Purchase own CPAP or wait for insurance?

[Lizamd]

Hi...just diagnosed with sleep apnea and fitted for CPAP last night at sleep center. I've been told that I now must wait a week+ for consultation and prescription for machine and mask. After finally being diagnosed with this I'm anxious to get started and not wait a couple of weeks for insurance to approve and kick in for a machine. Wondering if I should just bite the bullet and order a machine and mask online. Any advice welcome. I'm very eager to feel good. Thanks!

[ChicagoGranny]

It's your money, honey.

It's good to have a backup machine, so if you do buy one on your own, see what it will cost you to get a second one later with insurance.

[Pugsy]

Most online machine and mask purchases are going to require a copy of the RX. So if you don't have it yet then online purchasing from some place like cpap.com can't be done without that RX.

Now it doesn't stop you from maybe buying a machine privately and then using it as a travel or back up machine.
Masks also require a RX but we can get around that little hurdle by just buying replacement parts and building a complete mask that way. Replacement parts don't require a RX.

Now you could have cpap.com try to get that RX from your doctor before you can get your hands on it..they will do that...fax the doctor. It's all explained at their website.
Right now there is an awesome hot deal on a really good machine
See this thread.
viewtopic/t112426/CPAPCom-selling-PRS-6 ... t-314.html

[Lizamd]

Thank you for your responses. The sleep center will not give me the RX until my consultation appt later next week. Grrr...am on the cancellation list, but I don't like waiting when I know I can feel better sooner. After talking with insurance it sounds like the best financial sense is to purchase my own. I found a company that has the following pricing: Transcend $529, Remstar Auto A flex $868, and Airsense 10 auto set $995. Being new at this, I'm unsure if these prices are reasonable or not. Maybe I just cool my jets and wait out the process.

I'll check out the CPAP.com site to see if they can help obtain the RX, and I'll check out the special while I'm there. I like the idea of the backup.....

[Julie]

You've probably had apnea for ages, months, years, decades, so why on earth one more (or two) weeks are worth you're laying out so much money is hard to fathom unless you're very well off and in such bad shape that you suddenly fear for your life if Cpap isn't started tomorrow.

[Janknitz]

You can call your insurance now and find out what your out of pocket costs will be--it pays to do your homework.

You want to know what their reimbursement is for an E0601 machine (ANY CPAP or APAP machine), and for each kind of mask (full face, nasal, nasal pillows (we can get you those billing numbers too), hose and filters. The reimbursement is not brand or model specific. Make sure you understand how much, if any, deductible and co-payment apply and whether the insurer requires a rental or a purchase.

Armed with that information, you can make an informed decision. Calculate your out of pocket costs for the initial set up (it really doesn't matter WHAT your doctor orders, it will be within these categories and billing codes) and then compare it to getting your own set up. Don't forget to factor in the fact that meeting an insurance deductible for the year may reduce other costs during the rest of the year. You may decide it's more economical and less headache to get your own, but if you decide to go with insurance :

When you talk to your insurer, you also need to know which DME's are the preferred providers for your insurer.

Now decide which machine you want. The top of the line machines are the ResMed Airsense Auto (or Airsense Auto for Her) and the Philips Respironics (someone will have to chime in with the model numbers). Ask the doctor to prescribe exactly the machine you want--make and model info in the prescription (some doctors balk at this).

When you meet with the doctor, ask to get a copy of the prescription IN YOUR HAND. Don't let them send it to their preferred DME, though they can tell you whom they recommend. Then YOU call the DME's and tell them what you want, and see if they will provide it. Don't let them play stupid DME games with you (see "What you need to know BEFORE you meet your DME" in my signature below). Be polite, firm, and in control of your future.

Good luck.

[Gasper62]

APAP's are available without an Rx on Amazon............... : https://www.amazon.com/s/ref=nb_sb_ss_i ... aps%2C1024

Good luck.

[Lizamd]

Thank you. My initial question was posed as an effort to begin doing my research/homework. I have already discussed with my insurance company what is covered, which in my case is much more expensive in the long run than purchasing a machine outright. Given that, I need to learn more about the equipment. This is all very new to me... After last night's experience I sensed that the machines need to be titrated or calibrated to the individual's needs. If that's not actually the case then it would be nice to know my options, and get a sense of what normal and reasonable costs might be. Yes, I can wait another couple of weeks if necessary, but why should I otherwise? I'm ready to feel good and prevent any further deterioration of my health as quickly as possible. I appreciate the guidance offered.

[ChicagoGranny]

Yes, I can wait another couple of weeks if necessary, but why should I otherwise?

Do you know what type of sleep apnea you have? ---->

- Obstructive sleep apnea, the more common form that occurs when throat muscles relax.
- Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing.
- Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, occurs when someone has both obstructive sleep apnea and central sleep apnea.

If you have one of the two less common forms, you may need a more expensive machine.

After last night's experience I sensed that the machines need to be titrated or calibrated to the individual's needs.

Yes, they do. This is traditionally done by the sleep lab. Is this not what was done when ---->

fitted for CPAP last night at sleep center

?

You say "fitted". We normally speak of masks being fitted. Determining the correct machine settings is called titration.

[avi123]

del

[ChicagoGranny]

Is an Rx required on this one:

http://1800cpap.com/airsense-10-cpap-wi ... esmed.aspx

Yes! Are you a member who has 4000 posts or are you a rank beginner?

[Lizamd]

Yes, I can wait another couple of weeks if necessary, but why should I otherwise?

Do you know what type of sleep apnea you have? ---->

- Obstructive sleep apnea, the more common form that occurs when throat muscles relax.
- Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing.
- Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, occurs when someone has both obstructive sleep apnea and central sleep apnea.

If you have one of the two less common forms, you may need a more expensive machine.

Yes, obstructive...

After last night's experience I sensed that the machines need to be titrated or calibrated to the individual's needs.

Yes, they do. This is traditionally done by the sleep lab. Is this not what was done when ---->

fitted for CPAP last night at sleep center

?

This is what was done...

You say "fitted". We normally speak of masks being fitted. Determining the correct machine settings is called titration.

Yes, fitted for mask and machine titrated. I'm certain I won't be given the specific details of either until my consultation. I do know how much better I felt upon waking after just 5.5-6 hours on it last night.

[lathnos46]

I felt the same way you do a few weeks ago, before I got my machine. I just could not wait. But I did wait, even though I drove 2+ hours to a different DME location since my local one wasn't going to be able to get my machine to me until several days later, after Memorial Day holiday. It is so hard to wait but I am glad I did not order a machine and just waited for the insurance to all get sorted out. I will buy a back up machine at some point but I don't want to do it under pressure and am glad I kept my money in my pocket. Insurance covered almost all of it.

[ChicagoGranny]

I'm certain I won't be given the specific details of either until my consultation.

While you are waiting, entirely avoid backsleeping. On the back, gravity directly pulls the tongue and soft palate into the airway. Many people get some relief, but not a cure, by sleeping on their sides or stomach.

[cant_sleep_in_nj]

It's your money, honey.

It's good to have a backup machine, so if you do buy one on your own, see what it will cost you to get a second one later with insurance.

I agree 100%