Newbie Questions...

[KotaNole]

Hey Guys and Gals,
I have not been diagnosed with Sleep Apnea yet, nor have I had my sleep study. They can't get me in for a sleep study until the 21st.

Quick review, starting in March I started having Severe Fatigue and a little dizziness. I had every blood test you could think of ran, along with CT Scans, MRIs, etc. I did end up staying a night in the Hospital due to a Heart Holter Monitor coming back with a pulse as low as 22 during the night with a couple of puases thrown in. I was then of course asked by my GP and Cardiologist if I snored, when I said I didn't think I did, I was of course automatically dismissed from having sleep apnea. Fast forward I have a tilt table test, and this time with a new Cardiologist. Turns out I have Neurocardiogenic Syncope. I am kept on my Anti-Depressant that the GP put me on as it is said to help. I started having headaches every day a couple of months later, and assume it is just the Generic Celexa. After getting off of that, turns out it wasn't the Anti-Depressant, so I head to the GP. His answer is giving me different pain pills and muscle relaxers, and come back and see him in a month. He agreed I could probably get a sleep study, but he wanted to try the pills first. Finally fast forward to today, I am still having fatigue and headaches every day, along with my wife saying that I do snore (not wake the neighborhood snore). I finally got fed up with my GP and called my Caridologist, who didn't have any problems referring me to have a sleep study.

I have read other reports on here where people hoped that they would indeed have Sleep Apnea so that they would have an answer and relief, and I feel the EXACT same.

Ok, to stop boring you and on to my actual question. Since I have had all of these tests done, along with a night in the hospital, I have met my deductable with UHC. Looks like they will pay 100% of the sleep study after meeting my deductable, and 80% of the machine costs after meeting the deductable (which I need to call and confirm).

My question(s) are:

1) To get the Phillips or Resmed machines I want, it looks like I could pay the DME upwards of $2500 for everything? That is just what I gather from the forums. That would put me at $500 out of pocket for the machine, etc. Which through the Hospital would be fine, as you can pay as much a month as you like (usually).
2) Looks like I can get the Phillips machine I want, mask, etc, and would pay less than $200 out of pocket if I get my prescription and buy online.

I haven't called my insurance yet to even ask if I can do that. I am torn between the (2) as with #1, I wouldn't have to deal with insurance paperwork, etc. I also could exchange masks, and not have to deal with sending one back via mail, etc.

If I go the 2nd route, how bad is the insurance paperwork to fill out? Also, how quick do they usually pay back their amount?

Thanks!

PS: I am a 27 year old male. Was 5'9 175lbs. After being on the Celexa, I gained 20 lbs.

[Pugsy]

Confirm with your insurance provider that they will reimburse for online purchases first. Some will, some won't.
If they will then the paperwork is not bad at all. When I bought an item from cpap.com they furnished me with an email attachment of a standard universal insurance form complete with diagnosis codes, item code and their tax ID number. All that was needed was to fill in the top portion of the form with personal insurance information after printing it out. I did not file because it was for an item not covered by insurance but it would have been easy to do.
One form is all.

Also, just because you buy your machine on line doesn't mean that you can't use a DME for masks and such.
I have a DME that I use for masks and supplies. I bought my machine through private party. It was worth it to me toget what I wanted, when I wanted it and no hassle from DME about the machine I wanted. In my case out of pocket with co pays was pretty much a wash.

[LinkC]

I have BCBS-Fed and have never filled out paperwork for CPAP. My PCP referred me to the Sleep Doc, who faxed my 'script to a DME whom she knew did BCBS. All I did was sign the forms indicating possession of the machine.

[KotaNole]

Yes, thats a plus for the DME, no paperwork to do.

WIll also consider the machine online and mask(s) from the DME.

At this point I will probably just go with the DME to keep things simple. Armed with info from this site, I should be fine.

What is the going rate for the PR System One Pro and Resmed S9 out the door from the DME?

