Question for Ontario people

[rosacer]

Hi my neighbors

A friend of mine is waiting for an emergency appointment with a pneumology Dr. to get his sleep test and then the prescription for a machine. He has OSA, he was diagnosed 3 years ago but not treated. He never had the copy of the results on his hand or the prescription for the machine, complicated situatuon . Now he really needs to start treatment ASAP.

Could somebody tell me how it works the Ontario government help for CPAPs.

I think somebody told here the government pays only a % for a CPAP price, is it possible to pay the difference and get a good APAP instead? What about the mask, is the amount given for the CPAP + mask?

Is it worthy to buy at big price from a DME with the government help or to use the difference he will need to put any way to buy on internet?

Is there a maximum salary or other requirements to be eligible for this government plan?

Thanks, I'm helping my friend to get on track in the hosehugger's world.

Rosie

[Elle]

Contact the Assistive Devices Program at the Ontario Ministry of Health. You can google that to get a number. I am in BC so it is different but I found this information through Google. They have a website.

[rosacer]

Thank you Elle, there is a lot of useful information in the link. If you are diagnosed with OSA you are admissible.

I have still a couple of questions about prices for machines using the DME (the respiratory vendor registered with ADP) which is paid 75% for a CPAP or APAP ( I don't know who decides which one you can get, a CPAP or APAP ) and a basic mask (what is a basic mask?). Which brand can you buy with the funds allowed.

(The ADP provides funding assistance for a complete CPAP or APAP system. For ADP purposes, a CPAP or APAP system consists of a CPAP/APAP device, heated humidifier, basic mask and headgear, carrying case, 6 ft tubing, all necessary caps and filters, power cord and patient instruction manual.)

I found the government's document explaining all the process/rules and as per that document I understand it's very hard to have an APAP. In that case is it possible to arrive to an arrangement with the DME to pay the difference and finally get an APAP ? not sure.

I still don't know the value of the CPAP allowed, it says in 2004 it was $985 or so. Is it a brick without data recording capacity? Lots of questions. If the machine costs $2000 the government will pay 75% from $985? then my friend will need to pay $1261? this is weird complicated as everything with government, always the big mystery until you discover at your expenses.

If somebody from Ontario has get his/her equipment it could be nice to hear about your experience.

Thanks

[tetragon]

Thank you Elle, there is a lot of useful information in the link. If you are diagnosed with OSA you are admissible.

Not quite, at least according to the province's manuals.  There also needs to be "the presence of significant symptoms or medical risks without treatment, and the absence of symptoms or risks with treatment", (paras 425 and 520, Respiratory Equipment: Policy and Administration Manual, http://www.health.gov.on.ca/en/pro/prog ... manual.pdf) (and yes, I know).

I have still a couple of questions about prices for machines using the DME (the respiratory vendor registered with ADP) which is paid 75% for a CPAP or APAP ( I don't know who decides which one you can get, a CPAP or APAP ) and a basic mask (what is a basic mask?).  Which brand can you buy with the funds allowed.

(The ADP provides funding assistance for a complete CPAP or APAP system. For ADP purposes, a CPAP or APAP system consists of a CPAP/APAP device, heated humidifier, basic mask and headgear, carrying case, 6 ft tubing, all necessary caps and filters, power cord and patient instruction manual.)

They are not paid 75%, it is instead 75% to a specified maximum (para 700.03, ibid).  I don't recall there being a choice for a "basic" mask (I think it was some F&P mask, I can't recall the model).  I would suggest simply setting aside an extra $300 or so for a non-basic mask (I'm using an "upgraded" CPAP mask).  As for APAP eligibility, that's para 425.01; there needs to be a pressure requirement difference of at least 4cm on a fixed pressure of at least 10cm between REM and NREM or supine and non-supine.

I found the government's document explaining all the process/rules and as per that document I understand it's very hard to have an APAP.  In that case is it possible to arrive to an arrangement with the DME to pay the difference and finally get an APAP ? not sure.  

The closest I got to an APAP was an RT letting me hold one of the new Series 60 APAPs.

