Insurance wont pay...purchase our own?

My wife developed afib this summer. To make a very long story short all her afib events happened at night during her sleep, in addition a heart monitor showed her heart rate slowing into the 30's or below at night. A sleep study was done and the sleep study organization and her cardiologist recommended a CPAP machine. Eventually she also had a cardiac ablation and has had no afib events since then (end of October). Insurance is refusing to pay for a CPAP servicing company to provide us a CPAP mahine and come out and hook it up etc....as the insurance company says her levels do not meet their levels. We have been round and round with the insurance company and they are not going to pay and the CPAP companies private prices were really high.

I was disheartened until I saw you can buy a CPAP machine on your own and they are quite readily available. Is this a good route to go down? Anything we need to know prior to purchasing a machine?

You have a private message.

I recommend the ResMed AirSense 10 AutoSet for Her.
Several reasons and I don't have the time to list them all so I will let the other forum members chime in.

Yes, you can do this on your own without help from a cpap supplier company. It's not difficult unless there ends up being some sort of weird and unusual complications and if that happens cross that bridge if/when you come to it. Odds are..that bridge won't come up.

Does she have Sleep Apnea, has she been tested? If you can prove she has a condition that needs CPAP, they should cover it if you get the doctors to cover it. Sounds like a Pacemaker is in order to control the heart rate, that's not what XPAP is for.

Yes you can save lots of hassle buying your own, all you need is a script and cash. Our benefactor here cpap(dot)com are good and fair people to deal with, I bought one of mine from them for a spare.

She may need a special kind of XPAP, for her problem, others here are more up to what's needed. Jim

Many people have purchased machines online.
Two great places are cpap.com (sponsors of this forum),
and Secondwindcpap.com (gently used or open box for even lower prices).
Curious?
Click on any of our equipment listed in our posts for info, including prices for new units.

daveculp wrote: ↑

Tue Feb 20, 2018 2:19 pm

A sleep study was done and the sleep study organization and her cardiologist recommended a CPAP machine.

daveculp wrote: ↑

Tue Feb 20, 2018 2:19 pm

as the insurance company says her levels do not meet their levels.

Sounds to me like there was a sleep study done and she probably didn't meet whatever criteria the insurance company uses for paying for the machine but the doctor wants her to have one. That's a good enough reason to get one in my book.

Goofproof wrote: ↑

Tue Feb 20, 2018 2:41 pm

Does she have Sleep Apnea, has she been tested? If you can prove she has a condition that needs CPAP, they should cover it if you get the doctors to cover it. Sounds like a Pacemaker is in order to control the heart rate, that's not what XPAP is for.

Yes, she underwent a three night sleep study and according to the cardiologist and the sleep study organization she has sleep apnea and needs a CPAP machine. However the insurance is refusing to pay as they say her levels (number of times she stops breathing etc....) do not meet their minimum for a CPAP machine. According to her cardiologist afib and other arrhythmia can be caused by sleep apnea and around 1/2 of patients who have afib also have sleep apnea. SO far the cardiac ablation has prevented any other afib episodes.

Pugsy wrote: ↑

Tue Feb 20, 2018 2:45 pm

daveculp wrote: ↑

Tue Feb 20, 2018 2:19 pm

A sleep study was done and the sleep study organization and her cardiologist recommended a CPAP machine.

daveculp wrote: ↑

Tue Feb 20, 2018 2:19 pm

as the insurance company says her levels do not meet their levels.

Sounds to me like there was a sleep study done and she probably didn't meet whatever criteria the insurance company uses for paying for the machine but the doctor wants her to have one. That's a good enough reason to get one in my book.

I thought maybe tests were done after the heart was worked on, and now it's just the doctors concern based on ????. The doctor should make his case or a sleep study. If the Dr. can the INS should step up! Jim

It's more than just stopping breathing, the dr should be able to write it so it will get past the paper pusher. Squeaky wheels get greased...

Goofproof wrote: ↑

Tue Feb 20, 2018 2:56 pm

It's more than just stopping breathing, the dr should be able to write it so it will get past the paper pusher. Squeaky wheels get greased..

I know but as you well know just because a doctor writes a RX doesn't mean that the insurance company bean counters will pay for it.
Hell...if it would I would get my insurance to buy me that hot tub my doctor says would help my arthritis pain instead of having to take the pain pills.
There's a lot of stuff that insurance won't pay for no matter how much a doctor might squawk about it. I assume that OP's doctor has probably already tried being the squeaky wheel and that's why he is here.

A doctor's letter of MEDICAL NECESSITY sometimes carries more weight than a prescription.
Get that, and you might have more ammunition.

In addition to the Resmed for Her machine, I would also recommend asking the cardiologist if you can occasionally borrow an oxygen/pulse monitor (or buy one yourself that works with Sleepyhead). This way, you can occasionally track to make sure that she is getting sufficient oxygen at night. I use mine 2-3 nights in a row every couple of months due to slow heart.

30's is serious, she is getting down where I was, unless that has been fixed she needs help, I got a twin lead De-Fib Pacer, because a one chamber wouldn't up mine. I don't know if it does what is needed yet, my O2 meter shot craps. Readout failed. Should get new one... Jim

If you have a doctor's prescription, you should be able to order a machine from a reputable supplier. I recommend that you get the latest automatic from either Resmed or Respironics. Better not to get one of the "lesser" brands.

If you didn't have a prescription there are ways around it.

Insurance is refusing to pay for a CPAP servicing company to provide us a CPAP mahine and come out and hook it up etc....as the insurance company says her levels do not meet their levels.

What were her levels? Hide her personal info and post her sleep study or for now whatever numbers you have. Maybe her levels do not really warrant a CPAP.

What freakin insurance do you have.? I have Medicare and Medicade. I had to prove that I was using mine from my dme provider Lin care.

For CPAP #1 (1999) they came to the house, showed me how to use it, and followed up for about a year until that company went out of business. Short of showing up at my door, there was no means to check compliance. Even then, they can only check "motor" hours no "compliance" hours. Supplies were not covered by the insurance that I had at that time, so I ordered from E-bay.

CPAP #2 (2005) I ordered on-line. I was able to buy it for $500 from an off-plan supplier for a 30% co-pay. The "preferred" supplier (10% co-pay) wanted $1,500 for the same machine and was being a royal pain.

CPAP#3 (2009) was also ordered on-line. It was in December and I had a large balance in my flex spending, so I got the AEIO-Med Everest 3. It was a good machine until it broke (my neighbor has since fixed it).

CPAP #4 (2016) was ordered when Obamacare standards were in place, even though my insurance was not an "exchange" plan. They came to the house like the first time. This time, I had to rent it to buy and show compliance.