, you will find out if that happens in your case.
At least, with CP, you can press the system a little harder to be more liberal than they are inclined to be otherwise.
You may even be able to call them out publicly if it comes to that. (Save that for a last resort)

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pettyfan45
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Re: Getting CPAP on Missouri Medicaid insurance

Post by pettyfan45 » Mon Jul 27, 2015 4:54 pm

So I got in touch with someone at Missouri Medicaid add I learned some things.
I can get a new machine after 5 years or if it brakes withing that time and can't be fixed (as a long as it is something that warranty would have covered).
The thing that sucks is I don't get to pick my machine the DME does (but they go with what the doctor prescribes, so they can't give a single pressure machine if I should be getting an auto machine).
If in 3 months the the CPAP they pick for doesn't work out the I can swap it for a different one (that the DME picks).
Also I don't need another sleep study (on less I need to try a bi level machine or need to have my pressure adjusted if they give a single pressure machine).
Still waiting to hear back on how supplies are covered and under what circumstances I might not be able to get a CPAP.

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SewTired
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Re: Getting CPAP on Missouri Medicaid insurance

Post by SewTired » Mon Jul 27, 2015 8:37 pm

Do read posts on this subject AND write down the models that work with Sleepyhead. Get the doctor to write the prescription for the SPECIFIC machine YOU choose! So, if you go with Respironics, you want a 560. If you go with Resmed, you want an Airsense Auto (or an S9 Auto). The DME is REQUIRED to dispense whatever the doc writes on that prescription. Make sure he doesn't add 'generic' on there. Otherwise, you will get a brick and that won't help you in the long run. Do the research, write it down, bring it with you. remember to advocate for yourself because nobody else is going to.

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palerider
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Re: Getting CPAP on Missouri Medicaid insurance

Post by palerider » Mon Jul 27, 2015 10:15 pm

SewTired wrote:Resmed, you want an Airsense Auto (or an S9 Auto).
if you're going to offer advice, use the right words, or the DMEs will weasel out of giving a good machine.

there are THREE s9 auto machines, one is crap, two are fine.

the s9 autoSET, and the s9 vpap auto are fine, the s9 escape auto is crap. never say "s9 auto" because that would let the dme give the person crap... on your advice.

the airsense 10 autoSET or autoSET for her are the machines to get from the airsense 10 line.

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