Canadian Home Healthcare

[sherpa]

I've had my initial sleep test, confirmation of apnea, have a trial Remstar Pro C-Flex with nasal pillow, and done 2nd sleep test. I'm currently awaiting the results and then proper Rx setting from my Doctor. I'm wondering - I received the trial machine from Canadian Home Healthcare and they are quoting me approx $2000 for machine, headstrap/nasal pillow, plus services, maintenance etc. If I purchased the machine and headstrap/nasal pillow independently it is about $1000. Does anyone have any idea if it is actually beneficial to use a company like this for purchase of the machine, maintenance, etc? I can't seem to fathom the $1000 difference - does it really require that much maintenance or yearly recalibration? if I didn't use them who would the data collection go to? Does it even need to go to anyone or am I kind of good to go once I have the machine set properly. Just trying to get some experienced feedback.

[Julie]

Hi from the Maritimes - you need to a) ask your insce co. if they'll reimburse you for a machine you get e.g. from Cpap.com online (having e-mailed a scanned script from your MD). If you don't have insurance or don't care (can afford a machine on your own) you're better off doing it that way - I've done it and many others have. The machines are generally trouble free in terms of reliability and longevity - most have at least a 5 yr lifespan and very often quite a bit more. You'll probably want to replace your mask more often, certainly parts, but other than that, you're fine to buy online from the U.S. HOWever - ResMed, one of the two major sellers (the other being Respironics) does not allow shipment of their machines/masks outside of the U.S. (tho' they're actually made in Australia!), and while dealers here can get them, the resell cost to you is high... so, what some of us do (if lacking family/friends in the U.S.) is order the equipment to be sent to a company like "Reship.com" in the US that then will send it to you for a not-very-large fee... still worth the difference between Can. and US dealer prices. And don't worry about the relatively remote chance of needing service (as I said above) because even if you do there are dealers here that can help, and you can always send the things back to the US if necessary. And of course you don't pay duty on things as they're marked 'Medical device" or something to that effect.

As far as data goes, presuming you get a data capable machine (one that collects more than just compliance data), you can download (free) SleepyHead software from this forum, complete with instructions, etc., and follow your own progress with out help... most of us do that and tweak features when necessary (to the great annoyance of dealers who like to tell you that you shouldn't do it!).

The machine you now have is not terrible, but not new and doesn't have many features the new ones do... look at the Airsense 10 for instance (on Cpap.com) to see what it does. By the way, Cpap.com does sponsor this forum, but we all (just patients from everywhere) are NOT shills by any means, just think they really do have the most variety, best service and website, etc., and it's a convenient place to check out equipment (pix, graphs, reviews, etc.).

[SteveGold]

It will vary by province, but in Ontario the government covers the first $800 of a machine (if memory serves). When you deal with one of these companies they submit that portion for you and you don't need to worry about it. What I don't know is whether you could buy the same machine online at half the cost and still recoup the government's portion. It's worth looking into before you buy.

[sherpa]

Thanks Julie - my insurance will cover $215 and the ADP program $645 so it would be mostly covered. I am using the Respironics model and I priced it and the mask with delivery at $1079 via http://canadacpapsupply.com/ - The Respironics is fine for me - i don't have a problem with it. The additional $1000 for the "upgrade" per CHH seemed a bit steep even with 3 yr maintenance, service, support which made me wonder - I kind of figured once i have the setting right I'll be OK - The only think I may consider is the ability for auto adjust pressure but I haven't actually looked into it yet.

[rosacer]

Hi Sherpa

Check the exchange rate before arriving to any conclusion. Now that we have a low dollar value it becomes expensive to buy whatever in USA. I know it very well, I just check it today.

If the difference is not important it is maybe better to buy in Canada and you will have the grantee at hand (no big $ to send it back to US) in case of need.

Rosie

[Pesser]

Thanks Julie - my insurance will cover $215 and the ADP program $645 so it would be mostly covered. I am using the Respironics model and I priced it and the mask with delivery at $1079 via http://canadacpapsupply.com/ - The Respironics is fine for me - i don't have a problem with it. The additional $1000 for the "upgrade" per CHH seemed a bit steep even with 3 yr maintenance, service, support which made me wonder - I kind of figured once i have the setting right I'll be OK - The only think I may consider is the ability for auto adjust pressure but I haven't actually looked into it yet.

Buy from http://www.secondwindcpap.com/

If you call them they will tell you what machine they have that's brand new---out of the box; with a two year warrenty. They will ship to Canada without a prescription.

[Julie]

If you get an auto machine, not only does it give you more options treatment-wise, but can also be run just in plain Cpap mode... but a plain Cpap machine won't do auto, and most of us use autos.

[SleepWrangler]

Thanks Julie - my insurance will cover $215 and the ADP program $645 so it would be mostly covered.

The $215 figure leads me to believe you are in Ontario. If not then sorry for the irrelevant info.

Respiratory Equipment Policy and Administration Manual, September 2012
http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

Changes to How the ADP Funds Positive Airway Pressures Systems
http://www.health.gov.on.ca/en/pro/prog ... 131218.pdf

Local suppliers tend to inflate the overall cost with expensive services and products. Personally I found the extras not worth the cost and had a local supplier only sell me the ADP approved package at the ADP approved price and nothing else. Suppliers coach wording to make it appear that optional services are mandatory. They are not.

Employment insurance or government assistance may reduce your out of pocket expenses so the local supplier cost may not be a concern for you.

Cpap.com and members on this site supplied me everything the ADP program did not.

Best of luck with your therapy.

[sherpa]

Thanks SleepWrangler that is very helpful - yes I'm Ontario based.

