Fellow Ontario Residents - Questions about ADP

[Bella]

To begin with I have CSA, not OSA, so I get to deal with 2 provincial programs - the Assistive Devices Program and the Ventilator Equipment Pool (VEP). My CSA is severe with an AHI of 128. I have problems exhaling so I need a bilevel machine. And then I "forget" to breath, so I need a machine with a timer. In other words a bilevel S/T. I qualified for the ADP. Because of the type of machine I need I qualify for a "loaner" machine from the VEP. Completely no charge for the BiPap S/t (Synchrony), heated humidifier, hose, carrying case.

While I was waiting to be approved I rented a machine from a registered vendor. To get my money back from my insurance I need proof of approval. Do you get a copy of the approved form back from the ADP program?

I have questions are about coverage for my mask(s) and supplies like filters. From what I read on the ADP site - digging through the information for professionals - a complete xpap set-up includes the machine, heated humidifier, case, mask and head gear and filters.

I've already paid full price for 2 masks (first one leaked). Do you know how I would get my money back from the ADP or do I have to do this through the vendor. He's not making much off of me now seeing as I don't need to buy a machine from him. Does the ADP only cover 1 mask every 5 years? And do they ever cover supplies like filters? I had to fill out two ADP forms and I'm sure that I was told that one was for supplies.

Thanks for any help that you can give.

PS - I have questons about the machine too!

[Gerri]

Hi Bella

ADP paid $780 for my CPAP machine. My insurance company paid 80% of the remainder. We ended up paying about $150. Through my insurance company I am able to get a new mask every 6 months.

I believe it's your insurance company and not ADP that helps pay for the mask. Every six months I send a bill into my insurance company and they reimburse me.

Gerri

[Darth Vader Look]

ADP has a 2 level funding program. The first level covers CPAP's and APAP's whereby the ADP will pay up to 75% or $780 ($1040 x 75% = $780) of these machines.

The second funding program covers a BiPAP. Not sure how this works but you can contact them at the toll free number 1-800-268-6021 and talk to a person who knows more than I do.

[Bella]

Thanks for the information. I noticed on the ADP site that the wording for funding for a bilevel machine is slightly different than that for a cpap. It does sound like they might pay a bit more. But I found in one of their Newsletters, or provider guidelines, that an entire cpap/bipap setup is to include the machine, hose, case and mask. I guess since the cost of the machine alone is more than what the funding is, it's not billed like it is all inclusive. What I'm trying to find out (and yeah, I've talked to a few people at ADP ) is since I didn't have to pay anything for a machine or receive funding for a machine, is there still that $780 funding available for me through ADP - at least to cover the cost of a mask. I can afford the mask - it's partly principle. On the other hand, the first mask I bought, the Comfortfull, leaks like a sieve, and I would like another ff mask as a backup. I've bought a Swift and I love it, but when I had a bad cold a while ago I wasn't comfortable with it. So if I have to buy a third mask within the space of 3 months, I'd sure like some funding if I can. My insurance is horrible. I think that if I'm lucky, they will cover 1 mask, every 10 years. Yes, 10 years.

[WillSucceed]

I think that Darth's advice regarding talking directly to ADP to find out what they will fund is worth listening to. You could also call the vent. pool in Kingston to find out what they offer regarding masks, etc.

Just as a suggestion, when you contact ADP (or any other service provider), get the full name of the person you are talking with right up front -this usually makes people on the other end of the phone line sit up and take notice. Also, tends to make them feel inclined to be a little more helpful when they know that you know who they are and, when they know that you can track them down through their supervisor if they are not helpful.

I know that this sounds pushy, but it makes good sense to know who you are speaking to and, tends to make for better service.

[wkwchau]

My vendor, Shopper HomeHealth Care, did all the paper work for me; and then deduct the ADP portion. Even though there are some restrictions about how much the vendor can charge for the machine. Some vendors, like mine, will bill you extra for the service (or so called package deal). So for the same machines, one may pay few hundred more than others depending on the vendors. The lesson I learned is that you may want to discuss the total cost up front with the provider before let them serve you.

[Bella]

Well I spoke to another person at ADP yesterday (and yup I've got all of there names). ADP funds CPAPs and bilevels, but they do not fund bilevels with timers. Those are covered by VEP and VEP provides them without charge. While that's nice, it is in theory a loaner, and I don't like "borrowing". ADP will not fund me if I want to buy a bilevel with a timer. Their involvement for cases like mine is that they approve the application and then forward it to VEP. My proof that I've been approved is a letter that I got from VEP stating that I've been approved. I hope that that is enough for my insurance company. I rented a machine from the time I was diagnosed until now, and for my insurance company to cover the rental they need proof of ADP approval.

The question I still have - and forgot to ask when talking to them - is that I filled out two forms, one for the main equipment and one for supplies. The vendor told me that the second one would cover my mask and things like filters. Have any of you heard of that? My insurance company doesn't cover anything like that, and in fact, will only cover xpap related things once every 10 years.

Thanks all

Bella