insurance coverage is 70%. have older machine with leak.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
aznh

insurance coverage is 70%. have older machine with leak.

Post by aznh » Mon Sep 15, 2014 10:25 am

I have an older machine. Have used cpap for about 4 years without too many problems. Recently began bubbling air out of my closed mouth. While trying to figure out what has changed, I found my machine is leaking a significant amount of air from the place where the water chambers connects to the machine. I recently retired d in order to care for my mom so my "insurance "is CHAMPVA " which will only covet 70% at most. I am wondering if I would be better off financially buying equipment and supplies online and just paying the whole costs myself as opposed to going through my durable medical provider. I ask this because the durable medical Providers prices are VERY high so even paying 30% may be more than buying directly online. Anyone else with any experience in this? my machine is a REMstar pro2 and I use a respirinics s profile lite mask

library lady
Posts: 1116
Joined: Wed Feb 05, 2014 11:10 am
Location: Rochester, MN

Re: insurance coverage is 70%. have older machine with leak.

Post by library lady » Mon Sep 15, 2014 10:32 am

I would go to https://www.cpap.com, check out pricing and shipping costs of the latest PR and Resmed machines that have full data efficacy, then check the prices of same with your local provider. This will give you an idea of the difference in the amounts you would pay and help you decide which way to go.

_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: AirFit™ F10 Full Face Mask with Headgear
Additional Comments:  Sleepyhead
Now using AirFit F10 mask; Quattro Air is backup mask. RemZzzz mask liners with both.

User avatar
Pugsy
Posts: 63942
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: insurance coverage is 70%. have older machine with leak.

Post by Pugsy » Mon Sep 15, 2014 10:37 am

You may just need new couplings and then you can bide your time and figure out what you want to do about a new machine.

https://www.cpap.com/productpage/respir ... lings.html

I think I have a couple that you can just have. Register here at the forum and then send me a private message and in the meantime I will go see if I can find those couplings. I am pretty sure I have a couple new in still in unopened bad.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

aznh
Posts: 11
Joined: Mon Sep 15, 2014 11:06 am

Re: insurance coverage is 70%. have older machine with leak.s

Post by aznh » Mon Sep 15, 2014 1:08 pm

Pugsy. Thank you so much for the offer. That is exactly where the air is leaking but the rubber or silicine still feels very soft. My thought is that perhaps this is the time to get a new machine though. I don't know why I'm bubbling. But the noise I make is so significant that my husband keeps waking me and I end up with dried saliva pasted on the side of my face! I don't see why an airleak would cause that. Maybe I will need to move towards a bi-pap although I have quite low setting gs (6). Scrolling around on this site I see that machines now seem to be much "smarter "and able to give you information about your sleep. I don't know if they can give oxygen sats but I am thinking that looking into a new machine may be worth it. Plus maybe it would be smaller and easier to carry on plane trips. I just am unsure if I should just call up Keene medical or look online and do it myself.

User avatar
archangle
Posts: 9294
Joined: Sun Mar 27, 2011 11:55 am

Re: insurance coverage is 70%. have older machine with leak.

Post by archangle » Mon Sep 15, 2014 3:42 pm

Those "legacy" Respironics machines often need some tinkering to get the humidifier connection to really fit right, both with how the tank fits in, and how the coupler is seated. I forget whether it's possible to put the coupler in backwards, but check that.

You could also have a worn out coupler.

You can also just remove the humidifier and connect directly to the blower unit, but, of course, you lose the humidification.

However, the right model of PRS1 or ResMed S9 or A10 machine does have a lot of advantages, especially in terms of monitoring how your therapy is working.

Check my signature line for recommendations on which machines to get, and more importantly, what to avoid.

You might find a good buy on a used machine on Craigslist or elsewhere, but you'll see a lot of people who want way too much money because of the fantasy "non-insurance" billed price from where they bought their machine from. You may find a good deal if you watch the ads for a while.

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
Please enter your equipment in your profile so we can help you.
Click here for information on the most common alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check for yourself.

Useful Links.

User avatar
M'ohms
Posts: 516
Joined: Fri Aug 09, 2013 2:44 pm
Location: Georgetown, Indiana

Re: insurance coverage is 70%. have older machine with leak.

