Completely Lost

[rangerdave]

But are you in Ontario? Most people here respond re dealers and insurance in terms of U.S. knowledge and experience... if you are up here, it changes a lot.

Yes I am in Ontario. As mentioned, between my insurance and ADP I will/should have complete coverage. My concern is making sure I get exactly what I need. Fit and function. Thanks

[rangerdave]

Can someone help me define the criteria for deciding on which cpap machine to get? All I know is I'll probably get a prescription to purchase a cpap unit...probably not a autoset but I'm sure. If my insurance allows, is an autoset the way to go? What about brands or models? As mentioned, I have been using the S9 Elite during my trial period but another DME close by sells Philips Respironics REMstar (?) units. How the heck do you decide with little to know time in investigate? I do know I like the ResMed Quattro FX mask the best so far! haha ONE thing settled!
Dave

[Bama Rambler]

From everything I've read, you want the auto setting (APAP or VPAP) machine of whichever brand you go with. That will be the PR560/561 by Respironics or the S9 AutoSet by ResMed. I would insist on either of those if you possibly can. You'll also want the heated tube humidification on either of those units.

I have the PR460TS which is a very capable machine with full data recording. It's not truly an auto setting machine but does have an auto feature that can be used for 30 days. I had no clue about the different machines until after I got mine or I would have insisted on an auto setting machine.

[Bill44133]

Can someone help me define the criteria for deciding on which cpap machine to get? All I know is I'll probably get a prescription to purchase a cpap unit...probably not a autoset but I'm sure. If my insurance allows, is an autoset the way to go? What about brands or models? As mentioned, I have been using the S9 Elite during my trial period but another DME close by sells Philips Respironics REMstar (?) units. How the heck do you decide with little to know time in investigate? I do know I like the ResMed Quattro FX mask the best so far! haha ONE thing settled!
Dave

Hi Dave.

Here is the link to data capable machines: http://maskarrayed.wordpress.com/2011/0 ... -machines/

Also here is a link you should read and understand before you do any more talking to the DME:
http://maskarrayed.wordpress.com/what-y ... me-part-i/

I wish you well!!

[paradoiley]

Since you are in Ontario, different rules apply if you need/want to use the Assistive Devices Program. You should completely disregard the above link to maskarrayed.wordpress.com. It doesn't work that way here.

Here is the link to the ADP information on CPAP. http://www.health.gov.on.ca/en/public/p ... /cpap.aspx. When you read through it, it sounds wonderful.

The Assistive Devices Program fixes the price of machine that you are prescribed. The machine that you purchase under this program must come from the following document.

http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

I'm sure the list is updated from time to time, but I haven't found a more recent list on the internet. What I have found is that the prices are changing as of March 1st according to this letter.

http://www.health.gov.on.ca/en/pro/prog ... p_labs.pdf.

It doesn't matter which DME you choose, if you are using ADP, they have to sell it to you for that amount. ADP will pay 75%, you or your insurance pay the rest.

Now for the small print...
For the price in the document you will be able to purchase the S9 Escape. This comes with the standard tank, a standard hose, and a cheapo mask. If you want to upgrade to the Escape as suggested here, you will also need to buy the heated hose, the upgraded tank, and some nicer masks (which you probably want anyway). All of this will add up to several hundred dollars.

Additionally, most DME's will attempt to sell you a "Compliance Package". This will generally extend the warranty and give you free servicing. They will download the data off the machine and print out the graph for you to see how you are doing and work through any issues you might have. This package also costs several hundred dollars.

Finally, the ADP limits your choice in the machine that you are allowed to get. Unless you meet specific guidelines for APAP or BiPAP, you have to get your machine off the CPAP list. If you only qualify for CPAP, that is all you are allowed to get. You cannot request an APAP and pay the difference between the CPAP funding and the APAP price.

The requirements for APAP are
1) minimum prescribed pressure of 10
2) Your pressure requirements vary by at least 4 between sleeping on your side and back, or between REM and NonREM.

This is the form that your DME has to fill out to get funding for your machine.
http://www.forms.ssb.gov.on.ca/mbs/ssb/ ... 93-67E.pdf


So what can you do?

If you are prescribed CPAP and you are fine with that, go for the Elite (or respironics equivalent). This is the least hassle, and your therapy should be excellent.

If you want APAP, but only qualify for CPAP, you will have to pay for the machine yourself. Call your insurance and find out what you can do. You will also have to convince your sleep doctor to write a prescription for APAP. Some may, some might not.

Call your insurance and find out what they will pay for and whether or not they insist that you get the ADP funding.

I got lucky. My doc consented to write an APAP prescription, and my insurance ended up paying for the whole machine (less the 10% copay). The DME wrote a short letter to my insurance indicating that I didn't qualify for ADP funding for APAP. It was still frustrating finding all of this out on my own though.