CPAP providers who don't require a sleep study?

[seth]

I have been a CPAP user for for 20 years. My last study was around 12 years ago and I don't have access to it. I use an Autopap so the pressure is taken care of. My current machine died. I am trying to get a new one under insurance coverage. My insurance company does not require a sleep study. Every company who sells CPAPs and accepts insurance I have talked to requires a sleep study (basically for CYA purposes). I know from experience that I can't sleep without the CPAP, so a sleep study is not good for my health. Anyone know of a dealer who doesn't require a sleep study? If I can't find one, I will have to buy one out of pocket.

Thanks

[Okie bipap]

Your family doctor can write you a prescription for a new machine. If your insurance does not require a copy of the sleep study, then the DME should not be able to impose further requirements on you. If you want to purchase a machine without using your insurance, machines can often be found on Craig's list for a very reasonable price. Members here often sell machines. There are currently 2 ResMed machines for sell by people here on the forum. I bought my back up machine from a member for about half price. It was brand new, still packed in the manufacturer's box.

[seth]

The problem is, every DME I have talked to imposes that restriction.

Buying out of pocket is the alternative, it is easy to do, and if I can't find a way forward that is what I'll do.

[SewTired]

Seth, contact your insurance company. Some people have done 3 way phone conversations with insurance and DME in order to get things through.

[seth]

Thanks, I am trying that out

[TheDuke]

Through the years I have purchased 5 XPAP machines.None of the DME's have made any sleep test demands', and all have involved insurance. Earlier, two different doctors did strongly urge me to be retested and I complied.When I bought my most recent machine I expected Medicare to require a fresh sleep test, but their only requirement was that I was seen face-to-face by the sleep doctor to review and confirm my treatment. The doctor was new to me, but he quizzed me regarding my history and treatment, and performed some common physical exam routines .He wrote a new prescription, faxed it to a local DME (Parent firm is Rotec) who ordered the specific BiLevel machine I preferred.

TheDuke

[TASmart]

The only concerns the DME should have is that there is a valid prescription for the device and to verify insurance coverage if needed. In fact with a prescription, if you want to pay out of pocket that should be fine with the DME.

[seth]

No issues paying out of pocket. I just bought a travel machine that way. But every DME I have talked to requires a sleep test for insurance claims, even though the insurance company does not. The insurance company is now talking to a number of providers, will see if that yields any results. If not I will likely just buy the new home machine out of pocket.

[Guest]

Seth, contact your insurance company. Some people have done 3 way phone conversations with insurance and DME in order to get things through.

Thanks, I am trying that out

When you talk to your insurance be sure to ask them if they will reimburse you if you buy from an online vendor. cpap dot com can provide you with the needed documentation if they will. Else just check Craigslist in the Health & Beauty section.

I suspect any DME who requires you have a sleep study has some financial interest in the sleep lab and I would avoid them.

[LSAT]

Seth, contact your insurance company. Some people have done 3 way phone conversations with insurance and DME in order to get things through.

Thanks, I am trying that out

When you talk to your insurance be sure to ask them if they will reimburse you if you buy from an online vendor. cpap dot com can provide you with the needed documentation if they will. Else just check Craigslist in the Health & Beauty section.

I suspect any DME who requires you have a sleep study has some financial interest in the sleep lab and I would avoid them.

Having a sleep study is a Medicare requirement and most insurance companies follow Medicare guidelines...it's not the DME. For insurance to pay a DME, there must be a Sleep Study and a Prescription.

[Guest]

Having a sleep study is a Medicare requirement

Of course it is. Who said it wasn't?

Did I miss where you asked the OP which insurance he has?

Did I miss where the OP said he is trying to use Medicare without having a sleep study?

Or are you out to attack someone because you lead an unhappy life? Please, Take the time to find out what in your life makes you so unhappy.
You know the 'ol Medicare loves company syndrome.

Do you switch right to attack mode w/o reading anything? Let me replay this OP for you...

I have been a CPAP user for for 20 years. My last study was around 12 years ago and I don't have access to it. I use an Autopap so the pressure is taken care of. My current machine died. I am trying to get a new one under insurance coverage. My insurance company does not require a sleep study. Every company who sells CPAPs and accepts insurance I have talked to requires a sleep study (basically for CYA purposes). I know from experience that I can't sleep without the CPAP, so a sleep study is not good for my health. Anyone know of a dealer who doesn't require a sleep study? If I can't find one, I will have to buy one out of pocket.

Thanks

Having a sleep study is a Medicare requirement and most insurance companies follow Medicare guidelines...it's not the DME. For insurance to pay a DME, there must be a Sleep Study and a Prescription

IMHO anytime a DME asks for something which has not been requested or required by insurance has something to gain or they would just fill the Dr's Order for equipment.

Now if you have questions to ask the OP please go right ahead. Do you have anything helpful to say?

[TASmart]

I have been a CPAP user for for 20 years. My last study was around 12 years ago and I don't have access to it. I use an Autopap so the pressure is taken care of. My current machine died. I am trying to get a new one under insurance coverage. My insurance company does not require a sleep study. Every company who sells CPAPs and accepts insurance I have talked to requires a sleep study (basically for CYA purposes). I know from experience that I can't sleep without the CPAP, so a sleep study is not good for my health. Anyone know of a dealer who doesn't require a sleep study? If I can't find one, I will have to buy one out of pocket.

Thanks

========

they cant demand a sleep test
they must demand an Rx from a doctor

your insurance might demand a sleep test
but if your family doctor will write the Rx
then you should be okay with your history and not need any tests for insurance

Didn't your DME demand a sleep test result and as of last report you do not have any type of machine?

[seth]

I am using my old machine (around 8 years old) currently. Note that my last machine was paid for by insurance, I was able to find a DME that didn't require a sleep test. That DME has ceased selling CPAPs. I also now have a newly purchased travel machine as a backup if needed, so there isn't a sense of urgency. But the only approach I can think of at this time is to wait for my insurance company to try to find an in network DME that doesn't require the study. They said they won't reimburse for a purchase made out of network.
If all else fails, I buy one out of pocket.

Thanks

[seth]

Heard back from insurance. Another person said they won't even try to find a DME that doesn't require a sleep study.
Unless there is a 'light' sleep study that doesn't require me to spend a night without the CPAP, I am just going to buy one out of pocket.

[ChicagoGranny]

Heard back from insurance. Another person said they won't even try to find a DME that doesn't require a sleep study.
Unless there is a 'light' sleep study that doesn't require me to spend a night without the CPAP, I am just going to buy one out of pocket.

I have Medicare, and I am buying all of mine self-pay from now on. Bought one that way earlier in the year. Government is too much hassle to worry with.

I bought a used one with low hours and a one-year warranty from secondwindcpap.com. If you look at the cost over five years, it's minor compared to the great benefit CPAP brings.