Post by M'ohms » Mon Sep 15, 2014 6:32 pm

If you decide to purchase a new machine, I'd ask your DME what you would have to pay if you go through insurance. My DME told me that I would only pay my portion of the insurance-contracted amount, not the amount billed. This is a significant difference!

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Supplemental oxygen at 2.5 lpm
AutoSV 960 with heated hose. Settings: EPAP Min-12, EPAP Max-17, PS Min-5.5, PS Max-13, Max Pressure-25, Rate-Auto, Rise Time 1. Use Sleepyhead and Encore Pro.

aznh
Posts: 11
Joined: Mon Sep 15, 2014 11:06 am

Re: insurance coverage is 70%. have older machine with leak.

Post by aznh » Mon Sep 15, 2014 7:03 pm

Thank you for your replies. On this unit the water reservoir has the male unit and the machine the female, so there won't be a way without an adapter to bypass the water reservoir. Even if I don't use water that is where the hose goes. I really appreciate everyone's advice. I decided to just bite the bullet and call my DME. She told me to get my doctor to submit an RX for a new machine since there are so many new features that could help me. So I will go that route at least to the point of finding out the price and my charges. So now I'm spending time reading all your posts about the best machines. In the meantime I think a piece of chewing gum strategically placed may help the air leak, I still don't think that will solve my bubbling though, but worth a try!

User avatar
tortoisegirl
Posts: 167
Joined: Thu Jan 16, 2014 6:52 am
Location: WA

Re: insurance coverage is 70%. have older machine with leak.

Post by tortoisegirl » Mon Sep 15, 2014 8:31 pm

Yes you should only have to pay co-insurance (percent) on the approved price, not the list price. And this is after any deductible you may have. The issue however comes down to trying to determine your insurance's contracted amount for CPAP machines (and the humidifier, hose, mask, etc) prior to the claim being paid.. I tried both my insurance and the DME without luck, and have heard this from many other folks too.

My insurance says that it varies; yet I know somewhere they have the numbers for each plan. The DME said they only quote their list price, to ensure patients don't expect to pay less than it could be. I couldn't even get the DME to tell me on average what someone paid for a CPAP setup after insurance. I got a pretty good idea ahead of time though from knowing I would pay my percentage (20%) of a price between that of an online DME and the highly marked-up brick & mortar DME list price. It ended up being much closer to the online price thankfully.

If you don't have a deductible, your co-insurance is low enough that going through insurance is still most likely to be cheaper. It gets more complicated when a deductible is involved though. Many folks nowadays have a deductible that exceeds their machine amount, so they end up paying out of pocket either way. Then you would consider paying out of pocket, especially if you are otherwise healthy and it is near the end of the year (when you are less likely to get any benefit from having your deductible paid). Best wishes.

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: CPAP pressure of 5; diagnosed AHI=9; also have PLMD & insomnia

User avatar
archangle
Posts: 9294
Joined: Sun Mar 27, 2011 11:55 am

Re: insurance coverage is 70%. have older machine with leak.

Post by archangle » Mon Sep 15, 2014 8:36 pm

aznh wrote:Thank you for your replies. On this unit the water reservoir has the male unit and the machine the female, so there won't be a way without an adapter to bypass the water reservoir. Even if I don't use water that is where the hose goes. I really appreciate everyone's advice. I decided to just bite the bullet and call my DME. She told me to get my doctor to submit an RX for a new machine since there are so many new features that could help me. So I will go that route at least to the point of finding out the price and my charges. So now I'm spending time reading all your posts about the best machines. In the meantime I think a piece of chewing gum strategically placed may help the air leak, I still don't think that will solve my bubbling though, but worth a try!
I think the "female" plug is actually a "gender changer" that can be pulled out.

Does your machine look like this?

Image

If so, pull the clear silicone rubber part out from the blower unit and the hose will fit onto the CPAP machine where the water tank plugs in.

Pull this part out: (and don't lose it.) This is the part Pugsy was talking that you might want to replace.

Image

If you've got one of the screwy ResMed hoses, it might not fit because it's recessed, but all standard hoses should fit. It might be a little confusing because the male connector on the blower unit is recessed, and it sort of looks female if you don't look closely.

Hey, we've got a female impersonator hose connector here.