[Guest]

Not sure who your insurance is with, but call and talk to your rep. I ordered my equipment offline, rather than through the DME because of "shady" dealings from the get go. My rep called me back and told me they would need a copy of the sleep study with the titration (to prove I had it done and the readings), a copy of the prescription as the dr. wrote it, the invoice from the equipment order, and the insurance form provided with codes. I did learn that my deductible was more becuase of the online being "out of network" so you won't get as much compensation as you would if going through a local DME, but doesn't mean you won't still pay out way more through the DME anyway. I could never get my DME to give me a full paid for price, so I went with the online. I am satisfied with out of pocket amount even if my insurance doesn't pay me a dime.

[KotaNole]

Not sure who your insurance is with, but call and talk to your rep. I ordered my equipment offline, rather than through the DME because of "shady" dealings from the get go. My rep called me back and told me they would need a copy of the sleep study with the titration (to prove I had it done and the readings), a copy of the prescription as the dr. wrote it, the invoice from the equipment order, and the insurance form provided with codes. I did learn that my deductible was more becuase of the online being "out of network" so you won't get as much compensation as you would if going through a local DME, but doesn't mean you won't still pay out way more through the DME anyway. I could never get my DME to give me a full paid for price, so I went with the online. I am satisfied with out of pocket amount even if my insurance doesn't pay me a dime.

I didn't even think about "out of network", which an online supplier wouldn't be. That would make the DME a lot closer in price. But the satisfaction of KNOWING what your getting has to be pretty good.

I work with several people who have CPAPs. I will have to ask around how the DME is.

[KotaNole]

Going for my sleep study tonight. I am a little nervous, but hopeful about the outcome, as it would be nice to finally have an answer!

[ems]

Going for my sleep study tonight. I am a little nervous, but hopeful about the outcome, as it would be nice to finally have an answer!

Don't be nervous. It's a pain, but nothing to be nervous about. Nothing hurts, etc. Just try and relax the best you can. 6:00 a.m. tomorrow, it will be over. I kept thinking that and before I knew it, they were waking me up to get out of there!

[KotaNole]

Ok, I had my sleep study last night.

I was kind of disappointed from the start as I learned it wasn't going to be a split study any way you cut it. She said that the only way they would put me on CPAP was if my O2 dropped to 69% which was very unlikely to begin with.

Of course she couldn't share any information with me, and said it would be 3 weeks before I get the results.

I contacted my Cardiologists' PA which is the one that set it up for me to begin with. I have an appointment with him on 10/5, so I am seeing if he can bulldog down the info for me by then. Waiting to hear back from him.

The date they scheduled me for the Pulmonologist appointment is 3/11, really? Who would be the one contacting me in 3 weeks with my results? Then I guess the Dr. would just fill out the prescription after the titration? As he surely doesn't expect me to wait till next year, as that would just have to be a check up on the CPAP if I need it correct?

On a side note, I slept pretty good until 1 or so when she woke me up to adjust some of the wires, and I got up to go to the bathroom. Then I felt like I was awake until 5:30, although she did say I slept. Either way, I am super tired today.

Sorry, end rant! I just want to know if I have it or not, then I can wait for the titration etc.

[Pugsy]

I just want to know if I have it or not, then I can wait for the titration

This part is the hardest..the waiting. I didn't make criteria for a split study either. Sleep tech slyly told me I had sleep apnea anyway when he cheerfully said "you know I can't really discuss it but hope I am on duty when you come back, enjoyed chatting with you"

I later found out I didn't make the required 15 events per hour that they use for split study criteria. I am worse in REM and every time I would hit REM sleep I would have a couple of events and bounce out of REM ...then had to go through the sleep cycle to get back to REM...Ran out of time when I finally had enough REM..no time then for pressure trials.

Use this time to educate yourself just in case..

[KotaNole]

Who should I contact to hoepfully get my results back sooner than 3 weeks? The sleep center, or the secretary of the Pulmonologist (who I have never met with)?

I was hoping the Cardiologist PA who set me up for the Sleep Study would round them up, but no dice. Thats ok, I can bulldog them myself!

Thanks