Ontario peeps: ADP funding for Resmed S8 Elite II

[ScottyT]

I'm still exploring CPAP funding through the Ontario ADP funding scheme. I'm wondering if anyone's managed to get an S8 Elite II with the ADP funding. It's not on the list of approved systems under this scheme from May '08, but I have my fingers crossed that I'm overlooking something. And is it really all that much quieter than the S8 Elite, which is listed as an approved system?

If it's listed as an approved system, ADP and my insurance will add up to a net cost of $0 (thank goodness.)

And hello! I'm new.

Scott

[Hawthorne]

It may be that you could get that machine with the ADP funding even if it is not on the approved list BUT, it will probably turn out that the ADP will pay the $780 (Ithink that's right) for either machine and your insurance may pay only a set amount.

If you want a more expensive machine, you may be able to get it it you are willing to pay anyhting over and above the ADP funding and what your insurance will pay, out of your own pocket.

I don't know if it it quieter since I have never had a Resmed machine.

[Trease]

I am new to all this and have never used anything but the Resmed S8 Elite II. The only noise I hear is coming from the mask. I'm a light sleeper and it doesn't bother me. Good luck!

[freepostg]

Hawthorne is right. You will only get the $780.00 through ADP..if you have private insurance, you may be covered for some/all of the diff.

[ScottyT]

Thanks. I'm willing to pay a bit more to get the Elite II rather than the Elite, to a point. My insurance will be kicking in a set amount, which would be enough to buy an Elite. I'm worried how much more I'd have to pay for an Elite II. I'm not made of money. But I'm the sort of guy who will go days without sleep if there's an annoying noise in the room, so getting the quietest machine I can find is important to me.

Again, thanks!

[Arthurs]

Where can one find this "list" of approved devices? I'm looking to get a F&P HC608, my provider says it's not on the list, and can supply the HC604 instead.

I'd be interested to find out how much they'd charge you over and above the $780. I'm coming to the realization that CPAP providers here in Ontario are too spendy!

[ScottyT]

The ADP website is not the easiest thing to navigate. Here it is:

http://www.health.gov.on.ca/english/pro ... evices.pdf

[Arthurs]

Thanks for the link Scotty, interesting they limit the list of approved devices and that explains why my provider will not get the HC608 for me. Not sure if I see the Resmed device you want on the list.

[Arthurs]

I will add that the F&P HC604 that I'm trying out now is *extremely* quiet! Not sure if it will meet your needs, you might want to get a demo machine to try for yourself. Love the heated hose feature as well. My provider wants another $250 on top of the 25% I have to pay for my portion of the ADP.

[ScottyT]

Yeah, the one I want is not there, the Elite II. The Elite (the predecessor) is there though.

So in your experience, to get the $740 or whatever ADP funding, you HAVE to have one of the machines on the list? That would not make me a happy camper.

[Arthurs]

That's the story I got from my provider, it has to be on the list. For me it's real tempting to dump my provider, forget about ADP, and get the machine I want (the F&P HC608) from cpap.com since this is coming out of my pocket. $260 ADP + $250 (machine upgrade) is not that far off from the $549 listed on the website for the 604! But then they'll probably stiff me with a machine rental fee of $150 for the demo! I guess I'll compromise and get the HC604 from my provider (which is still a very nice and extremely quiet CPAP), and sell the cheapo basic mask (or maybe keep it for backup). Got a new Swift II for a very good price on auction. Don't get me started on how much money my provider wanted for a mask upgrade!!!!

[Arthurs]

Hmmm, this is really getting interesting, from the Respiratory Devices Manual found at this link: http://www.health.gov.on.ca/english/pro ... 070627.pdf

"7.5.1 Continuous and Autotitrating Positive Airway Pressure Systems

The ADP will pay 75% of the approved price listed in the Respiratory Devices
Catalogue. The client will pay the remaining 25%.

Clients receiving social assistance under Ontario Works (OW), the Ontario
Disability Support Program (ODSP) or Assistance to Children with Severe
Disabilities (ACSD) will receive 100% of the approved price.

ADP registered respiratory vendors may charge the client less than the ADP
approved price, but the vendor may not charge the client more that the ADP
approved price."

So since the HC604 is listed in the other publication list Scott provided a link earlier at a maximum approved price of $1040, of which ADP pays 75%, my interpretation of this regulation is that my provider cannot charge me more for the HC604 than the 25% of the approved total price set by the government. Can someone set me straight on this point? The provider wants to charge me $250 beyond the ADP 25% client portion of $260. Maybe I'll call the Ministry of Health tomorrow and get some straight answers on this!

[ScottyT]

Are you sure the extra charge isn't being labeled as the cost of the mask or hoses or somesuch?

Let me know what you find out!

[Arthurs]

Ok, finally got through to a claims assessor for the ADP program at the Ministry of Health (after being put on hold for a ridiculously long time), and he said that the maximum amount that can be charged by the provider for a CPAP machine that is on their approved list is $1040.00, of which the government pays $780, and the client pays $260. However, it's left up to the provider to choose the appropriate machine from that list that is offered to you at that price of up to and including $1040. In other words, if you want a machine that is more expensive than the one offered as part of the "basic" package, the provider doesn't have to sell it to you for the same price if they will incur some "loss" on their part. What this "loss" actually amounts to is undefined, so they can get away with charging an "upgrade" fee over and above the $1040 for the more expensive machine of your choosing, as long as it's from the approved list. Nice!

If you do a search of this forum, there's a thread that reported some "funny business" with two separate invoices being issued, one for $1040 for the ADP claim, the other for the full machine price to the private health insurance company.

If the machine is not on the approved list, you can ask the manufacturer to go through the process of getting it tested by the Ministry of Health, and maybe 3 months later it will be put on the approved list, otherwise you're on your own in paying for a machine not on the ADP list.

[Arthurs]

Are you sure the extra charge isn't being labeled as the cost of the mask or hoses or somesuch?

Nope, basic mask and headgear, hose, case, heated humidifier are included as per government regulation. All I wanted was a better machine, and looking at cpap.com, the price difference between the HC234 and the HC604 here is only $54 USD. The provider wants $250 CDN for the same upgrade!!!!!