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
Please enter your equipment in your profile so we can help you.
Click here for information on the most common alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check for yourself.

Useful Links.

aznh
Posts: 11
Joined: Mon Sep 15, 2014 11:06 am

Re: insurance coverage is 70%. have older machine with leak.

Post by aznh » Mon Sep 15, 2014 9:26 pm

Archangel, my machine looks a bit like that, only it has a built in tray on the front about 3 inches wide with a metal plate that pushes down when you connect the water reservoir. So without the reservoir it looks like a part is missing. I do think you are right about my being able to connect the hose if I remove that piece. I will definitely try it, thank you. You are also right that they are a little tricky about being sure that water reservoir is connected correctly, but I have been doing this for years and have played around with it like crazy and it is still leaking. Do you think that if the machine is leaking it pushes out more air trying to get up to the correct pressure? Im wondering if that is why I keep ending up with mouthsful of air. Seems like either too much air is coming in, or I can't exhale the air out through my nose. Anyway, if I can figure out how to attach the hose directly I am going to try that tonight and post if it worked tomorrow ( and if I still bubbled!)

User avatar
archangle
Posts: 9294
Joined: Sun Mar 27, 2011 11:55 am

Re: insurance coverage is 70%. have older machine with leak.

Post by archangle » Tue Sep 16, 2014 3:00 am

aznh wrote:Archangel, my machine looks a bit like that, only it has a built in tray on the front about 3 inches wide with a metal plate that pushes down when you connect the water reservoir. So without the reservoir it looks like a part is missing. I do think you are right about my being able to connect the hose if I remove that piece. I will definitely try it, thank you. You are also right that they are a little tricky about being sure that water reservoir is connected correctly, but I have been doing this for years and have played around with it like crazy and it is still leaking. Do you think that if the machine is leaking it pushes out more air trying to get up to the correct pressure? Im wondering if that is why I keep ending up with mouthsful of air. Seems like either too much air is coming in, or I can't exhale the air out through my nose. Anyway, if I can figure out how to attach the hose directly I am going to try that tonight and post if it worked tomorrow ( and if I still bubbled!)
I think that tray is just the front part of the humidifier. The blower unit just sits on top of the humidifier, which is a long flat plate thing. If you take off the water tank, you should be able to simply lift the blower off of the humidifier at the front. The power cords daisy chain at the back. If you want to do without the humidifier, you can simply plug the power cord directly into the blower unit.

Have you pulled the clear silicone rubber fitting out of the front of the blower unit and looked at it? That's probably the cause of your problems. I had to fiddle with mine a time or two. You can order them online, or your DME may have them at a somewhat reasonable price. (or not.)

The humidifier looks like this: Image

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
Please enter your equipment in your profile so we can help you.
Click here for information on the most common alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check for yourself.

Useful Links.

aznh
Posts: 11
Joined: Mon Sep 15, 2014 11:06 am

Re: insurance coverage is 70%. have older machine with leak.

Post by aznh » Tue Sep 16, 2014 11:29 am

Archangel, that is indeed my machine. I had never removed that connector before lastnight. I did get it removed and was able to attach the hose with no air leaks. I am going to fiddle around with it today to see if I can put it back together without a problem. I had a lot of mask leaks and was still bubbling last night. Will use a different mask tonight. I decided that since I am able to use this without leaks, I wont bother about a new machine for now. Lookingat champva ithink I will be better off going in to the Pcp I had at the va and having them order it. I haven't been to that pcp for years and cant get the time to see her now unless I take my mom with me. I'm afraid that will so confuse her (Alzheimer's) . So I will just try to get a new mask and see if that will help. I thank everyone so much for their help.

User avatar
archangle
Posts: 9294
Joined: Sun Mar 27, 2011 11:55 am

Re: insurance coverage is 70%. have older machine with leak.

Post by archangle » Tue Sep 16, 2014 10:52 pm

I vaguely remember having to tinker with that %*%$&#( connector for a long time on my old CPAP machine and getting it to stop leaking. One problem can be putting it in backwards. Another problem can be if the black insert is damaged or somehow misfitted.

One way to help check it is to start the machine and plug the end of the hose with your thumb and listen for leaks.

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
Please enter your equipment in your profile so we can help you.
Click here for information on the most common alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check for yourself.

Useful Links.