Just diagnosed - Ecstatic!

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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nutricula
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Just diagnosed - Ecstatic!

Post by nutricula » Tue Dec 09, 2014 7:15 pm

After complaining for over ten years of fatigue and brain fog (along with numerous other sleep apnea symptoms!) I was finally diagnosed as having sleep apnea during a home sleep study. This is after a long road of being treated for depression, ADHD, and anxiety issues; all of which lead to various symptom relief but never actually feeling 'right'. My AHI was just under 30, so not nearly as bad as some of the others I have seen on this forum. That being said, I have been suffering a great deal (especially over the last couple years) in my day to day life; and welcomed this diagnosis as a long sought after potential solution to numerous mental and physical problems.

I know the CPAP can be difficult to get used to, however I am so committed to addressing my fatigue issues that I don't expect to throw the towel in on this. I do go back this weekend for an overnight lab study, which they said they will also be doing my titration during the same night.

I do have a couple of questions I am hoping some of you are able to help me with:
1. Do insurance companies typically offer a rental or a reimbursement for the CPAP device? I know this varies from company to company, however I really want to choose my own device and just received a used, outdated, rental device. I would classify my insurance as really good overall, however I know there are a lot of variables here.

2. I have read numerous success stories from the 30+ page thread, and this is very promising for someone new to CPAP. For those that don't notice a change, do you have a suspicion as to why? (compliance issues, equipment, etc.)

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Pugsy
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Re: Just diagnosed - Ecstatic!

Post by Pugsy » Tue Dec 09, 2014 7:39 pm

Welcome to the forum.
Might want to do a little more reading...start with these 2 blogs
http://maskarrayed.wordpress.com/what-y ... me-part-i/
http://maskarrayed.wordpress.com/

You need to contact your insurance company to see how they handle things...don't rely on the DME (cpap equipment supplier) to do this for you as they often don't even check and instead just tell you what "most" insurance companies will do.
Insurance companies and even plans within the same company can vary with what their coverage is.

You always have the choice to choose a machine that you want....the DMEs don't always have to supply it though unless your doctor gets real specific on the RX. So sometimes we might have to keep shopping DMEs until we find one that will supply what we want.
My first DME choice flat out refused to supply the brand I wanted much less the model. I fired them before I even got the machine.
But then my doctor wrote a generic "cpap with heated humidifier at so and so pressure" script..I had no leverage to force them to supply what I wanted. If you can get the doctor to be specific about brand and model on the RX then you have a lot more leverage.

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Sleeprider
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Re: Just diagnosed - Ecstatic!

Post by Sleeprider » Tue Dec 09, 2014 8:07 pm

Welcome to the forums. Your questions bring back memories of my own uncertainty about getting appropriate equipment years ago. I never had a titration study as I did not tolerate the sleep study well, so was prescribed an auto self-titration machine.

1. Do insurance companies typically offer a rental or a reimbursement for the CPAP device? I know this varies from company to company, however I really want to choose my own device and just received a used, outdated, rental device. I would classify my insurance as really good overall, however I know there are a lot of variables here.

Call them and ask their policy. Many insurance companies require a rental to verify you tolerate CPAP, that it is the right machine and you comply with minimal usage. I was surprised to learn when I call my insurance that they gave me a list of suppliers that include not only DMEs but also Pharmacies and retail sleep centers. I get mine through the pharmacy because I don't need or want the support of the DME, but the point is to ask what your options are. Who knows? Maybe you can ask for an Auto CPAP and forego the titration if you're comfortable with that. It sure would be less expensive.

2. I have read numerous success stories from the 30+ page thread, and this is very promising for someone new to CPAP. For those that don't notice a change, do you have a suspicion as to why? (compliance issues, equipment, etc.)

Cross that bridge if, or when you come to it. The reasons vary with each person and generalizing won't help you anyway. You know the importance of data recording, so be sure to insist that whatever you get is capable of telling you or the therapists the information necessary to get the most out of your treatment and evaluate efficacy.

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bwexler
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Re: Just diagnosed - Ecstatic!

Post by bwexler » Tue Dec 09, 2014 8:18 pm

There is no such thing as what a typical insurance company will do regarding PAP therapy.
That is like asking what a typical 17 year old will do at a party with the keys to the family car in his pocket.

