RX after 5 years????? Help

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
chriscummings83
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RX after 5 years????? Help

Post by chriscummings83 » Mon Jul 21, 2014 3:12 pm

I did a sleep study 5 years ago, and now I have insurance. Are they going to make me go through the sleep study all over again? I'm looking for a Auto CPAP as I have now but of course a newer model???? Also one DME said they rent the machine for 10 months, then I own it on the 11th Month? (that sounds Expensive) Or is there DME's that allow me to just purchase it through insurance?

Chris

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sc0ttt
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Re: RX after 5 years????? Help

Post by sc0ttt » Mon Jul 21, 2014 3:18 pm

If you still have your prescription that's probably still good to buy one outright.

Otherwise it depends on your insurance if they'll want a sleep study before they cover a new one.

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chriscummings83
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Re: RX after 5 years????? Help

Post by chriscummings83 » Mon Jul 21, 2014 3:21 pm

My insurance covers 90% after I hit my $100 deductible which is already met!!!!!!!
Just didn't want to have to go through another sleep study for my time and sleep in a weird place again.

JDS74
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Re: RX after 5 years????? Help

Post by JDS74 » Mon Jul 21, 2014 3:27 pm

At a minimum, they (the insurance company) will require a new prescription.
If your auto CPAP if a full data model, it may be that they will accept a week or so of data signed off by your doctor.
The best way to be sure is to call them and ask. Also ask if they will reimburse for direct purchase from an online vender.
That's the fastest way to get a new machine.

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tortoisegirl
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Re: RX after 5 years????? Help

Post by tortoisegirl » Mon Jul 21, 2014 8:18 pm

Also ask if your insurance requires a rental or will buy it immediately, especially since this isn't your first machine. Rental (and how long) vs. purchase will depend on your insurance, not the DME. If they do require rental for a specific number of months, it is typically the purchase price spread out over that number of months, so you would just pay 10% of 1/10 of the insurance negotiated price each month, assuming 10 months rental and your 90% coverage.

Since my insurance allowed immediate purchase my DME actually didn't let me rent it, although they said they would switch it to a rental if I ended up returning it within a few months (I assume that would be a lot of paperwork though to reverse a paid claim?). I had wanted to rent as my doctor thought I might need an advanced machine. Agreed its likely you will need a new prescription (even if your old one didn't have an expiration date), and it will most likely be dependent on the doctor as to if they require another study. Although sometimes I have read about the insurance coming back and requiring another study. Seems silly since its uncommon for apnea to go away, and the sleep study often costs more than the machine. Note that the prescription doesn't need to be from a specialist; any doctor will do. Best wishes.

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kaiasgram
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Re: RX after 5 years????? Help

Post by kaiasgram » Tue Jul 22, 2014 3:41 am

I switched from Kaiser to Blue Shield this year. Blue Shield did not require me to have another sleep study, they accepted the report from my Kaiser sleep study (done two years ago) and a new prescription from my new sleep doc who is a Blue Shield covered provider. At my first meeting with the new sleep doc I brought in my SD card so he could verify that I'm compliant with my therapy.

Here's hoping you don't need to have another sleep study.

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Krelvin
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Re: RX after 5 years????? Help

Post by Krelvin » Tue Jul 22, 2014 1:13 pm

It has been 8yrs since my last sleep study. My last Primary was a blank on sleep apnea the machine etc.. I got it before her. My new primary is very much into cpap etc... she recommended that I have a consultation with the Sleep Dr. first to see if a study was even necessary. Since I can get reports from my machine and bring them in, he will be able to see what I am currently doing with my current settings and machine. I want to replace my current machine which I have had for 6 years now.
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Day_Dreamer
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Re: RX after 5 years????? Help

Post by Day_Dreamer » Tue Jul 22, 2014 1:32 pm

chriscummings83 wrote:My insurance covers 90% after I hit my $100 deductible which is already met!!!!!!!
Just didn't want to have to go through another sleep study for my time and sleep in a weird place again.

I only completed a home sleep test

Doctor wrote script from that and both the HST and APAP were covered by my insurance

some vendors like Easy breathe have doctors employed.....