Does anyone know if you purchase directly from cpap.com or other providers - can you still get ADP coverage or do you need to go through a group like CHH.
If I wanted to get something like the Airsense 10 APAP with nasal pillows (i.e upgraded headgear) - what is the best means to do so and still get ADP coverage - for Ontario based person? Sorry if the questions are too specific - I'm just trying to figure out what the options are and how the process works - The PDF is helpful as it seems to mean that an approved vendor must be used for ADP to cover any costs.
The doc says "the upgraded mask and headgear is an item not included in the funding amount provided for a PAP system (225.01);" so I wonder is it better to just purchase the machine alone from an ADP approved vendor and then buy the headgear you want independently ? when I spoke with CHH they said the upgraded Nasal pillow headgear was $300 which is about $200 more than seems to be available elsewhere.

[SleepWrangler]

The doc says "the upgraded mask and headgear is an item not included in the funding amount provided for a PAP system (225.01);" so I wonder is it better to just purchase the machine alone from an ADP approved vendor and then buy the headgear you want independently ? when I spoke with CHH they said the upgraded Nasal pillow headgear was $300 which is about $200 more than seems to be available elsewhere.

My strategy was to have the local supplier provide me with an ADP package for CAN$215 and then source everything else as cheaply as possible.
viewtopic.php?f=1&t=95962&p=921197#p921197

The local prices for Nasal pillow headgear is likely inflated to support, what I consider, an ancient sales model (i.e., personalized, brick and mortar location, phone support, high margin). If you want the extra hand-holding then pay the premium price. People who bother to find these forums generally don't need it.

[Hose_Head]

Thanks SleepWrangler that is very helpful - yes I'm Ontario based.

Does anyone know if you purchase directly from cpap.com or other providers - can you still get ADP coverage or do you need to go through a group like CHH.
If I wanted to get something like the Airsense 10 APAP with nasal pillows (i.e upgraded headgear) - what is the best means to do so and still get ADP coverage - for Ontario based person? Sorry if the questions are too specific - I'm just trying to figure out what the options are and how the process works - The PDF is helpful as it seems to mean that an approved vendor must be used for ADP to cover any costs.
The doc says "the upgraded mask and headgear is an item not included in the funding amount provided for a PAP system (225.01);" so I wonder is it better to just purchase the machine alone from an ADP approved vendor and then buy the headgear you want independently ? when I spoke with CHH they said the upgraded Nasal pillow headgear was $300 which is about $200 more than seems to be available elsewhere.

The answer is no. To get the ADP grant you have to buy through the Ontario DME.

Before you go any further, I highly recommend that you read the ADP website. It outlines exactly what is covered and for how much. For example, it prohibits the DME from charging you more than their specified schedule. I'm not sure but off hand I think it also provides you with a mask for a set price.

Once you get your ADP equipment, then shop online for your supplies and anything else you need. The local DME will very likely try to continue to rip you off. Note that some supplies such as Resmed masks cannot be shipped to you from USA suppliers so you will have the added cost of a reshipper (such as reship.com) to get them - it might be cheaper to shop around in Canada in that case. For example, Clinicalsleep.com in Vancouver usually has good prices for masks, hoses and other supplies and offers free shipping.

[SleepWrangler]

Before you go any further, I highly recommend that you read the ADP website. It outlines exactly what is covered and for how much. For example, it prohibits the DME from charging you more than their specified schedule. I'm not sure but off hand I think it also provides you with a mask for a set price.

I agree with everything you wrote.

Be aware that vendors often use misleading sales tactics that technically comply with the ADP funding rules but magically inflate the package price with optional upgrades. Their upgrades are made to appear as standard. My vendor, for example, gave me three options to choose from. None of them were a bare ADP package. You have to emphatically insist on the ADP approved package with no options. The ADP lists a "basic mask" which is not clearly defined so who knows what the vendor will offer?!

[Oughtsix]

I don't know anything about insurance in Canada. But I do know that in 10 years of being on a CPAP I have never had a DME touch my CPAP to do anything other than retrieve compliance information for my insurance company. My sleep doctor has also retrieved compliance information from my CPAP for the insurance company.

All changes in settings and such I have always done myself to provide the best nights sleep for me. Once you have your CPAP and the DME has its money and the Doctor has his money you are pretty much on your own... which is probably a good thing because I am much better judge of what settings are best for me than either the Doctor or DME.

I have 3 CPAPs. My original 10 year old Fisher Paykel which is just as dumb and just as functional as the day I received it from the DME. My 4 year old Resmed Series M that I bought off Craigs list. The humidifier on the Series M stopped working and I could replace the humidifier with a used one for about $70 if I was so inclined. I set everything on the Series M myself to my liking after experimenting with different configurations for a few nights. My most recent machine is my PRS System One. When I picked up the System one from the DME I told them over the phone that I didn't need their typical dog and pony show I just wanted the CPAP. When I got there the technician started going through the setting with me and I stopped him and told him I would figure them out on my own. In and out in 5 minutes.

I have experiment with the min and max auto pressures on the System one as well as different Cflex and Aflex settings. I love being able to retrieve the data from my CPAP in sleepy head myself so see how the different settings affect my AHI. So far a pressure range of 7.5 - 13 with no Cflex or Aflex seem to give me the lowest AHI. My prescription is for a pressure range of 6-10.

[sherpa]

This is a really helpful link http://www.health.gov.on.ca/en/pro/prog ... manual.pdf
As it gives what the cost actually is. I think I will request just the machine of my choice for the price quoted and opt out of the mask upgrade where they seem to gauge. And I'll buy mask on my own. Thanks so much for the help. It is very much appreciated.

[sherpa]

Hey I just looked at all the info that was provided to me regarding ADP from Canadian Home Healthcare and the total number of places they provided website / online information regarding the ADP program is zero. One of the forms provides an address and phone number. I'm really glad I found this place and thanks for the prompt feedback