Success or failure at PAP therapy is largely dependant on the commitment of the patient.
If you are committed, you will do the research necessary to get the right equipment for you condition. You will research sleep hygiene and arrange to follow good sleep hygiene to the best of your ability. You will use your equipment every time you sleep. You will learn to get and use software to follow how effective your treatment is, and learn what you can do to improve your outcome. You will mange your medical team and DME to insure they each provide you with what you need from each.

When you take charge, starting today, and ask for help here as needed, you WILL SUCCEED.

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Sir NoddinOff
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Re: Just diagnosed - Ecstatic!

Post by Sir NoddinOff » Wed Dec 10, 2014 1:05 pm

You've already received some great advice... all I have to add is that with your goal-oriented upbeat attitude I think you will be successful very soon. Welcome aboard. Keep us updated on your progress.

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I like my ResMed AirFit F10 FFM - reasonably low leaks for my ASV therapy. I'm currently using a PR S1 AutoSV 960P Advanced. I also keep a ResMed S9 Adapt as backup. I use a heated Hibernite hose. Still rockin' with Win 7 by using GWX to stop Win 10.

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nutricula
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Re: Just diagnosed - Ecstatic!

Post by nutricula » Tue Dec 16, 2014 3:12 pm

Thank you so much for the kind words and encouragement. I completed my titration this past weekend, and determined the pressure needed to keep my airway open is 16. I have also been working/hassling the DME and my sleep lab to push the Rx and order along, however it looks like it will be a couple weeks before I have my equipment. Frustrating to say the least, but I guess waiting another couple of weeks on top of a decade won't be the end of the world.

On the plus side, I did find out my insurance will be providing me the AirSense 10 Autoset.

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photonic
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Re: Just diagnosed - Ecstatic!

Post by photonic » Tue Dec 16, 2014 4:16 pm

bwexler wrote:There is no such thing as what a typical insurance company will do regarding PAP therapy.
That is like asking what a typical 17 year old will do at a party with the keys to the family car in his pocket.

Success or failure at PAP therapy is largely dependant on the commitment of the patient.
If you are committed, you will do the research necessary to get the right equipment for you condition. You will research sleep hygiene and arrange to follow good sleep hygiene to the best of your ability. You will use your equipment every time you sleep. You will learn to get and use software to follow how effective your treatment is, and learn what you can do to improve your outcome. You will mange your medical team and DME to insure they each provide you with what you need from each.

When you take charge, starting today, and ask for help here as needed, you WILL SUCCEED.
Right On!! Straight talk. 'nuff said
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princessbelle
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.

Post by princessbelle » Tue Dec 16, 2014 4:32 pm

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Last edited by princessbelle on Wed Jan 21, 2015 7:13 pm, edited 1 time in total.

Sleeprider
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Re: Just diagnosed - Ecstatic!

Post by Sleeprider » Tue Dec 16, 2014 5:06 pm

Glad to hear you completed titration and the uncertainty of what machine you will get is resolved. The Airsense 10 is a very good machine and will let you evaluate your treatment and progress. A prescription for 16 CM H2O is a relatively high pressure, and the EPR feature will probably be appreciated. A number of people with higher pressure requirements like yours end up using BiPAP machines, but you actually have to fail on a CPAP first. I think you'll be just fine, but it will be interesting to see your progress.

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Janknitz
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Re: Just diagnosed - Ecstatic!

Post by Janknitz » Tue Dec 16, 2014 10:03 pm

princessbelle wrote:I don't know how many this affects but I will put what I know in about my insurance. I have BCBS of Illinois but I live in Michigan. My BCBS with Illinois requires 3 months of rental with exception to our right purchase if it is a replacement machine. My issue came to light with the new machine, my benefits with BCBS of Illinois don't matter, at least according to BCBS, I have to go by the contract BCBS has with Michigan a 10 month rental. My husband is finding out who the benefit administrator at work. I think it is fraud that we (us and the employer) pay for a package with benefits we are not allowed to use. Just something to think about if you live in a state but your insurance is an out of state policy.
I lived in Hawaii which mandated certain things be covered but the out of state insurer from my husbands employer did not cover that treatment. I filed a complaint with the state and got coverage. However, your case is different because you are receiving the treatment, and there's unlikely to be a state law mandating purchase after 3 months. "Federally Qualified" plans (often plans that cross state lines are federally qualified) may be exempt from state regulation.

