Canadian Newbie - 1st CPAP Purchase & Repair Issues

[unclebob]

First, thanks to all posters- have been following this forum about 1 month and it has really helped me learn the jargon ie hosehead, rainout etc as well as the issues involving OSA. Special thanks to Rested Gal, W T the Muck and Spiritus among others who have been particularly insightful!

I am a Canadian from Ontario about to purchase my first CPAP. Was leaning toward the new Remstar Auto with C-Flex and the Mirage Activa mask. One supplier advised to stay away from the C-Flex in general as due to it's complex nature with more moving parts it is much more prone to breakdown. They compared it to Fisher&Paykel with which they had far fewer problems.

My two questions are:

What has been your experience with repairs/downtime and especially if you have C-Flex? My intention was to get an Auto and thought it would be nice to throw in a kind of bi-level component.

Second, if you are from Ontario - do you have any suggestions regarding the purchase? I am aware of the Prov Govt $780 funding. I also have an insurance plan that will pay 50% of cost to max $1000, they do not seem to have a problem with an on-line purchase. I have contacted CPAP.COM but they did not have info on Canadian duties or taxes so am not sure I should order out of country. There are Canadian on-line suppliers but have not really checked them out, have you?

Any help or ideas you have would be very much appreciated!!

[Spiritus]

First, thanks to all posters- have been following this forum about 1 month and it has really helped me learn the jargon ie hosehead, rainout etc as well as the issues involving OSA. Special thanks to Rested Gal, W T the Muck and Spiritus among others who have been particularly insightful!

...


Second, if you are from Ontario - do you have any suggestions regarding the purchase? I am aware of the Prov Govt $780 funding. I also have an insurance plan that will pay 50% of cost to max $1000, they do not seem to have a problem with an on-line purchase. I have contacted CPAP.COM but they did not have info on Canadian duties or taxes so am not sure I should order out of country. There are Canadian on-line suppliers but have not really checked them out, have you?

Any help or ideas you have would be very much appreciated!!

Hi,

Since I just purchased a machine from cpap.com (the folks who sponsor this forum) and I am also in Ontario, I say forget about the OHIP and just buy direct from these folks.

First of all, you will find the prices of this equipment in Ontario to be ungodly expensive. In my opinion, factoring in the exchange, buying a unit in Ontario with the OHIP contribution will be more expensive.

For example, the auto-pap machines are being sold for over 2500.00 here, and the same unit is less than $1000 from these folks. Plus, they are exceptionally forthcoming with help, suggestions, and encouragement.

This, in any case, has been my experience. And, of course, getting railroaded into whatever healthcare provider my doctor picked did not improve my mood any.

Rob

[wading thru the muck!]

unclebob,

Glad to hear you found our comments insightful. The geat thing about this forum is on the Canadian issues I can't help you but Rob (Siritus) can. You can benefit from his experience and that's a great thing.

As far as the machine to buy it depends on what pressure you are at and how frequently you need to be there. In my case I have a low titrated pressure and infrequent events so I spend most of my night at 6cm... no need for c-flex. For the 3 months I've had my Puritan Bennett 420E (Auto)it's work flawlessly. At $599 USD including the software (@ cpap.com) it's the best deal out there IMHO. I bought the Fisher Paykel HC150 humidifier to go with it but PB is comming out with and integrated humidifier (early '05?) similar to the Respironics one.

I like your thinking though... trying to get the benifit of ALL the technology out there. Good luck in making your purchase.

[WillSucceed]

Rob:
You did not mention what happened at the border regarding import of the machine from the States.

Did you have to pay any duties? Taxes? etc.? Or, was it a simple American dollar to Canadian doller exchange rate on your credit card?

How was the machine shipped? Cost of shipping?

Enquiring minds want to know!
Thanks

[Spiritus]

Rob:
You did not mention what happened at the border regarding import of the machine from the States.

Did you have to pay any duties? Taxes? etc.? Or, was it a simple American dollar to Canadian doller exchange rate on your credit card?

How was the machine shipped? Cost of shipping?

Enquiring minds want to know!
Thanks

Hey Will,

When the machine arrives, I expect that I will have to pay GST. The GST will be collected from me by Fedex. I don't think there will be any PST payable. As far as duties are concerned - we have free trade, so there won't be any. Of course, there will be exchange to factor in, but the Canadian dollar, at this time, is very strong compared to the US dollar.

I used my own Fedex account - that's the only wrinkle that some people might face. The folks at cpap.com have had bad experiences with the courier company billing the taxes back to them, so they don't offer that service. It's no problem to get your own Fedex account, though. Just log on to http://www.fedex.ca and follow the links until you find the account creation page.

Best,

Rob

[unclebob]

Thanks for your response Spiritus & Muck!

Need a little more help.

