APAP Machine

[Severeena]

I am trying to find out information and I am hoping to get it here.

My one DME says they can swap out my cpap for an APAP, but the APAP is much more expensive.

My second DME says the APAP costs $2000.00 and he feels the insurance company will not go for the idea of the APAP.

I am wondering if this is true or is it that the DME's will be losing their wonderful commissions.

[wading thru the muck!]

Prices @ cpap.com

REMstar auto with c-flex $632

ResMed S8 Vantage auto with EPR $679

Puritan Bennett Goodknight 420E auto $524


These are the three most up to date "state of the art" auto-paps and NONE of them sell for anywhere near $2000.

[Severeena]

I know they don't.

I know it has to do with profit. That is all there is to it. the almighty PROFIT

[Colorado Jan]

Severeena...

I don't know much, but I've seen other threads on these boards where folks say that the DME is paid the exact same insurance reimbursement for both CPAP's and APAP's. So they probably don't want to swap out because the CPAP is a less expensive machine and they make a bit more with it.

Can you get your doc to write a script specifying APAP? Then the DME HAS to give you an APAP, no matter what their profit margin is.

Jan in Colo.

[Severeena]

My doctor is ready to write out the script and fax it if the insurance company will go for it.

I just wish he would have written it for the APAP in the first place.

[jnp323]

My DME said that since there is no CPT code for APAPs, it would be very difficult to get one. However, BiPAPs do have CPT codes, so they are easier to get approved by the insurance company. The fact that a BiPAP is twice as expenseive as an APAP is irrelevant. I am trying to get an APAP, but I might have to get a BiPAP instead. It's tough when you have to compromise on your health because of the insurance company!

[DW]

The CPT code for an APAP (purchase) is the same as a CPAP: E0601 NU

I would suggest going through cpap.com or billmyinsurance.com and get what you want.

DW

[rested gal]

My doctor is ready to write out the script and fax it if the insurance company will go for it.

The insurance company doesn't care whether the machine is a straight cpap or an auto-titrating cpap (autopap.) The insurance company is going to pay the same ONE amount (whatever one price for "cpap" they've agreed on between the two of them) to the DME, no matter which machine you get...straight cpap or autopap.

It's the DME that balks at giving you an autopap, not the insurance company balking.

It's the DME who may be misleading just a tad if they say, "Oh, your insurance won't authorize paying for an autopap."

What they are really saying is, insurance companies won't pay us a penny more for an autopap than they will for a straight cpap, so we (the DME) don't want to give you an autopap.

Technically an autopap IS a cpap machine. It's an auto-titrating CPAP machine. If your doctor specifies that he wants you to have an autopap, that's what the DME should give you. The insurance company will pay the DME "cpap" price for the machine because the autopap IS a cpap machine.

It's the DME balking, not the insurance company. Or at least that's the way I understand it from reading umpteen million posts about the very confusing world of DME/insurance company's "agreements." The sticker price, even on straight cpap machines, doesn't necessarily reflect what the payment agreement is, either.


I'd suggest trying Billmyinsurance.com, too...to see if it can work with your insurance company. Bmi is run by the same folks that run cpap.com. They know what's what.

[WillSucceed]

Rested Gal wrote:

It's the DME that balks at giving you an autopap, not the insurance company balking.

For what it is worth, you folks in the States are not the only ones dealing with this issue. Here in Ontario we have the Assistive Devices Program (ADP) which contributes up to 75% of the cost of these machines (and others) once every 5 years.

ADP considers CPAP and APAP to be the same animal, use the same code and pay the same bucks. Our equipment suppliers don't tell this to patients and if you don't stamp your feet, insisting on a script for APAP (which most Dr's don't want to give) you don't get one. Just like with you folks, our equipment suppliers get less profit by selling the APAP.

When I asked about APAP, I was told that they are "only for people in places that don't have sleep labs." Had I known about this forum BEFORE my sleep studies, and learned what I needed to know, I would have rocked the boat for an APAP right from the get-go. Instead, as usual, I took the hard route and had to fight for the insurance company to pay for the APAP that I now have.

Here is the part that you all y'all get to feel good about:
PB 420E @ CPAP.COM = $524.
PB 420E @ Ontario Supplier = >$2,000.

Nice, eh? Your dollar is worth more, but not that much more!

I have to admit, I have checked out lots of sites in the US that sell CPAP stuff online and I have not found better prices than CPAP.COM. I object to the shipping fees that they charge to send stuff to Canada, so I just make purchases when I am physically in the US, asking whatever supplier I am at to match prices. Makes me crazy that the identical equipment in Ontario is so much more expensive! I'm envious of you folks being able to order stuff so simply, and inexpensively (relative to here) from places like CPAP.COM

[Guest]

An APAP is a more a diagnostic device than a theraputic device. The ideal situation would be to have an in-lab sleep study with CPAP titration. That means that during the sleep study the appropriate pressure is ascertained. Then a script is written for you to have a CPAP/BPAP machine. If you are still having problems then another sleep study can be performed. The APAP is an alternative but it should only be used for 2-4 weeks. The machine tries to respond to your breathing by making adjustments throughout the night. The information regarding the pressures and how you breathed on those pressures is recorded. The information from the machine is downloaded and the doctor can write a script to adjust the pressure of your regular CPAP based on the data from the APAP. Often the DME company is willing to give you the APAP for a month and then switch it out for a regular CPAP. I am a registered sleep tech and do not work for any DME company. However, I can see their point. They pay about $250 for a CPAP machine. They then have to associated costs such as payroll, rent, insurance, etc. They get insurance reimbursement for the machine of $500-800. They make a profit. The APAP costs them about $1200-1800 but they still only get reimbursed by the insurance $500-800. No company will stay in business with such a large loss. The truth is the APAP should only be a temporary diagnostic measure and is not necessary as a long-term therapy device since the regular CPAP will reach the same result once an appropriate pressure is ascertained.

