Searching for a new CPAP Machine.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
nanwilson
Posts: 3464
Joined: Tue Apr 13, 2010 10:35 am
Location: Southern Alberta

Re: Searching for a new CPAP Machine.

Post by nanwilson » Fri Feb 12, 2016 10:18 am

One big problem folks in the US who are suggesting Cpap.com....... You CANNOT buy Resmed or Respironics equipment from the states, both of those companies ban shipping to Canada. BUT you can buy the exact same product in Canada, so My_Dream must purchase either of those two types of machine and supplies in Canada. I buy from Cpap,com when its "other" than Resmed or Respironics brands, otherwise I must purchase those here in Canada. Try clinicalsleep.com or Cpapoutlet.ca, I have bought from both with great service and prices. Just got a P10 from cpapoutlet for under $100 and they are in Ontario
Nan
Started cpap in 2010.. still at it with great results.

My_Dream
Posts: 89
Joined: Wed May 21, 2008 2:21 pm
Location: Brampton Canada

Re: Searching for a new CPAP Machine.

Post by My_Dream » Fri Feb 12, 2016 10:38 am

stienman
Thanks for looking into it for me, I thought it was just a color difference.

OkyDoky
When I read the part in #1 that stated "designed to help prevent arousals" I thought it was a funny joke, but reading on, it's not. Thanks as it sounds like it maybe the better machine, and here I thought it was all about the "White".

Does it truly matter which machine I'm selecting as I thought the middle bands all went up to 20 on pressure. My pressure is 14 so will this machine work for my settings?

nanwilson

I called up a place called FMC with is in Toronto, 1/2 hr drive and the receptionist gave me pricing on the ResMed AirSense™ 10 AutoSet CPAP w/ HumidAir™ Humidifier and it was around $1150.00 which was cheaper than the online price so once I figure out which model of machine and mask, I'll go visit them next week.

If I can figure out the details on the email I posted earlier, I believe Sunlife will authorize $2000.00 so I should be ok. I still have to figure out the ADP portion or as Sunlife put it "If CPAP is approved by a provincial plan". Maybe things have changed but for my last machine, I bought it and just gave Sunlife the receipt and was reimbursed. .

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OkyDoky
Posts: 2870
Joined: Mon Aug 25, 2014 5:18 pm

Re: Searching for a new CPAP Machine.

Post by OkyDoky » Fri Feb 12, 2016 11:04 am

My_Dream wrote:Does it truly matter which machine I'm selecting as I thought the middle bands all went up to 20 on pressure. My pressure is 14 so will this machine work for my settings?
Either Autosets are good machines and will probably do fine for you but if you have the option for the 3rd algorithm for the same price, I would take it just in case it worked better for me. You are correct as to the top pressure of 20 cm H2O on these machines. And yes at a pressure of 14 these machines will work for you as long as that pressure controls most of your apneas and you don't have a lot of increased pressure needs. You have to go to a bilevel to get a higher pressure of 25 cm. Some people are able to tolerate the higher pressures without problems, and it seems you have been using yours for some time, while others have difficulty and with pressures 15 or above necessary, some doctors will prescribe bilevel.
ResMed Aircurve 10 VAUTO EPAP 11 IPAP 15 / P10 pillows mask / Sleepyhead Software / Back up & travel machine Respironics 760

Hose_Head
Posts: 804
Joined: Wed Mar 12, 2008 6:43 pm
Location: Ontario Canada

Re: Searching for a new CPAP Machine.

Post by Hose_Head » Fri Feb 12, 2016 11:32 am

My_Dream wrote:
Hose_Head
Yes, the last machine (ResMed S8 Elite 11) I paid out of pocket about 7 years ago and Sunlife Insurance reimbursed me 100%. To make a long story short my sleep doctor gave me a new prescription for a cpap machine just before he retired 1.5 years ago, but I'll assume it expired so I asked my family doctor to give me a new one. I'll assume the insurance will expect that.

This is the email reply I got from Sunlife.

Message

Thank you for contacting Sun Life Financial. I welcome this opportunity to assist you.

Under your plan, a CPAP machine (Constant Positive Airway Pressure) is covered at 100 percent to the reasonable and customary amount of $2,000.00 every 3 benefit years.

