newbie with questions..

[leam]

Or a questionable newbie...

Did my sleep study, don't have the numbers yet but as the sleep tech did say I met the criteria for needing a cpap during the night I'm making an assumption.

The issue is that my current insurance runs out shortly and I have to start paying for different insurance soon and wait until it kicks in. Ideally I'd get the CPAP and stuff taken care of on the old insurance so I have time.

What all do I need to take into consideration when finding a machine? What are some recommended options, conversly, what are some options that are a waste of money? What questions should I ask the Dr when they go over the results of the study? AM I required to wait for the Dr to interpret the study?

Leam

[sleepycarol]

Here is my experience.

I was scheduled to have a split night study. This is where you spend part of the night determining if you have sleep apnea and then the remainder of the night you are hooked up to a cpap. Only trouble is you have to get 2 hours of sleep in order to do the split study. I did not have the split study because I only slept a little over 2 hours and so was unable to have it done. I THOUGHT I slept more than that but they have certain criteria they go by and as far as depth of sleep.

It took approximately 2 weeks for the doctor to interpret the study and then I was scheduled to go back for the second part of the sleep study which is the tirtation (where they figure out what pressure you need). That involved another weeks wait as I went to a satellite clinic otherwise I would have had to wait for a month before I could get in to the main clinic.

Have you been put on a cpap during your sleep study? If not you will either go back to the sleep clinic for that or be prescribed a loaner apap to find your pressure needs.

Most insurance companies require that you be compliant for so long before they will purchase your machine. You may want to call the insurance company and ask about their policy. If you have to show compliance you may want to wait until you switch companies if it is after the first of January.

[Pad A Cheek]

Hello Leam and welcome to the forum.
I would suggest you first read Our Collective Wisdom by clicking on the yellow light bulb. That may answer many of your questions.

First I would say be sure to request from your sleep doctor the complete sleep study results of the first night. You will more than likely have another sleep study to determine what pressure you need, that is called the titration. Get a copy of this sleep study too, and put them in a safe place.
When your doctor prescribes your machine, request that he prescribe a fully data capable machine. One that records the leak rates, the apneas, the hypopneas and the vibratory snore and the pressure. You may or may not want an Auto PAP. There are many discussions on the forum about both. If your pressure is above 14 you may need some exhalation relief, such as Cflex or Aflex as it is called on some machines. Get the prescription yourself, and take it to your place of choice for the equipment. There are many DME, durable medical equipment, providers that are very good, but you may need to check out a few before you find the one that will treat you great. Be persistant and take charge of your health.

A heated humidifier is important, but your sleep doctor should prescribe that almost automatically. Have your doctor state that the mask prescribed is Patient's choice. This is the most challenging part of the treatment. You may have to try several for several nights each until you find the one that really works for you. Ask the DME if you can exchange a mask if it does not work for you and how long can you try it out.

Be patient with yourself and keep your can do attitude and you will make it through the first rough month. No matter what do not give up, there are loads of people here that will support you and help you get things sorted out.

Welcome to the forum and soon you too will be a Proud Hose head like me.

Karen

[engrdad]

Leam,

I was in the same situation concerning insurance (but with a little more time). Who is writing your script? Recommend getting a rush job on the sleep results. My doc said they only needed the summary findings (not the full narrative report) to do the script. Also, talk with insurance about paying for the machine in full instead of renting. I was successful in doing this.

Note, the DME (durable medical equipment) supply company will get reimbursed the same regardless of the type of CPAP, therefore unless specified on the script, you will likely get the cheapest machine (i.e. the biggest profit for them). Therefore, I would recommend that you specify (i.e. get the doctor to specify) exactly what you want. My recommendations: Get a fully data capable machine (not just compliance data). Get a heated humidifier. Research masks and try several under pressure if possible. Include the smartcard and smartcard module in script. Include getting the provider's manual in the script (I was able to get this as well!). I also included the Encore Pro software in the script but was not successful in getting this. However, you can get the software developed for the cpap user called Encore Viewer (however, insurance will not likely pay for this). If insurance will not pay, recommend getting this on cpap.com (much cheaper). Research getting an AutoPAP machine (gives you options, you can always use it in straight CPAP mode). Sorry so rushed but promised to go buy groceries with my wife.... Below was what was written on my script for reference. I gave this to my doc and his PA just reduced it and pasted onto the script.

Below is what is on the script:

1 Respironics REMstar M Series Auto CPAP w/A-flex (w/integrated heated humidifier
2 Minimum Pressure 5cms/H2O
3 Maximum Pressure 12cms/H2O
4 A-Flex setting 3
5 Ramp off
6 Show AHI/ Leak feature ON
7 Integrated Smartcard module w/smartcard
8 Encore Pro Data Software (v. 1.8i or later)
9 Provider's manual
10 Nasal mask, Full Face mask, or Nasal Pillows mask of patient's choice

[Slinky]

... Did my sleep study, don't have the numbers yet but as the sleep tech did say I met the criteria for needing a cpap during the night I'm making an assumption.

