Will Tri-Care Cover Second Machine?

[Air Force Retired]

I am seeking the knowledge of those who have had experience with Tri-Care regardng the above subject. I just had my second tritation because my present machine, even at a lower pressure than assigned causes me to wake up with chest discomfort/Pain. I have been checked out by a doctor and nothing medical is wrong. My present machine is not an "auto". My question is: If the second tritation doctor orders an "auto" machine for me can you tell me if Tri-Care will cover the cost except for my co-pay? I just got the first machine in November 2010.

[scrapper]

I doubt it because straight cpap's and autocpap's are billed by the same code--they are the same machines in the eyes of insurance.............and so you're usually limited to one every 5 years.

Hate to be negative.........I know it's not the answer you want, but it is the answer I believe to your question.

[Janknitz]

You might talk to your doctor about getting a BiPAP. First, it works differently than an auto and may be better at relieving the discomfort you are having. Second, it is a different billing code--hence a different machine, and you may have better luck getting TriCare to cover it since they have already paid for one machine under the HCPC code E0601.

Good luck, sleep well.

[mbkjad]

I think you are going to be out of luck since they use the same billing code. I can also tell you that a buddy of mine who has much worse OSA than I do went for his second titration (after 2.5 years) and the doctor prescribed a BiPAP machine and TRICARE is denying that. The denial just came in last week so it is not a done deal yet but at a minimum you are going to have to stick to your guns. What worries me more than anything else about his situation is that we are still on active duty. Typically TRICARE questions less for us than for retirees and as I am joining the retiree's on 1 May I am a little worried how all of that will go in the future (but not enough to not retire).

Good luck!

Mike

[Goofproof]

Odd's are s second machine would have close to the same results. At 10 cm your pressure isn't high. As you start treatment it is normal to have some chest pain, it like exercizing pain gets gain. as Time goes by you won't notice the pressure. I started at 15CM, No Ramp after having my chest opened, my pain only lasted for a month, now I wake up and can hardly feel the machine running. You can buy a machine online at anytime out of pocket, the prices are much cheaper that way. Jim

[nanwilson]

Morning Phil
If your healthcare won't pay for a second machine, keep your eyes glued to cpapauction, secondwind, etc. I bought a Respironics M series, auto a-flex on this site from another member for $50, only 250 hours on it. The deals are out there, you just have to be vigilant.
Good luck
Nan

[Air Force Retired]

Thanks to all who gave their take on this issue I will know more when I get the results of my sleep study from last Thursday night. If I am prescribed an auto or BiPap I will check with my DME and see what she can do. If she can't work something out I will go to the auction and buy the one I need out of pocket. I did check there and saw more than one that will fit the bill no matter which one is prescribed and a very desent price.

[GumbyCT]

Thanks to all who gave their take on this issue I will know more when I get the results of my sleep study from last Thursday night. If I am prescribed an auto or BiPap I will check with my DME and see what she can do. If she can't work something out I will go to the auction and buy the one I need out of pocket. I did check there and saw more than one that will fit the bill no matter which one is prescribed and a very desent price.

What you need to do is speak with Tri-Care directly to find out how they work. But hey it's your call.

[Bons]

I'd ask the doctor about a prescribing a bipap. My insurance company had no problem bumping me from a capap to a bipap to a bipap ASV all within 10 weeks. Then I switched doctors and discovered that there was no valid medical reason for the ASV. But I'm stuck paying for that (co-pays) because now that the first doctor documented that I failed bipap (in order to put me on the ASV) the insurance company will NOT allow me to go back down to bipap on their money.