If CPAP is approved by a provincial plan, we will consider the remaining amounts not reimbursed by the province and it will be deducted from the $2,000 R&C amount. Repairs are not subject to the $2,000.00 for the initial purchase

If CPAP is approved by a provincial plan such as ADP, we will consider the balance and above information will NOT be requested (provincial plans' requirements are similar to Sun Life Financials).

The following CPAP system funded by ADP includes: CPAP machine, Mask and Headgear, Heated Humidifier, Carrying Case, 6 FT Tubing, Power Cord, All necessary Filters and Caps and Client Instruction Manual.

Funding may be provided as a whole "system" or only for those items that need replacement after the initial purchase every 5 years. The prescription from the family doctor only states a Cpap machine replacement.

Eligible supplies
• battery
• Mask filter Example: Flexifit Diffuser Filter
• Machine filter - Example: Resmed S8 Filter
• humidifier/humidifier bottle
• masks
• foam or gel cushion for mask
• nasal pillow --- examples of brand names: Mirage Activa Cushion
• mouthpiece
• nasal seal kit
• tubing / headgear / chin strap
• 12 VDC adapter
• yearly pressure checks
• calibrations or pressure adjustments
• Service package (represents one pre-paid charge for the following types of services - examples: mask refits, annual maintenance, loaner fee in case of repairs, filters, etc.)
• cleaning solution for masks/tubing
• insulation for tubing
• ResScan Data Card
• Elbow Assembly

Ineligible items
• extended warranty
• battery cable adaptor
• battery case / pack
• battery charger
• Power Pack - example: Eliminator Powerbox
• instruction manual
• compliance training
• CPAP pillow (for head) — example: PAPillow, Multi-mask Sleep Aid
• CPAP Stand (to elevate tubing)
• Hose Lift

Based on the above information, your spouse would be eligible now.

Please note that this information is based on your current contract with Sun Life Financial. If there are changes to your contract or your coverage terminates, you will no longer be eligible for this type of expense.

Sincerely,

Sun Life Financial Canada



I'm thinking of getting the ResMed AirSense™ 10 AutoSet CPAP w/ HumidAir™ Humidifier $1225, and the P10 for the mask.

This reply you received from Sunlife reads almost exactly the same as the response that I received from my insurer, Great West Life, several years ago. The thing to remember that this likely is a canned response sent by a low-level administrator and is not a direct response to the specific question that you asked. In my case, I ended up calling Great West Life to have a little talk about it. It turned out that they WOULD NOT PAY for anything in Ontario until the insurance subsidy from ADP had been used. The hook is the statement in your letter from SunLife where it says "If CPAP is approved by a provincial plan, we will consider the remaining amounts not reimbursed by the province and it will be deducted from the $2,000 R&C amount. " In your case, CPAP is approved by a provincial plan and therefore, it appears that SunLife will only pay for the "remaining amounts not reimbursed by the province".

It helps to remember that SunLife, like all insurance companies, will try to minimize the amount that it needs to pay out under a policy. They are in business to make money, not to pay it out.

Before you pay anything out of pocket, I strongly recommend that you contact SunLife again and get an unequivocal answer from someone in authority to your specific question, in writing if possible. The question to ask is "will Sunlife reimburse me 100% for a cpap that I purchase without going through the ADP subsidy process?"

Good luck. And please let us know how you make out with SunLife.
I'm workin' on it.

My_Dream
Posts: 89
Joined: Wed May 21, 2008 2:21 pm
Location: Brampton Canada

Re: Searching for a new CPAP Machine.

Post by My_Dream » Tue Feb 16, 2016 11:08 am

Hose_Head

Thanks for the reply.

I decided to call this company in the next couple days to make an appointment to view and purchase a machine and mask. Below is what I got from there web site and from what I understand from Sun life is FPM Solutions, bill direct to OHIP, I pay the rest and get total reimbursement from Sun life.

