Care Centrix (Cigna) or California Sleep Solutions (DME)

[FoggyFroggy]

Hey Y'all! There is such a wealth of information here that my head is spinning! Trying to take it one step at a time.

I had my titration study (got squeezed in just before year's end - Wahoo!!!) and am awaiting the script. In the meantime, I'm gearing up to go to battle for a good setup and not get ripped off by a money grubbing DME.

I have Cigna PPO insurance with a $2000 deductible. As such, my setup is going to come out-of-pocket. If the machine is rented, is that billed monthly or what? I contacted Cigna to find out who my in-network DME is, what is covered, co-insurance, etc. and they referred me to Care Centrix - http://www.cigna.sleepccx.com. Care Centrix will be responsible for all sleep therapy management. I have to wait until Monday to call them. Has anyone had any experience with this group?

I did dig a little deeper into Cigna's website and believe that the only in-network DME choice I will have is California Sleep Solutions. Again, anyone with experience dealing with them?

Thanks to the advice gleaned here on this site, I am not going in blind and will be armed with the information I need to insist on good service. I was able to get the tech to tell me that I will be getting a straight CPAP with humidifier script. He suggested I request a small quiet machine. I would like an Airsense 10 Autoset with heated humidifier. This machine has straight CPAP but also other functions I would like to have at my disposal should I run into problems adjusting. Should I ask my PCP to write the script specifically for this machine? Or do I need to? What if he refuses? I think Cigna bills using the E0601 code but I'm not certain about that yet.

I have ordered copies of my studies including raw data, graphs, etc. and I will definitely obtain a copy of my script as well. Again, smart advice gleaned here!

Thanks a million to the veterans here who are willing to invest in helping us noobs! I REALLY appreciate you!!!

[Janknitz]

The cost of your sleep test and titration might have gone toward your deductible, but your deductible probably started again in the new year (.

Ask the doctor to specify exactly what you want on the RX. Otherwise be prepared to fight for the auto set (there's a newer model, btw) b/c your RX will not specify a range of pressures. They will insist all you may have is a CPAP, not an APAP but you know better.

[FoggyFroggy]

You are oh so right, Janknitz! Deductible back to zero yesterday.

I will try to get my doc to write a specific script for the machine. I'm curious what the newer model is?

The cost of your sleep test and titration might have gone toward your deductible, but your deductible probably started again in the new year (.

Ask the doctor to specify exactly what you want on the RX. Otherwise be prepared to fight for the auto set (there's a newer model, btw) b/c your RX will not specify a range of pressures. They will insist all you may have is a CPAP, not an APAP but you know better.

[Janknitz]

Sorry, it is the Airsense 10. Misread your post.

[poppi2]

Get the Airsense 10 Autoset For Her. More functions. Earl

[FoggyFroggy]

Thanks, Earl! I did look at the "for her" model. Aside from the female algorithm, what additional functions does it have?

Get the Airsense 10 Autoset For Her. More functions. Earl

[cancun]

Hey Y'all! There is such a wealth of information here that my head is spinning! Trying to take it one step at a time.

I had my titration study (got squeezed in just before year's end - Wahoo!!!) and am awaiting the script. In the meantime, I'm gearing up to go to battle for a good setup and not get ripped off by a money grubbing DME.

I have Cigna PPO insurance with a $2000 deductible. As such, my setup is going to come out-of-pocket. If the machine is rented, is that billed monthly or what? I contacted Cigna to find out who my in-network DME is, what is covered, co-insurance, etc. and they referred me to Care Centrix - http://www.cigna.sleepccx.com. Care Centrix will be responsible for all sleep therapy management. I have to wait until Monday to call them. Has anyone had any experience with this group?

I did dig a little deeper into Cigna's website and believe that the only in-network DME choice I will have is California Sleep Solutions. Again, anyone with experience dealing with them?

