What are the chances my insurance will cover a new machine??

[citationjay]

In May of 2015 I was diagnosed with severe obstructive sleep apnea with an AHI of 56.6 and an oxygen saturation nadir of 76%. At the time I was completely oblivious & knew absolutely nothing about this condition.

I still don't feel as well throughout the day as expected. A lot of mornings I can sleep another couple hours after 8 hours of sleep. Still tired in the afternoons. Drag in the evenings.

I don't know if this therapy is working as well as possible or if a pressure change is needed. Using the Philips REMstar SE with humidifier set to 9cm which seems to be the most useless machine they could have sold me. Now using the AirFit F10 mask that is working much better than the Quattro Air I used for the first 6 months.

So my question is, if my doctor prescribes an auto cpap with advanced data will my insurance (blue cross) cover a new machine? Any advice?

[robysue]

So my question is, if my doctor prescribes an auto cpap with advanced data will my insurance (blue cross) cover a new machine? Any advice?

That's a question that you have to contact your insurance provider for. It may depend on the particular policy that you have. It may also depend on whether the doctor can provide a memo justifying why the change is medically necessary.

[Julie]

What problems are you having with the machine - maybe we can help. And I've never heard of someone needing the humidifier at 9 - where do you live?

[citationjay]

What problems are you having with the machine - maybe we can help. And I've never heard of someone needing the humidifier at 9 - where do you live?

Sorry, machine pressure is set to 9cm. Humidifier use 1 or 2. No problem with the machine perse, just not getting any data from it to know how I'm sleeping. Not feeling much better than I did before cpap. Still constantly tired after sleeping for 8 hours.

[Julie]

Can you be any more specific about the data problem - there are some very tech savvy people here. Have you tried downloading Sleepyhead?

[robysue]

Can you be any more specific about the data problem - there are some very tech savvy people here. Have you tried downloading Sleepyhead?

The OP is currently using a PR System One SE CPAP, which is a brick that doesn't record anything except usage data. That's why the OP wants to upgrade to an APAP: The OP is not feeling much different than before s/he started CPAP and would like to know if therapy is actually effective or not.

[SewTired]

You will have to check with your insurance. If your doctor can medically justify an apap, then not a problem. I would try that first. If that doesn't work, ask him to write out a script and either buy a used one or one from an online supplier.

If your plan is a supplemental to say Medicare, your chances are zero and you may as well just have the doc write out the prescription and buy one from online. Medicare will only buy one machine every 5 years and they don't go from a cpap to an apap. Only cpap to bipap. An acquaintance tried to get an upgrade. I found him a barely used Airsense Auto on Craigslist. He's a happy guy now.

[Jane Jetson]

May I jump in with a question about the AirFit F10? It seems most people here have the P10.

I have been doing this since January and I am not where I need to be to feel good. I feel better but am still sleepy and need naps a few times a week.

It seems I have replaced the mask almost monthly. I understand it has a frame and a cushion insert. After about a month, the cushion insert gets soft and it starts to leak. So far the DME has replaced the whole mask (not headgear) each time. Is it possible to only replace the pillow part? I am hoping that would save me money. I have tried to gingerly remove the pillow part but it seems like it is attached to the frame. I don't want to break anything. I also (erroneously) thought the elbow was permanently attached to the hose early on. I was able to remove it after someone explained it is part of the mask. I was afraid to use too much pressure for fear of damaging the elbow and the hose.

Same this time I guess. Does anyone know? Would the DME tell me if I asked?

[citationjay]

May I jump in with a question about the AirFit F10? It seems most people here have the P10.

I have been doing this since January and I am not where I need to be to feel good. I feel better but am still sleepy and need naps a few times a week.

It seems I have replaced the mask almost monthly. I understand it has a frame and a cushion insert. After about a month, the cushion insert gets soft and it starts to leak. So far the DME has replaced the whole mask (not headgear) each time. Is it possible to only replace the pillow part? I am hoping that would save me money. I have tried to gingerly remove the pillow part but it seems like it is attached to the frame. I don't want to break anything. I also (erroneously) thought the elbow was permanently attached to the hose early on. I was able to remove it after someone explained it is part of the mask. I was afraid to use too much pressure for fear of damaging the elbow and the hose.

Same this time I guess. Does anyone know? Would the DME tell me if I asked?

Yes! You only need to replace the cushion, not the whole mask. It pops right off. Pull the side forward on the bottom of the mask. I was replacing mine every 30 days when I started. Had the same one now for 5 months. Wash with mild soap & warm water every few days, still fine. Have a spare ready to go when needed.

https://www.cpap.com/productpage/resmed ... -mask.html

[yaconsult]

Insurance companies often provide machines to new cpap patients on a rental basis and then, after a certain amount of time, you own it. If they are renting it to you, it might be pretty easy to get it swapped out for a good data capable autoset with the help of your doctor. I would try discussing it with your doctor as DMEs won't make any changes unless it's ordered by the doctor. The insurance pays the same amount for dumb bricks as it does for a good autoset, so they don't really care. The DME is the one with the financial incentive to give you as cheap a machine as they can get away with.