Greeting folks, I have a few questions

[Cloud 9]

Hello all. I have been lurking on your wonderful site for the last two weeks, and I have gotten tons more information than I ever could have thought to ask.

I received a seperation agreement from my company when my position was eliminated, and I only have one more month of good insurance remaining. I scheduled a consultation with a sleep doctor to address my apnea. I have been told multiple times that I stop breathing during sleep, and during a recent medical procedure where I was under anesthesia, I must have given them quite a scare, because they told me I should address the issue soon.

I scheduled a consultation with a sleep doctor, and recently underwent a sleep study. Yesterday the doctors office called me and asked that I come in for a CPAP fitting and begin using it until my titration date. They would not provide me with any details of my study, other than my apnea is severe and a CPAP is indicated. Apparently the doctors like to keep the details in their court. I go back for my second consultation to go over the results in 8 days.

I went in this afternoon for the fitting. They had a Resmed S8 sitting next to me (basic model). I asked if this was the unit I would use from here on out and the nurse replied that is was. I asked if it was data capable, and the reply was no. I explained my insurance situation to her and told her that I wanted to get the most versital machine I could while my insurance is in effect. I wanted the capability to monitor the data, should any of my parameters change in the future. She told me only an autoset would do that, and an autoset would not really help me. I explained I would use it in a CPAP mode as perscribed, but just wanted the flexibility in the machine since this will likely be the only one for a few years into the future. I also explained that I would pay out of pocket any difference in price of the units. She said she could not charge more than what the insurance company would pay regardlees of the machine type. Our session ended when she said she would discuss this with my doctor, and would have someone call me back tomorrow and go from there.

I also asked if they were DME providers and she said no, that they only order the machines through the DME.

My questions:

Is it common for the doctors staff to provide the machines, the set up and the fittings initially?

What is the protocol if I purchased the machine elsewhere or via internet. Would It be considered bad form to expect initial setup, fitting, and follow up services with my doctors staff.

I have narrow nasal passages, and am a mouth breather at night. I have a mustasche, and a close cropped goatee that starts just below my lower lip and extends about an inch underneath my chin. Should I be looking at a particular type of mask or be prepared to shave? I cant imagine anything that would make an airtight seal aside from a firemans mask.

My hope is that the doctor will just indicate the APAP and have the staff order one for me, but I have not been around here long enough to know what the next step would be if not. I really wouldn't want to be on my own at least initially in case things don't work well in the beginning. Thanks, in advance for any insight or comment you may have.

Scott

[Chronitia]

Hi! The insurance crunch I'm sure is some added stress but hopefully you'll get everything sorted out in time. Having just gone through this, hopefully I can answer your questions.

1.) Is it common for the doctors staff to provide the machines, the set up and the fittings initially?

The method probably varies based on what your insurance company provides for / requires. I have a provider who only works through one particular distributor in the area. This meant a drive rather out of the way for me to go to their location, and the people there provided the machine and the initial setup/"fitting"

2.) What is the protocol if I purchased the machine elsewhere or via internet. Would It be considered bad form to expect initial setup, fitting, and follow up services with my doctors staff.

That's an odd question, maybe I don't understand. Is there a way for you to buy the machine yourself and still be reimbursed by your insurance? It seems crazy to me to pay full price out of pocket just to get an extra feature "in case you need it in the future."

For me, the distributor was EXTREMELY helpful in this area. They called me up to schedule the fitting and explain the features of the machine I was getting. (This is based on the prescription your doctor writes, but often is just the most generic thing they have since the DR might not know the difference.) We figured out that I wanted some features not included in the model they would give based on the Rx I had, so what the person at the distributor told me is to do some research online, figure out what model I want, and to have my Dr write a new Rx. She cancelled my current order and did just that. I picked out a model, a mask, etc, and called up my Dr office telling them what I wanted. The next day, they called back to say my Dr approved my request and had forwarded the new Rx to the distributor. It took an extra week or two since they had to special-order the stuff I wanted, but once they had it the distributor fitted me with the new stuff no problem. And best yet, I got a high end machine for only 10% of the sticker price!

3.) I have narrow nasal passages, and am a mouth breather at night. I have a mustasche, and a close cropped goatee that starts just below my lower lip and extends about an inch underneath my chin. Should I be looking at a particular type of mask or be prepared to shave? I cant imagine anything that would make an airtight seal aside from a firemans mask.

Up until a few days ago, breathing through my nose felt like I was breathing through coffee stirrer straws. When I was a kid I had to have tubes in my nose. So I was having this problem but read a CPAP tip to start using heavy duty nasal spray to open things up. Saline helped a bit, but this morning I tried the 0.05% oxywhateveritis OTC nasal spray. It's like night and day, my nose is shockingly open and I'm having no trouble breathing at all. You aren't supposed to use these all the time, I'm hoping one use a week (2-3 sprays per nostril) will be enough if I maintain it with saline. Part of the problem supposedly is that the nostrils are inflamed and then stay inflamed...so if you can get them clear once, it's easy to keep them clear. here's hoping!

In terms of shaving...not sure about the stuff on your chin but I often have a lot of stubble on my upper lip and my mask does fine. If it's really thick and long facial hair...don't know, you just might have to have a really tight strap to keep it tight. If you think you can get over the mouth breathing (I always had mine open but have found it pretty easy to keep it shut with the nasal mask), I can't recommend my current mask enough (the sleepnet IQ, linked in my sig). It has a really thick gel seal all the way around...it's so flexible it seems like a foolproof seal. Even with loose straps I never notice any leaking.

Good luck!

[DreamStalker]

You have a very short fuse on your insurance coverage. You would have to check with your insurance to see what their policy is but man require at least one month rental period before they are willing to purchase (others 3 months).

I would get on the phone and talk to insurance to get details on coverage for CPAP equipment.

You should not worry yourself too much though as paying out of pocket with insurance vendor is not all that much more than some insurance copays ... depends on your coverage. Again call them ASAP.

As last resort you can always get equipment from the cpapauction.com site for even less coin.

So here is your priority list -

1) get the original prescription from your doctor ... they must by law.
2) call your insurance and get details on CPAP coverage.
3) get a copy of your sleep lab study for your own future reference.

Best of luck and welcome!

[echo]

HI Cloud9! Welcome the forum.

I'm going to send you to Slinky's post to read up about DME's and insurance : viewtopic.php?f=1&t=33168&p=281488&
(Note that the billing codes for CPAPs and APAPs are ALL the SAME, and payment is based on the billing code, NOT the type of machine)

There are a few other posts there on getting an APAP. Consult Slinky's other posts for that too She is our resident go-get-em-girl!

You may consider a data-capable CPAP as well, but as you say if insurance is running out then I would personally go for the APAP. Good luck!!