Thanks to the advice gleaned here on this site, I am not going in blind and will be armed with the information I need to insist on good service. I was able to get the tech to tell me that I will be getting a straight CPAP with humidifier script. He suggested I request a small quiet machine. I would like an Airsense 10 Autoset with heated humidifier. This machine has straight CPAP but also other functions I would like to have at my disposal should I run into problems adjusting. Should I ask my PCP to write the script specifically for this machine? Or do I need to? What if he refuses? I think Cigna bills using the E0601 code but I'm not certain about that yet.

I have ordered copies of my studies including raw data, graphs, etc. and I will definitely obtain a copy of my script as well. Again, smart advice gleaned here!

Thanks a million to the veterans here who are willing to invest in helping us noobs! I REALLY appreciate you!!!

I was recently switched to CareCentrix thru Cigna and so far so good. They had no problem with me telling them I refused to use Apria as my DME. It won't matter what DME that Cigna directly works with it is the DME's that CareCentrix works with. I already had a machine but needed a new mask so I did have to drive further to another state for a mask fitting (only 35 miles) but it was worth it not to get stuck with Apria. When you first call them let them know what machine you are wanting to get and like everyone says have your doctor write the script for that exact machine.

[FoggyFroggy]

Thanks, cancun! I'm chomping at the bit but will just have to wait until tomorrow to see what CareCentrix says.

BTW - Are you able to use SleepyHead with your Airsense 10 AutoSet? I just downloaded the software and it is not listed as a currently supported machine on the Welcome page.

I was recently switched to CareCentrix thru Cigna and so far so good. They had no problem with me telling them I refused to use Apria as my DME. It won't matter what DME that Cigna directly works with it is the DME's that CareCentrix works with. I already had a machine but needed a new mask so I did have to drive further to another state for a mask fitting (only 35 miles) but it was worth it not to get stuck with Apria. When you first call them let them know what machine you are wanting to get and like everyone says have your doctor write the script for that exact machine.

[cancun]

Thanks, cancun! I'm chomping at the bit but will just have to wait until tomorrow to see what CareCentrix says.

BTW - Are you able to use SleepyHead with your Airsense 10 AutoSet? I just downloaded the software and it is not listed as a currently supported machine on the Welcome page.

I was recently switched to CareCentrix thru Cigna and so far so good. They had no problem with me telling them I refused to use Apria as my DME. It won't matter what DME that Cigna directly works with it is the DME's that CareCentrix works with. I already had a machine but needed a new mask so I did have to drive further to another state for a mask fitting (only 35 miles) but it was worth it not to get stuck with Apria. When you first call them let them know what machine you are wanting to get and like everyone says have your doctor write the script for that exact machine.

Yes, Sleepyhead does work with the Airsense 10.

[poppi2]

Thanks, Earl! I did look at the "for her" model. Aside from the female algorithm, what additional functions does it have?

I believe "RERA Reporting" is the additional function.

[cancun]

Thanks, Earl! I did look at the "for her" model. Aside from the female algorithm, what additional functions does it have?

I believe "RERA Reporting" is the additional function.

I don't have the "for her" model but sleepy head still reports the RERA on my reports.

[OkyDoky]

Here is a copy of the Clinical Manual which explains the For Her Mode on page 6.
https://sleep.tnet.com/home/files/resme ... -guide.pdf
It can be a good model not only For Her. It looks like a more gentle response with less bouncing around.

[SewTired]

Your DME is going to charge you far more than you can get it from our hosts. My suggestion is to simply buy it out of pocket, EVEN IF Cigna doesn't give you credit for it on your deductible. Unless, of course, you want to wait for something else to use up your deductible and then go through the games.

[BearWayne]

I too have Carecentrix and am about to get a new machine. My insurance rents the machine for 3 months, then pays the balance. I am going to purchase my machine using my FSA account as I anticipate a job and insurance change very soon. I have a question: why choose an APAP over a CPAP if given the choice?

[OkyDoky]

I too have Carecentrix and am about to get a new machine. My insurance rents the machine for 3 months, then pays the balance. I am going to purchase my machine using my FSA account as I anticipate a job and insurance change very soon. I have a question: why choose an APAP over a CPAP if given the choice?

With an APAP you have the choice to use it in APAP mode or CPAP mode but with a CPAP you only have CPAP mode.