I still don't know the value of the CPAP allowed, it says in 2004 it was $985 or so.  Is it a brick without data recording capacity?  Lots of questions.  If the machine costs $2000 the government will pay 75% from $985? then my friend will need to pay $1261?  this is weird complicated as everything with government, always the big mystery until you discover at your expenses.

Yes to the $1261, given the 2004 cap.  The cap is higher now.  What I found at my DME is that they quoted me prices with the province's component already removed (so their basic package (meets the provincial minimum) was less than $300.

If somebody from Ontario has get his/her equipment it could be nice to hear about your experience.

Thanks

When I picked mine up last year, the government would pay up to $780.  The province did base their price cap on a brick with a cheap mask (it was some flavour of non-Icon F&P).  I have a non-brick, but I did pay extra for it and a more comfortable mask.

[rosacer]

Thanks Tetragon, very interesting !

My friend will be illegible. He passed a sleep test years ago while in hospital because of heart problems, the heart's Dr is the one pushing him to go see the sleep apnea specialist and start treatment.

When he was in hospital they plug him to a CPAP (I don't know the pressure but I imagine it was high) with who knows which FFM mask (a Quattro ); he found his experience really terrible, he was unable to sleep with all that and the awful FFM so he said no CPAP and didn't continue the process to have the CPAP prescription etc. Myself I needed to pass one night at hospital and they lend me a CPAP (not bad I wonder if I had the good pressure ) with a torture nasal mask, I said to myself next time I need at least to bring my mask

My friend is autonomous worker, so no health=no work=no money to buy an expensive kit.

If I understand well (please correct me if I'm wrong) :

a) you need to be prepared to pay $300 for a good mask. That I can understand and I accept it's a good investment if you are allowed to test different masks until find the one which fits your facial features, for that there is no other way to go.

What I found at my DME is that they quoted me prices with the province's component already removed (so their basic package (meets the provincial minimum) was less than $300.

b) Then you need to pay around $300 for the basic package which is a brick CPAP and maybe a useless mask for you. If you want to have a better machine you need to add more money, at the end it seems you are paying what $600 ? for an APAP. Is that APAP full data capable model?

All that is very complicated for somebody whom is starting in the OSA world, I live at 3hours from my friend, I don't know if I will be able to go with him see the DME because that's not an easy negotiation when you don't really know the machines, prices and possibilities on internet, etc.

I wonder if it worth something to go with the government's program or if it wouldn't be better for him to buy the machine on internet and the mask from the DME and that's all. I don't know if he is resourceful enough to go that way, the machine's guarantee is the good think I see buying it in Ontario. Do you need to pay more if you want to have the DME adjusting your machine's pressure until find the good spot?

WOW, I put myself in your place Tetragon and I see you didn't have that easy. The information you are giving me is very relevant, thanks again.

Another friend told him to go see at Vitalaire, what do you think? are they good?

Rosie

[tetragon]

I have a non-brick CPAP that I paid extra for, not an APAP. I got my prescription because I was a bit less tired than usual the evening after titration (nevermind that instead of going to work that day, I was cooped up in the lab for an MSLT). DMEs may vary, but I haven't had to pay mine for machine adjustments, data reads, or borrowing masks to try (once when they were waiting for a Swift FX for Her to come in and once to try out a non-pillows mask). I can't really suggest a DME as I didn't get a chance to tour any; my sleep doctor's receptionists picked the one closest to my apartment and faxed them the prescription.

[BlackSpinner]

Another friend told him to go see at Vitalaire, what do you think? are they good?

That is the people I used in Montreal. Not the best. Of the 30 minutes I spent with them, 20 were spent on paperwork. Mask fitting was done by "That looks good" from across the desk. I felt that the quatro I got was to big. "We don't have an xs in stock right now, take this one".

[rosacer]

Blackspinner, that's very bad to be treat that way. I wound't return at that Vitalaire. the friend whom is satisfied with Vitalaire when to St-Jerome I think, he believes all the Vitalaire are good instead he was very fortunate .