"Welcome to FPM Solutions CPAP and Medical Devices, the best source of CPAP and Respiratory devices in Ontario. We offer the widest selection, and carry the largest inventory of CPAP Machines and CPAP Masks in Ontario. We are fully licensed by Assistive Devices Program in Ontario to bill the cost of the equipment directly to OHIP. All our products are licensed and approved by OHIP, and ADP regulates the prices of our devices to ensure affordability and fair prices for our patients. Please call us for more information about ADP coverage and required documentation from Patients and Referring Physicians"

Unless FPM Solutions convinces me otherwise I'm favoring the ResMed AirSense™ 10 AutoSet™ with HumidAir and either the P10 0r the FX. I'm going to try on the P10 and if it's not comfortable I'll stick with the FX which is what I presently have.

Hose_Head
Posts: 804
Joined: Wed Mar 12, 2008 6:43 pm
Location: Ontario Canada

Re: Searching for a new CPAP Machine.

Post by Hose_Head » Tue Feb 16, 2016 2:34 pm

My_Dream wrote:Hose_Head

Thanks for the reply.

I decided to call this company in the next couple days to make an appointment to view and purchase a machine and mask. Below is what I got from there web site and from what I understand from Sun life is FPM Solutions, bill direct to OHIP, I pay the rest and get total reimbursement from Sun life.

"Welcome to FPM Solutions CPAP and Medical Devices, the best source of CPAP and Respiratory devices in Ontario. We offer the widest selection, and carry the largest inventory of CPAP Machines and CPAP Masks in Ontario. We are fully licensed by Assistive Devices Program in Ontario to bill the cost of the equipment directly to OHIP. All our products are licensed and approved by OHIP, and ADP regulates the prices of our devices to ensure affordability and fair prices for our patients. Please call us for more information about ADP coverage and required documentation from Patients and Referring Physicians"

Unless FPM Solutions convinces me otherwise I'm favoring the ResMed AirSense™ 10 AutoSet™ with HumidAir and either the P10 0r the FX. I'm going to try on the P10 and if it's not comfortable I'll stick with the FX which is what I presently have.
I guess I've been confused. My bad. From your earlier reply it was my understanding that you were going to ask SunLife to reimburse you for 100% of the cost of a new cpap. Now it seems that you are saying that you are going to have the DME bill OHIP (ADP) and get SunLife to pay the difference. This is more what I expected that you were proposing to do. My confusion is gone!

Good luck with your search for a new cpap! Please report back with what you eventually get and how the insurance-thing works out for you!
I'm workin' on it.

My_Dream
Posts: 89
Joined: Wed May 21, 2008 2:21 pm
Location: Brampton Canada

Re: Searching for a new CPAP Machine.

Post by My_Dream » Tue Feb 16, 2016 5:29 pm

Hose_Head

I believe I was the one that was confused as I thought Sunlife was going to pay for it all. From my understanding now the DME will do the paperwork to bill OHIP (ADP) and I will pay the difference and get SunLife to pay me 100%.

I did run into a problem, I had two prescriptions, one from my specialist that retired and I allowed the prescription to go beyond 6 months so it's no longer valid. The second prescription was from my family doctor which is not valid so I have to find a new specialist and get a new prescription. I'm now also under the understanding that I don't get to pick the type of machine (bpap, apap etc) the specialist does. What a learning experience. In Ontario, we have to be referred to a specialist via our family doctor so this may take some time now.

Hose_Head
Posts: 804
Joined: Wed Mar 12, 2008 6:43 pm
Location: Ontario Canada

Re: Searching for a new CPAP Machine.

Post by Hose_Head » Tue Feb 16, 2016 10:53 pm

My_Dream wrote:Hose_Head

I believe I was the one that was confused as I thought Sunlife was going to pay for it all. From my understanding now the DME will do the paperwork to bill OHIP (ADP) and I will pay the difference and get SunLife to pay me 100%.

I did run into a problem, I had two prescriptions, one from my specialist that retired and I allowed the prescription to go beyond 6 months so it's no longer valid. The second prescription was from my family doctor which is not valid so I have to find a new specialist and get a new prescription. I'm now also under the understanding that I don't get to pick the type of machine (bpap, apap etc) the specialist does. What a learning experience. In Ontario, we have to be referred to a specialist via our family doctor so this may take some time now.
I'm workin' on it.