So it doesn't look too good for winning your argument, but worth a try.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
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archangle
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Re: Just diagnosed - Ecstatic!

Post by archangle » Tue Dec 16, 2014 10:43 pm

Welcome.

Check the links in my signature line to avoid being screwed with a bad machine by your DME.

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bill-e
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Re: Just diagnosed - Ecstatic!

Post by bill-e » Wed Dec 17, 2014 7:53 am

nutricula,

It sounds weird to congratulate you on your diagnosis but I understand that you're happy to find a possible solution to your problems.

I was diagnosed in 2006 and like you was ecstatic that I would finally find relief from my chronic tiredness. I had friends who told me that it would be life changing. Well, to this day I really haven't noticed a noticeable ,improvement. I continue therapy for my heart but would stop immediately if there were no other ill affects from my apnea. I've had two studies and moved up to an APAP but i don't really feel any better.

I hope that you, like so many folks here have a good experience with your therapy.

Good luck,
Bill

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nutricula
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Re: Just diagnosed - Ecstatic!

Post by nutricula » Fri Dec 19, 2014 12:21 am

princessbelle wrote:I don't know how many this affects but I will put what I know in about my insurance. I have BCBS of Illinois but I live in Michigan. My BCBS with Illinois requires 3 months of rental with exception to our right purchase if it is a replacement machine. My issue came to light with the new machine, my benefits with BCBS of Illinois don't matter, at least according to BCBS, I have to go by the contract BCBS has with Michigan a 10 month rental. My husband is finding out who the benefit administrator at work. I think it is fraud that we (us and the employer) pay for a package with benefits we are not allowed to use. Just something to think about if you live in a state but your insurance is an out of state policy.
Thanks pricessbelle. I have been warned that starting January 1st, my insurance wants to validate at least 4 hours of use per night on 70% or more nights; or they will stop paying after 90 days. After 12 months, the device is supposedly mine. This is all coming from the DME, so take it for what it is worth.
Sleeprider wrote:Glad to hear you completed titration and the uncertainty of what machine you will get is resolved. The Airsense 10 is a very good machine and will let you evaluate your treatment and progress. A prescription for 16 CM H2O is a relatively high pressure, and the EPR feature will probably be appreciated. A number of people with higher pressure requirements like yours end up using BiPAP machines, but you actually have to fail on a CPAP first. I think you'll be just fine, but it will be interesting to see your progress.
The sleep tech also mentioned that the pressure was higher than he expected. He didn't seem to want to go in to too much detail, and just said the doctor will make the final call (which was 16). I will have to keep an eye out for central events, which seem to be more common with higher pressures from my limited reading.
archangle wrote:Welcome.

Check the links in my signature line to avoid being screwed with a bad machine by your DME.
Awesome, thank you!
bill-e wrote:nutricula,

It sounds weird to congratulate you on your diagnosis but I understand that you're happy to find a possible solution to your problems.

I was diagnosed in 2006 and like you was ecstatic that I would finally find relief from my chronic tiredness. I had friends who told me that it would be life changing. Well, to this day I really haven't noticed a noticeable ,improvement. I continue therapy for my heart but would stop immediately if there were no other ill affects from my apnea. I've had two studies and moved up to an APAP but i don't really feel any better.

I hope that you, like so many folks here have a good experience with your therapy.

Good luck,
Bill
Thanks Bill. I am sorry to hear your experience has not yielded relief from the chronic fatigue. I do have that worry as well, however I am trying to go in with the mindset that at the very least I will sleep better/healthier.

I am not sure when the last time you had a study done, or if you monitor your data; however I wonder if you are getting restful, uninterrupted sleep at the pressure you have. I have been talking with a colleague over the last couple of months who was diagnosed 14 years ago. He has been complaining about 'starting to feel run down again', and admitted he hasn't had a follow-up study in about 5 years. He suspects his pressure needs to be increased, and has just started the process to confirm his device and pressure working as intended.

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nutricula
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Re: Just diagnosed - Ecstatic!

Post by nutricula » Fri Dec 19, 2014 12:26 am

One last additional note: After multiple calls (borderline harassment) to the sleep lab and DME, they were able to get me in for an appointment to pick up my device on Tuesday.