[jonquiljo]

An APAP is a more a diagnostic device than a theraputic device. The ideal situation would be to have an in-lab sleep study with CPAP titration. That means that during the sleep study the appropriate pressure is ascertained. Then a script is written for you to have a CPAP/BPAP machine. If you are still having problems then another sleep study can be performed. The APAP is an alternative but it should only be used for 2-4 weeks. The machine tries to respond to your breathing by making adjustments throughout the night. The information regarding the pressures and how you breathed on those pressures is recorded. The information from the machine is downloaded and the doctor can write a script to adjust the pressure of your regular CPAP based on the data from the APAP. Often the DME company is willing to give you the APAP for a month and then switch it out for a regular CPAP. I am a registered sleep tech and do not work for any DME company. However, I can see their point. They pay about $250 for a CPAP machine. They then have to associated costs such as payroll, rent, insurance, etc. They get insurance reimbursement for the machine of $500-800. They make a profit. The APAP costs them about $1200-1800 but they still only get reimbursed by the insurance $500-800. No company will stay in business with such a large loss. The truth is the APAP should only be a temporary diagnostic measure and is not necessary as a long-term therapy device since the regular CPAP will reach the same result once an appropriate pressure is ascertained.

I have to quote everything you said, because my reply is that everything you are saying is wrong. If you are a registered sleep tech - then I do not know what planet registered you. An APAP is an automatically adjusting CPAP - and can run it as a CPAP as well. It is not an alternative to CPAP, but something different. They work well for people who breathe differently on different nights and in different positions. Some people like them, some people do not. You use them indefinitely just like you use a CPAP. I have never heard of a DME lending out an APAP for a month and then giving you a permanent CPAP after they determine how well you do. That's what a sleep study is for. I have heard of a Dr. giving an Rx for an APAP with a range of pressures instead of tirating your exact pressure. Insurance companies tend to balk at that, though. Yes, they do pay about $250 for a low end CPAP. They pay probably $350-$500 for an APAP. Your cost should not be more than 30% more then theirs. That's probably about what online companies make on a purchase which is more than fair.

If you are a sleep technician, I suggest you go back to school. If not, then stop giving out misleading and erroneous information to someone looking for help!

Severeena: The prices given by "wading thru the muck" earlier in this thread are about right on. Go to CPAP.com and look -- and these are prices to you if you buy on the Internet directly. Only a few insurance companies will deal with that situation, but yours might be one of them. Depending on your insurance situation and personal finances, it might be best to buy on your own and avoid a DME if you have a Dr. willing to help you out. "restedGal" gave cpap.com's company that can work with insurance and it's a good idea to check out. There is no CPAP or APAP that a DME will sell you that is worth more than several hundred dollars - and most likely it really costs them a lot less. Be careful of sleazy DME's - they are thick as thieves out there! Listen to the people on this board. If all else fails - find a few of the DME's that your insurance will work with and DME "shop". Tell them that "xxxx" company offered you XXXX , etc. and see what the next company will do. If your co-pay does not make it as feasible to buy from a DME then buying directly online (cpap.com or other companies) will sell you a machine for what it really should cost you. No games. Your Dr. can help in general by writing an Rx for an APAP - giving a range of pressures, etc. He or she can also help by writing any justification letter an insurer may need. "Technically" no one can force you to accept anything less than what your Dr. prescribes. But insurance companies will play games with that and possibly deny your claim. It sounds like you have seen all this and then some.

Good luck!


BTW - I will add that my "PR System One REMstar Auto CPAP Machine with A-Flex" cost me about $650 delivered. A Respironics APAP isn't the most expensive one out there, but it shows you how much these things really cost. Of course I paid out of my own pocket over the Internet, but frankly I saved money over what my co-pay would have been. Hopefully you will have better coverage. But APAPs are not expensive machines. Tell the DME that quoted you $2000 that I will sell them all they want for $1000 each!

[Guest]

My top-of-the-line Resmed Auto Cpap machine cost $853 on-line. I could have paid over $1200 in deductables and co-pays had I chosen to go thru a "preferred provider" and used my insurance the way I did first time around 4+ years ago. Now I spent less than $300 to use an honest "non-preferred provider". Kinda shows you why the medical industry is in shambles. The really sad thing about it is the fact most of it is just following Medicares lead. The ins. companies know how much they pay for "EO601", you think if someone submitted a bill for half the amount they pay a dme provider, they would be happy about it, not lower amount they will reimburse you. It will only get worse, medical care will become more and more a thing for the rich or government employed. jlk

[Hawthorne]

I wonder why "Guest" resurrected a 5 year old thread ????????