Diagnosed in November 2017 and still waiting...

Hello All!

Just let me start by saying what a fantastic Forum you all have here. Fabulous group with unparalleled knowledge. Trying to digest it all.
Allow me to introduce myself, My name is Xavier, 46 year old male, I am an Art Teacher for Miami (South Florida) Public Schools, I have CIGNA (ughh),snore like a lion
and live the "always tired and moody life" of a person with OSA.

In June my Primary suggested I take a Sleep Test but between the out of network cost and the fact that CIGNA only allows me a take home sleep test I did not get diagnosed 'till
November 2017... MODERATE OSA. After the diagnosis my Primary ordered an in-lab titration study and then there was complete silence. I didn't hear from anyone 'until late December when I decided to call
CIGNA. CIGNA tells me that they did not approve my in-LAB titration, the doctor needs to call in for a review, takes about a week, according to the CIGNA rep (wow, what piss poor attitudes these
people have on the phone). I do a little research and I discover that I don't meet one of the three requirements for an in-Lab (a co-morbidity) but can have a home titration. The funny thing is that the REP on the phone does not tell me this, I had to discover this on my own from a CIGNA PDF I found online. Sheesh! I call my Primary, let him know, he's starting to feel frustrated and says he'll call in an in-home titration then. OK, weeks pass, still nothing. A little research HERE at CPAPTALK and I discover CARECENTRIX (another thing the CIGNA rep never bothered to inform me about). I call them, (they have a full record of my OSA history) they say nothing has come in yet but that they can call the DOC for me. GREAT! They call and set everything up last week (that was nice, finally some progress). I still have to wait for CIGNA to approve though. I've waited this long what's another few days right? My doctor's office calls me and tells me carecentrix is going to send me the unit, through the mail with APRIA. Now I have not read much of the forums but anyone who has spent any amount of time here has read the APRIA warnings. So now I'm in a panic. My CIGNA (ughh) plan only covers 70% for APAP but its probably going to be a rental, between (most likely inflated ) fees and the 30% I need to pay to eventually own the unit would I be better off just paying cash for one? Has anyone gone through this choice of perhaps skipping the insurance?

Any guidance you can offer would be most appreciated, and sorry for the disjointed and fragmented story. Its probably a reflection of my personal experience with the process of trying to get treated for OSA through a system that seems -to me at least- to care more about the money than the patient.

Rant OFF


Thanks

find out how much first, If you have the garden variety apnea obstructive with little or no CA. Then you could buy an auto cpap secondhand, or new off of c/list or amazon for 350-450. sometimes the ins isn't worth going through.

I agree find out cost. Talk with your doctor and honestly in most normal cases you'd be better off getting an auto machine with data and help here. This site can help with your titration and if you buy machine online you'll most definitely save money.

Thanks VET & JACK for your rapid responses. Save money, thats' what I'm all about. I have seen many here recommend the Airsense Autoset 10. That can be had for 450? That sounds VERY reasonable. And yes, I see the great help being given here and I feel it may surpass that of my Primary.

I'm using the Dreamstation and very happy with it. Pugsy advocates for airsense as being more aggressive and works great for her and I respect her and her Opinions. That said either will do you just fine. So whichever you can't find cheapest that is auto and full data will do just fine.

I have tried the Dreamstation Auto, the Resmed Airsense 10 CPAP, Autoset and Autoset for her.

The Resmed machines are superior to the Philips Dreamstation ones in various areas, such as autostart for instance.

Dreamstation auto automatic start..... Sometimes breathing 2 or 3 times activates machine other times 5 to 7 starts it.

If cost is an issue either one will be fine.

You will be happy with either machine, I lean towards resmed.
The dreamstation is cheaper and can be titrated to work fine. It likes the min to be closer to the 90/95% pressure.
The resmed for her and the other model have 2 algorithms now. Check, but i think both model 10 have 2 auto algorithms, hard and soft, or whatever they are called.

I have dealt with Cigna/Carecentrix for about 6 or 7 years, and they can be a pain in the butt. I had a prescription, and it took maybe 6 weeks to get a new machine. Make sure you get a copy of your prescription and your sleep study results from your doctor, and keep it. Always crunch the numbers before taking the leap. The buy a gently used machine advice may be the best advise, but still work with Carecentrix. I have ugly thoughts when even thinking of them. You can use the bought machine as a backup machine when you finally get a new one. You'll need Carecentrix to get supplies and a new mask, probably every 3 months. Know that insurance companies jack up the prices, so always keep this in mind when dishing out your hard earned money.

I have high deductible Cigna insurance. My experience is that unless I meet the deductible, my out of pocket costs for supplies is less if i just buy them myself on Amazon, eBay, etc. The rental for my machine was easily 1/3 more than imwould have paid to buy it myself. If you might meet the deductible, going through the insurance makes sense.
Jim

Thanks for all the honest help. I called CIGNA and they have me down for a 750 dme deductible. After that I have a 30% obligation. So, bottom line is what you guys have been pointing to: best to go on my own as far as APAP purchase. Now the hunt begins.