Running out of time.

[Hornnumb2]

My sleep study is dragging there feet with the second night results. I need to get this equipment under this years insurance since I have a $1500 deductible. Can I get the doctor to do a prescription for a machine and then if something needs changing after the fact. Thanks Michael

[Wulfman...]

My sleep study is dragging there feet with the second night results. I need to get this equipment under this years insurance since I have a $1500 deductible. Can I get the doctor to do a prescription for a machine and then if something needs changing after the fact. Thanks Michael

How would we know? Call your doctor and ASK.

You REALLY ARE running out of time and it may be too late now.
But, there are various places like http://www.secondwindcpap.com which sell machines very cost effectively. And, you may not need a prescription.


Den

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[Protege]

As i recall, it took me two weeks to get My CPAP from the time i was diagnosed. For one thing, the sleep therapist I have apparently covers all of the sleep centers in town, so she's only in the office once a week. My doctor seems to have the same problem, because I've only been able to see him on Mondays. I will say, my sleep therapist has done a better job of answering my questions and concerns than my doctor has.

[chunkyfrog]

With that size deductible, you are basically not insured except for major illness, injury, or surgery.
Nice if you could use it for cpap, but otherwise, you would save money by not trying to go through the "system".

[Hornnumb2]

I have already meet the deductible for this year so I will only be out 25percent instead of 100.

[dooger54]

I had somewhat the same issue earlier this month. Had met my $5000 deductible and at $0 copayment to end of year. I got my prescription done in time but that wasn't the problem. I talked to my insurance, Blue Cross of Illinois and the local DME on the preferred provider list. The only way to get the machine through insurance was to rent it for 3 months, then you can buy after that. The three months would have taken me into 2016 and then I would have had to buy the machine with my own money, since the $5000 deductible starts over in January.

So I asked the DME what machine I could get, and they use the Airsense 10 auto. Cost through them is $3000. Bottom line, I went to,CPAP.com and bought the same machine myself for $880. Paid with it out of my Health Savings Account. End of story. Insurance did me no good.

[Gasper62]

Hey ! If the color pink doesn't bother you too much, a member just bought a brand new ResMed S9 Autoset for only $450.00 ! If I had to buy "out of pocket", I'd learn to love the pink one at approx. half the price of the silver ones.

[Wulfman...]

I have already meet the deductible for this year so I will only be out 25percent instead of 100.

But, 25% of an inflated price may be just as much (or more) as from another source. Lightly used or unused machines are "everywhere" these days. Many can be had very reasonably priced.
When I "did the math" way back when, I found that I could buy out-of-pocket (from CPAP.COM) for about the same as going through a local DME and my insurance provider. I actually bought my equipment through CPAP.COM and submitted an invoice (from me as the billing party) to my insurance provider (as the party being billed) and they paid 80% of it because they considered me to be "in-network".


Den

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[flightco]

With that size deductible, you are basically not insured except for major illness, injury, or surgery.
Nice if you could use it for cpap, but otherwise, you would save money by not trying to go through the "system".

Sounds like it is a High Deductible plan; 1500. is the bad part of these plans but they also have a very reasonable out of pocket max and once that is met everything , meds, supplies, equipment, etc is no charge for the rest of the year. I paid for my sleep study, part of my s10, by then all deductibles were met by June; after that my surgery, insulin pump, 6 months of insulin with testing supplies were all covered 100%. When you couple that with the reduced premiums for this type of plan it is not bad if you use it.

[russmac]

Even if you had more time, I don't think you're going to get very far without the study results.

[mariejeanne]

Doctors who are "in network" frequently collude with insurers to delay billing until after January 1st. Time to go camp out at the sleep doc's office until they do their job for YOU.

[Hornnumb2]

Well just heard from doctor that my cpap study was a fail and they want me to do another study with a bipap machine. I am already out $1500 for the 2 earlier studies and really don't have no money left to do this. I am at a lost of what to do.

[SewTired]

Well just heard from doctor that my cpap study was a fail and they want me to do another study with a bipap machine. I am already out $1500 for the 2 earlier studies and really don't have no money left to do this. I am at a lost of what to do.

Tell the doc that you aren't doing another study but would like a script for a bipap. Buy a used bipap (a respironics 560 series will give you Sleepyhead data which can be used to determine your final numbers). There were several good offers for barely used ones here recently, I'm sure you can find one for much more affordable than through insurance. Get a copy of your RAW study to make sure centrals weren't the issue. You can get that WITHOUT SEEING THE DOCTOR. Just show up and tell the gal at the desk that you want a copy of your study including the raw data and you will wait while they make the copies.

[Hornnumb2]

https://www.dropbox.com/s/mdhnm8aodq6wk ... t.pdf?dl=0

Here is the report.

[Pugsy]

I read your sleep report. I am having a hard time figuring out why they say failed cpap titration and want to do a bilevel titration. Was it because the higher pressure needed to resolve the obstructive apneas seriously disturbed your sleep or was it because of the centrals???
Did they run out of time because at the final pressure of 12 cm things seemed to be well resolved (per only the report showing no events) but not much time actually slept was spent at that pressure? 3 minutes at 12 cm pressure didn't show much but then that's not much time at all to measure any sort of effectiveness.

You could buy a bilevel machine privately and do your own titration at home....that's fairly easy to do.
The only concern I would have would be the centrals that are reported because it was unclear as to when the centrals popped up...were they present without cpap pressure or did they pop up as a result of cpap pressure.
So I guess I would be on the fence.....are they wanting to do a bilevel regular machine to deal with higher pressure needs or are they wanting to do a bilevel machine trial to see what happens with the centrals.
It appears they are still considering primary diagnosis of obstructive sleep apnea and not central/mixed sleep apnea.

You aren't going to get this resolved in time to get things covered with 2015 deductible being met. That's not going to happen in time to have insurance pay for the machine.

My suggestion would probably be to maybe consider getting a bilevel auto machine (regular bilevel and not the special bilevel needed to address centrals) and do your own titration at home. There's a good chance that will all that is needed but if not then you can revisit having that second titration sleep study at a later date.
If buying privately (that's what you will have to do without a RX) I would go with a bilevel machine instead of regular cpap/apap machine because if it was a failed titration due to you not tolerating the pressures needed to hold your airway open then you would have that same problem with a cpap/apap machine. Just buy a bilevel to start with...instead of buying apap now and needing bipap in a week because you can't sleep with apap.

The report you have....doesn't clearly explain why they are wanting to do bilevel but when in doubt I would buy bilevel (if I was buying privately) just to cover as many potential issues as I could.

Buying privately is still expensive but considerably less than $1500. Figuring out your own pressure needs is fairly simple as long as centrals don't rear their ugly head and complicate things.