Insurance and replacement machine

I have had my machine since 2009 and want to get a new one due to various reasons. The current machine is not providing me with the therapy I need and I would like a machine with the latest technology. I had contacted Anthem Blue Cross and they said that it would be covered but, the folks at the medical supply store say it may not be and need to do a pre-authorization(I understand this part). They also said that companies tell people they are covered when they are not. Does anyone have any experience with getting a new replacement machine? The machine and I want and really need(due to stuffiness) is one that automatically adjusts the pressure based on what I need.

Are you quite sure your stuffiness isn't caused by a too-high humidity setting (for the local conditions, climate, season)?

And have you seen an ENT doctor to look for anatomical blockages that possibly could be fixed?

I have played around with different humidity settings and it doesn't matter, still get stuffy. Went to an allergist and no allergies but they did tell me with long term CPAP therapy you can develop congestion. Also have been to ENT and nothing there either.

cubbygurl wrote:I have had my machine since 2009 and want to get a new one due to various reasons. The current machine is not providing me with the therapy I need and I would like a machine with the latest technology. I had contacted Anthem Blue Cross and they said that it would be covered but, the folks at the medical supply store say it may not be and need to do a pre-authorization(I understand this part). They also said that companies tell people they are covered when they are not. Does anyone have any experience with getting a new replacement machine? The machine and I want and really need(due to stuffiness) is one that automatically adjusts the pressure based on what I need.

Which machine do you have?
Are you using software to see your data? How do you know it's not providing adequate therapy?
Just because it's not an APAP, doesn't mean it's NOT providing adequate therapy.
Some/many insurance providers will replace machines after 5 years.
Don't blindly take the word of the folks at the medical supply store.

There are MANY machines available through any number of sources......forum members, CPAP.COM, secondwindcpap.com and a whole bunch of places. If you have your prescription (and should have), you can probably buy one much cheaper than having to jump through all the insurance hoops, co-pays and deductibles. Even if you don't have a copy of your Rx, you can probably still get one.


Den

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cubbygurl wrote:I have played around with different humidity settings and it doesn't matter, still get stuffy. Went to an allergist and no allergies but they did tell me with long term CPAP therapy you can develop congestion. Also have been to ENT and nothing there either.

Have you been doing nasal cleansing before bedtime?
Can you breathe BEFORE you go to bed and put on the mask?
Are you keeping your intake filters clean/replaced?

Sounds like it may be too much humidity.


Den

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I agree with Wulfman but try the rinsing in the am as the moisture from the rinse can add to your congestion.

Also look into Flonase or Veramyst (Fluticasone).

Like everyone else I am curious HOW you think your therapy is not optimal, although you should look into a new machine every 5 years as stated by others.

Good luck

IMO...If Anthem said the new machine is covered, why should the DME refuse to sell you a new machine? It doesn't make sense to me.
Have your doctor...any doctor...write a prescription for the machine you want. The DME must fill the prescription as written.