Spiritus - I see you received your new unit.

- Did the delivery, price, tax etc work as you planned?
- What prescription did you give CPAP.COM, ie was it issued in Ontario?
- What mask did you get?

My situation in Ontario is getting a little weird but maybe this is how the system works here. This is what has happened:

1. My MD referred me to sleep MD. Had a sleep study and was called back
in about a weekas they said it was critical a second one be done right
away.

2. At 2nd study they gave me a list of a dozen suppliers and was told to
pick one. An appointment had already been scheduled with the sleep MD
and this is where a misunderstanding took place. I thought this is when
the MD would inform me of the results of my tests.

3. A couple of weeks later the MD's office left a message that they had not
heard from me regarding the supplier I chose. I thought they were being
efficient in the follow up but ignored it as I was still researching OSA.
They called again saying I had severe apnea and find a supplier.

4. Met with a supplier and the first thing they did was ask for my prescription
Told them I didn't have one yet as I only wanted information re prices
and to use one on a trial basis. They gave me info but would not give
me a loaner without script.

5. I called the MD's office and was told they would not give the script
directly to me but would only fax it to the supplier. Told them I wanted
to purchase from CPAP.COM and they said they only prescribe in Ontario.
They would not fax script to a Canadian on-line supplier either.

So now I'm not sure what to do. I feel this is my script and should be allowed to buy whatever I want. How can I push this issue?

The MD's nurse told me over the phone I stopped breathing 294 times over 5.5 hours or 53 times per hour. Had 91% oxygen level, snored at 72 decibles and need a setting of 8 on CPAP. Judging by what I have read on this forum I'm not sure how severe this really is.

I am a 58 yr old, 50 pound overweight male with 2 yr old aortic valve replacement and some other minor health problems - lots of pills.

Questions are: will CPAP.COM accept Ontario script? How can I get the script without having the MD fax it to an Ontario supplier. Any other recommendations on a unit/mask? (Muck says PB 420E auto, Spiritus likes Resmed Spirit auto). How are others finding the prices in Ontario?

Thanks for any suggestions.

[wading thru the muck!]

Hi unclebob,

I'm no expert but I would say your OSA is moderate - not severe. Many on the forum would love to have a titrated pressure of only 8cm.

For the money I think the PB420E is the best...$599 USD with software. As far as a nasal mask the Activa is my choice. The Swift is also a great nasal pillow mask.

As far as getting a hold of your prescription, I don't know anything about how the health system works in Canada but my guess is your at the mercy of the Doc since he writes the script. My best advice would be to plead your story to the Doc personally not through a nurse or secretary. Tell him all you need is for him to give you a copy of the script and you'll take care of the rest. Reasure him that you are committed to be compliant with your therapy and you are a member of a support group to help you along with any difficulties. Your honest appeal to him is going to be your best shot unless Rob knows of some Canadian health system end around.

Rob has given excellent info re: importation into Canada. Definately a great reference for all Canadian cpap'ers.

I wish you good luck, don't give up. Your right in your desire to purchase from a supplier of your choice. You only need a prescription for the cpap, not the mask or the hummidifier. Get that and cpap.com with take care of the rest.

Keep at it and let us know if there is anthing else we can do to try to get this accomplished.

[Spiritus]

Hi Uncle,

I suggest you do the following:

1) Get a copy of your sleep study.

2) After getting it, tell your doctor that you're going to go to another sleep doctor/clinic if they won't let you buy where you want to.

3) If they won't play ball, go to another doctor - ensuring first that they will allow you to take your script wherever you want.

4) Buy from cpap.com, however you will need to do one of the following:
a) Ship to a US address if you have a friend or family who live there.
b) Get your own Fedex account. This is very easy to do online at http://www.fedex.ca. And:
i) Be prepared to give cpap.com some sort of deposit to allay their fears of getting stuck with duty/tax/brokerage fees. Apparently they have been burned in the past - this is unfortunate for us Canadians.

Rob

[WillSucceed]

[quote="unclebob"]

5. I called the MD's office and was told they would not give the script
directly to me but would only fax it to the supplier. Told them I wanted
to purchase from CPAP.COM and they said they only prescribe in Ontario.
They would not fax script to a Canadian on-line supplier either.

So now I'm not sure what to do. I feel this is my script and should be allowed to buy whatever I want. How can I push this issue?

This sounds pretty nuts to me. I'd be calling back to your doctors office and telling him/his staff that you want a copy of the script and the sleep study. If they refuse, tell them that you will be complaining to the College of Physicians & Surgeons about their refusal to share YOUR health information with you. I bet they well comply with your request.

[unclebob]

Want to update my progress to date on xPAP acquisition as other Canadians, particularly those from Ontario, might find the info useful.