The issue is that my current insurance runs out shortly and I have to start paying for different insurance soon and wait until it kicks in. Ideally I'd get the CPAP and stuff taken care of on the old insurance so I have time.

What all do I need to take into consideration when finding a machine? What are some recommended options, conversly, what are some options that are a waste of money? What questions should I ask the Dr when they go over the results of the study? AM I required to wait for the Dr to interpret the study?

First off, are you in the USA? Is this group health insurance w/your place of employment just changing insurers? There can be no prior existing condition clause w/these types of group policies. I "think", but am not sure, that one of the purposes of HIPAA was that as long as there was no lapse in insurance coverage even when changing even private insurances, there can be no pre-existing clause. But this last I am not sure of.

Then what comes into play is the annual deductable. And what the DME (durable medical equipment) coverage for CPAP is under the insurance plans. MOST insurance companies insist on a rental period prior to outright purchase of a CPAP machine. They want you to prove compliance before they purchase the CPAP. You can't blame them for not wanting to pay for a CPAP that ends up sitting in the closet collecting dust and unused.

You need to know what your current DME benefits are and what the DME benefits of your new insurance are. What about copays? What local DME suppliers are these insurances contracted with. Hopefully you will have the option of more than one.

I would make it clear right from the get-go with the sleep lab, sleep doctor and any referring doctor involved that you will NOT accept anything less than a fully data capable xPAP. If you should need any adjustments to your xPAP therapy you don't want your ordering doctor making adjustments by guess and by gosh. You want him to have access to the data that can indicate what the problem is and what the likely correction is. I made that clear to my sleep tech the morning after my titration and wrote it right on the paperwork I filled out and signed that morning. I reiterated it again when the sleep lab called to ask me what local DME supplier I preferred. I just plain told them I would NOT accept ANY xPAP that wasn't fully data capable.

Different sleep labs have different practicies. Some you just get a phone call from the lab telling you have sleep apnea and need a CPAP machine and the DME supplier will be contacting you to deliver or ship your equipment. Some, the better sleep labs, have you come in to see the sleep doctor and discuss the results of your studies and why a CPAP is recommended and to answer any questions you may as well as to discuss what equipment they suggest.

Your key concern once you've made it clear you won't accept anything less than a fully data capable CPAP is finding THE right mask for you. One that is comfortable fitting and pretty much leak free for you. The miracle mask for one person can be an absolute disaster for another person. The mask exchange policy of any local DME supplier should be a major concern when choosing a DME supplier.

MOST people will need AT LEAST a passover humidifier w/their CPAP and, the vast majority will need a HEATED humidifier. Most machines now have an integrated heated humidifier available. If you travel much, especially by air, these are the most convenient. However, if one doesn't travel often, especially not by air, the Fisher & Paykel HC 150 stand alone heated humidifier is by far the better choice. Just not as convenient to carry around when traveling.

[sleepycarol]

I am in Missouri and am changing insurance companies as my hubby has changed jobs. He did have union benefits that included insurance, but has went to non-union work and so will be removed at the end of the year from drawing union benefits. I have applied where I work for insurance coverage and all I had to do was provide my employer with a statement from the insurance company that I have benefits and the ending date of coverage. This was faxed to the insurance company and so my pre-existing conditions are covered from day one.

Providing proof of insurance is vital in order to get coverage for the pre-existing conditions.

[leam]

Answers to some questions. I'm in the US, and the sleep study included the sleep tech changing some of the settings during the night.

I'll go read some wisdom in a bit.

Leam

[leam]

Just talked to the Dr's office. On the machine I need a setting of 9, not sure what that means. They are calling the company that works with my insurance and I should get contacted within a week. All the things you all suggested were on the list.

Thanks!

Leam

[RipVW]

Just talked to the Dr's office. On the machine I need a setting of 9, not sure what that means. They are calling the company that works with my insurance and I should get contacted within a week. All the things you all suggested were on the list.

Thanks!

Leam

9 is the pressure setting for your CPAP (lowest possible is 4, highest is 20). Do review the collective wisdom available on this forum, especially regarding best choices of machines. Most of us suggest an autotitrating APAP machine that is data capable as the the best choice, and, depending on your insurance coverage/co-pay/etc., you might do better (save money & get a better machine) if you purchase online through cpap.com.

Good luck!

[upm903]

If u r interested in reports from the New Encore Viewer from Respironics I can run it for you and Email you the reports.

Using the utility at http://www.mycpap.com you copy your SmartCard to disk and Email me the file to UPMCPAP@hotmail.com .

All you need to buy now is just the card reader. You can save the sofware Price about 130$.

If satisfied you could reward me at the same Email.

Sam