My other friend is in Ottawa area, who knows what looks like the service there; it could be terrible too or a marvel. I can't understand those people keep their jobs treating the customers so carelessly. I wouldn't be happy at all and today I would vocalize my thoughts. There is another friend whom had a bad experience too but I don't remember if it was at Biron. I even offered to accompany her at her visit to the DME I wanted to ask a couple of questions to that person because the things she was telling to my friend made no sense.
If I was the manager of the place I would have a taught with those people, they make loss customers and destroys the company's image.

[Windmill]

It has been almost 3 years since I first started using a Cpap. The Ontario gov't paid the $780. and I was responsible for the rest of the cost. I was lucky to have insurance that paid 75% of the remainder, I still had to pay almost $300. out of my own pocket, total cost was close to $2000. By the time you get the machine, mask etc. the cost adds up fast. The mask that comes with what you get from the gov't coverage is a joke, hence you need to find and buy a mask that is comfortable; without that it will be very difficult to stay with it. I am retiring soon and will have no coverage at all so will be really looking around for supplies. Mask's on Cpap.com are much more reasonable than anything you can buy in Canada, even with the cost of shipping it is well worth it. Only draw back is if you want a Resmed product they won't ship to Canada. I am lucky to have a friend that lives in the U.S. where I can have my mask's sent. Good Luck and keep watch on this website....it is GREAT, helped me a lot!

[rosacer]

Good to know all that Windmill.

In that way I will tell my friend not to waste too much time with the government stuff. Because if I make well my maths, he will need to pay lets say it cost $2000 - $780 = $ 1220 any way.

The new Remstar 60 is $650 + $22 shipping= $672 + Ontario TX?
The System One Auto is $619 + $22= $641 + Ontario Tx ; then we add $300 mask. All that is a total of $972, lets say around $1000 which lets an economy of $220, I have never found 200 bucks on the sideways I wish I had .

The only difference is the guarantee which is 3 years if bought in Ontario and no need to pay shipping (and the time) back and forth to USA. The question is, does a guarantee worth $200? I'm not sure, instead I would buy a second hand machine as back up in case of need.

Very good information thanks! , we are almost done in the research, I hope this will help other Ontario people. Yes beautiful !

[BlackSpinner]

Check out clinicalsleep dot com in Vancouver. You have to call to get the real prices because they are not allowed to put them on the website by the manufacturers. They were not charging shipping costs in Canada and there is no tax on medical supplies. They do carry Resmed.

After exchange and shipping costs they came close to the US prices.

[rosacer]

Great idea Blackspinner, I haven't thought at that option, very good because they give 3 years guarantee .

I thought it could be TX to pay because one time Poste Canada charged me the TX for one of my machines, they ripped me off almost a $100 oh well it's too late now

Thanks.

[Elle]

I've emailed Clinical Sleep after hours for prices and had responses.

[tschultz]

In my case after my diagnosis of severe OSA I was insistent on having the S9 Autoset and after fighting to try and get the sleep doc to fill out the paperwork I decided to pay fully out of pocket. The requirements for APAP under the assistive devices program are very strict and I believe based on older machine capabilities and outdated criteria. I was more concerned with my health than saving the money - I looked at is an investment in my well being and future. I have not regretted my decision for the APAP instead of settling for CPAP.

From what I can see it seems that because of the assistive devices program (a government program), their criteria is used to determine what machine you are "permitted" to get. This is one area where our friends south of the border have the advantage of the billing code being the same for CPAP and APAP. Ontario treats them differently and this further complicates what the DME is able/willing to provide to you. I also found this also tends to complicate how some of the health insurance companies cover their portion as they view that if you don't meet the requirements of the assistive devices program they may not cover any costs. I know this was what I encountered getting my machine.

[rosacer]

The requirements for APAP under the assistive devices program are very strict and I believe based on older machine capabilities and outdated criteria.

tschults, I agree with you. I was very surprised to see the chart for the amount payed dated from 2004, I was wondering if it existed another chart I haven't found. The fact of the strict criteria for the APAPs (to me that's really crazy) is very negative. If the insurances take the government criteria to determine if you need or not a machine that's really bad. Even to be diagnosed seems to be out of sense if they take the government criteria to decide it. I hope the Drs are more intelligent than that.

Thanks for the comments.