1. Sleep MD would not give script directly to me and would not fax it outside Ontario. Discussed this with family MD and he convinced me this was OK. His argument was that with the prov govt funding of $780 there was no real savings ordering outside the country on line when all other expenses considered. These included initial shipping costs and future shipping costs for any repairs or maintenance. His second point which really convinced me was that a local supplier would handle any maintenace and provide an immediate loaner if needed.

So, decided to buy from a local supplier - but which one.

2. Sleep Lab gave me a list of 11 suppliers. Most were small outfits with one or two offices in Ontario and not particularly convenient. Chose to approach the 3 largest.

ProResp 16 offices - they screwed up my appt, no one was there and when a tech showed up had no idea I was coming. She did try to be helpful and quoted me on a F&P HC221 with Flexfit 405 mask- cost: $1315 less $780 funding so my portion $535.
Tech never heard of Remstar Auto C-flex and tried to steer me away from Remstar and particularly C-flex as they were prone to breakdown.

VitalAire 20 offices - they are exclusive Resmed dealers and quoted me on the Resmed S7 Elite plus software which then made it the into the Resmed Spirit auto. (They could not supply the actual Spirit) With the Mirage Activa mask price was $2165 less $780 - my cost $1385.

Medigas 28 offices - they are exclusive Respironics dealers and quoted me over the phone the new Auto C-flex with an appropriate Respironics mask for app $2200 (not in writing) so my after funding cost is $1420. Almost went with these people but they were not convenient for me, could not supply the Resmed Activa mask and possibly some delay in getting the unit.

Canadian Home Healthcare 6 offices - they were sort of convenient for me and could supply products from all major manufacturers. Was quoted for Resp Auto C-flex with Resmed Activa mask $2150 less $780 - my cost $1370.
Decided to go with these folks and also took the 2 year extended warranty (will explain later how this works). Total price was $2417.50 less $780 so my price was $1637.50.

My insurance will pay 50% of cost of device to max $1000. Not sure if this is going to be 50% of total cost or cost after govt funding. In any event my final out of pocket will be $637.50 or $818.75.

Now some interesting points:

I was given 3 different invoices when the purchase was done. One sent to the govt, a different one for the ins co and the real one for me.

In Ontario the unit must come with a heated humidifier and 3 year warranty in order to qualify for the funding. With my extended warranty I am then covered for a full 5 years at which time you can buy a new unit with govt funding.

The supplier will not give you the Clinician manual so you are not told how to adjust your pressure level. They set it at the prescribed level for a high setting and you can select your own low setting. My script was 8 so they set it at 6 and 8. I found I could not seem to get enough air at the lower setting (had bronchitis at the time) so thanks to Wading Thru the MuckI now know how to adjust the settings and have set it at 8 and 12. Seems to be working fine for me.

RECOMMENDATIONS

Same as anywhere else - buyer beware! Situation here is just as convoluted as the DME's in USA. The suppliers will sell you what they want for as much as they can get. I found I got a lot more respect and consideration when I went armed with printouts of the equipment as shown on CPAP.com and knew exactly what I wanted. Probably still got ripped off but only they know. Do your research first and be sure to read as many posts as you can on this forum and others. And always remember there is more than one supplier available so do play one off against the other if you can.

In Ontario, buy locally for the govt funding and service for your initial purchase. After that I intend to get a card reader and alternate masks from CPAP.com. (local supplier advised my Activa or Mirage full face would cost $350 - yep, hard to believe).

PERSONAL HEALTH QUESTIONS RE SLEEP STUDY

Was never told results of sleep study until I demaned it. Then all I received were copies of the letters sent to my family MD. It seemed to contain all the normal mumbo jumbo one would expect - REM, delta, PLM-index, arousal index (and my wife wasn't even there, so how do they know), NREM, EKG and SaO2 etc. All this pointing to severe Apnea so lose weight, no booze, no supine and get a CPAP. Pills later if CPAP a no go.

All of this was enough to scare the crap out of the unsuspecting so I guess that's why they don't tell you anything. However one concern I did have was the SaO2 being between 10% and 88% for 46.3 minutes or 14% of total sleep time. The mean was 91.2 %. The 10% figure seems a little too low - any thoughts on this?

Thanks to all posters for your help and especially those who sent private messages and called. In time, with more experience, I hope I can also pitch in.

[wading thru the muck!]

Hi unlcebob,

Thanks for that great update. You post will be very useful for many other people.

One concern I had for you is in regard to the extended warranty. Is this from the manufacturer? If not is it guaranteed by a third party. These extended warranties are usually just a big profit grab for the sellers and often will not pay when the time comes. They often include clauses for required periodic maintenence or other "hoops" you need to jump through to keep the warranty valid. I'd look over the warranty contract with a fine tooth comb.

I hope all works well with your equipment. Great job searching out your best option.