advice welcomed please

Brief background: I have been on cpap (apap) for about 3-4 years. I learned of my apneas from a gf whose father had a cpap. I snored very loudly and woke up alot, and was tired all day. I had no medical insurance but was able to get a resmed APAP black market and through experiment set it for min 12. I sleep alot better. But I still have some tiredness during the day and alot of memory/concentration issues. Not sure is I need adjusting of the settings or if I need something else.

Advice needed: I recently got medical insurance. It does not cover pre-existing conditions. Do I tell the doctor the background story and that I have been on APAP for several years and that it has helped but not enough, or do I just tell him I'm having sleep issues?

zenman72 wrote: Advice needed: I recently got medical insurance. It does not cover pre-existing conditions. Do I tell the doctor the background story and that I have been on APAP for several years and that it has helped but not enough, or do I just tell him I'm having sleep issues?

Sleep apnea? You never heard of it

Tell him you think you may have sleep apnea, but you have never been tested for it.

zenman72 wrote: I learned of my apneas from a gf whose father had a cpap.

Of course you have to decide what you're comfortable saying or not saying. But, learning about apnea from one's grandfather is not the same thing as being medically diagnosed and thus having a documented pre-existing condition. The fact that you've been using APAP and feeling a lot better, while strongly suggestive, also does not constitute an official diagnosis.

I think it would be truthful to tell the doctor that you believe you have sleep apnea but that you've never had a sleep study. You have symptoms, and there is a family history. I'm not sure if you'll have to say much more than that to be referred for a sleep study.

Pre-existing means that you have a diagnosis of OSA from a doctor...not self-diagnostic. Start from scratch with a doctor without telling him the sordid details.

I think you should totally ask your doc for a sleep study to confirm the apnea and to find out your optimal pressure setting.
good luck
DR

Pre existing condition includes any condition that you might possibly have sought treatment for in the past even if you didn't.
Believe me if your insurance company knows that you suspected sleep apnea in the past due to symptoms..they will flag it as pre existing. You don't have to have a formal diagnosis in past history for the insurance company to deny it.
It's not fair but that's the way they do things....so they can avoid paying. I have seen it happen often. Save yourself a possible headache and don't mention that you have any inkling of sleep apnea...let the doctor come up with that conclusion.

What machine do you have? There may be a way to get the data off your machine so you can see what is going on...like maybe a leak affecting therapy effectiveness.

cosmo wrote:

zenman72 wrote: Advice needed: I recently got medical insurance. It does not cover pre-existing conditions. Do I tell the doctor the background story and that I have been on APAP for several years and that it has helped but not enough, or do I just tell him I'm having sleep issues?

Sleep apnea? You never heard of it

+1
Once you get a diagnosis in your medical file, you're screwed.......big time!

Den

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You've got to weigh the pro/con of divulging information.

What do you think the doc can do for you? What is your DME coverage?

cosmo wrote:What is your DME coverage?

There won't be any coverage if insurance jumps on the pre existing band wagon. Period.

Besides...once it's even hinted at in the history it messes up any subsequent insurance purchases...like life insurance.

Like Wulfman says...once it's on the record... you are totally screwed.

Don't think that proving compliance makes any difference either...now next year when the new changes are implemented and enforced...different story supposedly but I won't believe it till I see it.

If someone wants coverage now for sleep apnea they need to play dumb and let it come as a big surprise that the doctor thinks it is sleep apnea.

Thanks all for your responses, it has made it alot easier to decide to play dumb (I'm good at that).

Pugsy wrote:What machine do you have? There may be a way to get the data off your machine so you can see what is going on...like maybe a leak affecting therapy effectiveness.

I have a resmed s8. I think you are right I probably have some leakage issues. I have had the same mask/tubing for 3-4 years and I suspect it is probably not efficient enough anymore. Shouldn't masks be replaced more often? I wanted to replace mine a year or two ago but everywhere I checked seemed to require a prescription just for a mask.

If your S8 has Escape or Compact in the model name there is no useful data on it.
If it says Elite or Autoset...it does.
Tell us what it says and if it is the Elite we can tell you how to get what data it offers off the LCD screen.

Masks...yes, you have gone way too long with that mask.
What mask type/name are you using?
Yes, they do require prescriptions but depending on what mask you want to use there are ways to buy the replacement parts and build your own mask. EBay sellers get around the RX requirement by selling each part as a replacement part because replacement parts don't require a RX. The down side is that you don't have a huge selection to choose from because they tend to offer the most popular masks.

zenman72 wrote:Thanks all for your responses, it has made it alot easier to decide to play dumb (I'm good at that).

Pugsy wrote:What machine do you have? There may be a way to get the data off your machine so you can see what is going on...like maybe a leak affecting therapy effectiveness.

I have a resmed s8. I think you are right I probably have some leakage issues. I have had the same mask/tubing for 3-4 years and I suspect it is probably not efficient enough anymore. Shouldn't masks be replaced more often? I wanted to replace mine a year or two ago but everywhere I checked seemed to require a prescription just for a mask.

Which specific model is the S8? Elite?.....Autoset/Vantage?......or Escape/Compact? The first ones are data capable and the Escape/Compact are not........they only collect hours used.

Which mask do you have? Yes, the online sellers started requiring prescriptions for complete masks a few years back, but will sell parts for them without an Rx. They are frequently available from individuals (on the forum) who wish to get rid of some that they have accumulated and/or didn't work for them. Sometimes they're available for free or for very little money. Some parts to nearly complete masks are also available on Ebay.


Den

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Pugsy wrote:...once it's on the record... you are totally screwed.

Great....now I've got a record!

ObamaCare will fix the pre-existing problem. It kicks in next year. I'd go ahead and get sleep study and physician diagnosis. No reason to continue to suffer waiting for new regs to kick in.