insurance refuse APAP

[Homer1959]

My insurance at work refuse to pay for a APAP, looks like they would pay for a cpap. It is common for an insurance to questionned a specialist on the kind of treatment ? They based their decision on the fact that study apparently shown that only 2% of the peoples with sleep apnéa needs an APAP because they can endure the constant pressure of a CPAP....I cannot prove that I fall in the 2 % .Whats your take on that ?

[Pugsy]

You are in Canada? Yep, that explains the difficulty. I have heard that Canada's rules and regulations can be tough if you don't meet criteria.

Any suggestions from Canadian members on what OP should do or could do?

[Guest]

Hello

What is your pressure set at. My pressure was set at 19 on straight cpap and then it was dropped down to 16. I could not handle it blowing at
16 constantly.

I asked my dme what options i had and was told that auto cpap would be better for me but Manitoba health would not cover it. So i sent my insurance a letter along with all the stuff from my sleep doctor and a letter from the dme saying i could not handle a pressure of 16 and that apap would be better.

The insurance cover 80% of the bill and that i was allowed 2 mask a year. Auto cpaps in Canada are really expensive my pr system one auto was $1500 and that did not include the price of a mask. Thank god for a coverage of 80 %

If your pressure is hign like mine let your dme know you are haveing trouble at that pressure and would like a apap machine. My dme was very nice and wrote a letter for me and the rest is history.

Good luck
Sudsy

[Hawthorne]

Every Province is different of course, since health care is a Provincial matter in Canada. I am in Ontario and getting an APAP is difficult. It requires quite a high pressure and a prescription specifically saying an APAP and, even then, in Ontario it may be rejected by the Assisitve Devices Program (an Ontario program that pays 75% of the machine).

Get your prescription and order from an online supplier like cpap.com. With a prescription for a cpap, you can buy an APAP or a CPAP. Of course, if you want a Resmed, they do not allow cpap.com to ship to Canada. You can get other auto brands though, with just a CPAP prescription for a LOT less money. Of course, any insurance you have may not reimburse for online purchases. For me, it was way cheaper and I got what I wanted.

[Homer1959]

My 95 percentile pressure is at 15.9. The insurance isn't from the province but from my employer. I managed through the human ressource of my company to force the insurance to cover the apap but based on an exception valid for one time only. So all is good, I was just surprise by the refusal of coverage even with a prescrption written from a specialist working at a clinic located in a hospital known for the excellent service provided especially in the specialized sleeping clinic studying all kind of disorder

anyway thanks for your input !!

[cabo]

Is it common for insurances to say what kind of treatment????? I have been a nurse for 30 years and the amount of people I have seen die or simply not get the care they needed because of the insurance companies is beyond belief.You think it's bad now just wait till Obama care kicks in. So the answer is YES they can!

[cflame1]

Insurance from Canada (levels of which vary by province) is very different from insurance in the US cabo.