Insurance comes through

jasper · Post by **jasper** » Tue Nov 13, 2007 7:13 am

I wanted to upgrade my M-Series Plus to an APAP machine, but I had had the Plus for only a year. I would have let it go, and just purchased the machine myself, but I was encouraged by some of the forum members to submit to the insurance company (Aetna), and they paid it!

I was not eligible for another machine for 4 more years, and I was also advised that an APAP is coded the same as a CPAP for insurance purposes. That was a little discouraging, but I thought, what the heck.

I supplied Aetna with a copy of my original study showing an AHI of 65, plus a copy of my titration study where they could only get it down to about 15 cm. I also had a letter of medical necessity from my sleep doc stating that an APAP would probably be beneficial in my case.

On top of that, I had already purchased an Aflex machine from cpap.com, and was able to show positive results in lowering my AHI to 5 to 7. (Graphs from Encore helped). So, with copies of all of that, a copy of the prescription showing “APAP” and the receipt from cpap.com, I went ahead and submitted.

Boy was I pleasantly surprised when I got the approval today.

BTW, by tweaking my pressures, I’m now consistently around AHI of 2.5. So, I count myself lucky to be one of the ones that APAP works well for.

How can today be anything other than a great one? Thanks everyone for your encouragement. This forum is a great resource.

DreamStalker · Post by **DreamStalker** » Tue Nov 13, 2007 7:35 am

Congrats ... way to go Jasper!

Slinky · Post by **Slinky** » Tue Nov 13, 2007 7:38 am

CONGRATULATIONS, Jasper. Way to go!!! (Picture a happy dance avatar here. I couldn't find it). Happy A-PAPping!

sharon309 · Post by **sharon309** » Tue Nov 13, 2007 8:26 am

what is the difference in a cpap and apap machine?
I have a m series Pro is that a cpap or apap?

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Wulfman · Post by **Wulfman** » Tue Nov 13, 2007 9:44 am

Congratulations, Jasper.

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sharon309 wrote:what is the difference in a cpap and apap machine?
I have a m series Pro is that a cpap or apap?

Sharon, you have a (good) data-capable CPAP machine. An APAP machine can be set for a range of pressures whereas a CPAP machine can only be set for a single pressure. Please read my comments in the other thread you started.

Den

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