How does insurance handle CPAPs? Selection? Help!

KRomeo · Post by **KRomeo** » Fri Nov 25, 2005 4:05 pm

Hi everyone, this is my first post.

I was diagnosed with Sleep Apnea last week and was told that i stop breathing 100 times per hour. The doctor said it was rather significant.

I am going tonight for another overnight study to get fitted for a cpap machine. My question is, how do I go about obtaining one?

I have Empire Blue Cross/Blue shield.

Do I get to pick the one I want? Do they make me take a paticualar one? Will I be responsible for any of the cost!? please help!

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also,

If i can pick which i want what do u think about:

AutoSet Spirit Auto CPAP + SNAPP mask?

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine

Ramona · Post by **Ramona** » Fri Nov 25, 2005 4:38 pm

They're probably just going to set your pressure during your second sleep study. When your doctor gets the results, he will write a prescription for your machine. Between now and then, do your research, so when you see him, you can talk to him about machines and masks and not feel so totally in the dark. The prescription will go to a DME and they will contact you about the machine and fitting your mask. Some DME's deliver and some don't. Some people like APAP machines, which have a set range of pressures. I have an APAP as a loaner until I have my second sleep study the end of December. It seems to work fine, although I would like to see how a regular CPAP feels. I've heard people complain about difficulty exhaling. I haven't had that problem, but I don't know if that's because I'm using an APAP or if it just doesn't bother me. As for your insurance, they're all different. You'll just need to call them and find out what your plan will pay.

KRomeo · Post by **KRomeo** » Fri Nov 25, 2005 5:10 pm

[quote="Ramona"]They're probably just going to set your pressure during your second sleep study. When your doctor gets the results, he will write a prescription for your machine. Between now and then, do your research, so when you see him, you can talk to him about machines and masks and not feel so totally in the dark. The prescription will go to a DME and they will contact you about the machine and fitting your mask. Some DME's deliver and some don't. Some people like APAP machines, which have a set range of pressures. I have an APAP as a loaner until I have my second sleep study the end of December. It seems to work fine, although I would like to see how a regular CPAP feels. I've heard people complain about difficulty exhaling. I haven't had that problem, but I don't know if that's because I'm using an APAP or if it just doesn't bother me. As for your insurance, they're all different. You'll just need to call them and find out what your plan will pay.

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how do they set my pressure? do i wear a mask tonight?

gar729 · Post by **gar729** » Fri Nov 25, 2005 5:30 pm

Hi and welcome KRomeo, Yes, they will fit you with a mask tonight and test you with either a bipap or apap machine to find out what pressure you need to stop the apneas. It's not fun, but you should be happy that there is relief out there for you. Good Luck.
I didn't have a choice as to which machine I could have. My DME handles one brand and one brand only. But, I've done well on it and can't complain. After one year on therapy I have decided to purchase an auto-pap, which I will buy through cpap.com. I just need to get my sleep Dr. to agree and write me a Rx.
Cpap therapy works, but it's a long term learning process for most of us. Don't give, 100 apneas per hour is more than significant. You should be feeling tons better once it's under control. Don't be afraid to question you Dr. thats what they are there for. This forum is indispensable as a learning tool and moral support.
Best luck
Gary

johnnygoodman · Post by **johnnygoodman** » Fri Nov 25, 2005 6:05 pm

Greetings,

Most likely they will not give you a choice of machine/mask, you may get a humidifier and you will not get the software.

A really good CPAP rig includes this stuff:

1. APAP Machine
2. A High End Mask (with optional cheek pads for mask straps)
3. Humidifier (optional tubing insulation if you experience rainout)

Past that, two big consideratoins are "do I want a travel friendly?" and "do I want it battery powered?".

Read quickly and report what you get handed by your sleep study people.

This board is sponsored by cpap.com. They have a sister website, BillMyInsurance.com that takes BCBS/Empire. The advantage of going with them is that YOU get to choose the equipment you want. APAPs instead of CPAPs, Activas instead of mid range masks, etc.

Once you get equipment from a dealer getting paid via insurance, you are pretty much "locked in" so definately consider that option too before you take delivery of equipment.

Hope this helps. Welcome to cpaptalk!

Johnny

sthnreb · Post by **sthnreb** » Fri Nov 25, 2005 7:17 pm

Hello, if you want the software for the machine, (assuming you get one with a card reader) you can get it ***free*** from Respironics for download, 103 megs:

http://software.respironics.com/cgi-bin ... ge=[Encore]

You can get a card reader for it for $24 plus $6.80 shipping at

http://2factors.com/ You will need the DT3500

A total of $30.80, so, who needs to use the insurance for that?

I paid $199 for an older version of the software! This is a good deal!

Nita · Post by **Nita** » Fri Nov 25, 2005 10:54 pm

I didn't find this place until I already had my machine. My doctor referred me to the DMA she wanted. I went and was put on the Resmed Autospirit first. I loved that machine. They knew about my insurance, and could even tell me what they would pay.

Later I had to turn the autospirit in and they gave me the Resmed S7 Light for purchase. I asked about the Autospirit, but they said my insurance probably wouldn't pay for that one.

They fit you for masks.......but really not. I was sitting up in a chair, trying on masks. That isn't the same as when you are laying in bed.

If you're using your local DMA, they have lots of info. Just learn here, ask the right questions, and get what you want. Good luck.

Ramona · Post by **Ramona** » Sat Nov 26, 2005 1:48 pm

When my DME fitted my mask I was sitting in an electric recliner. When we thought we had a pretty good fit, she reclined the chair until it was as flat as she could get it. Then, since I'm a side sleeper, I turned on my side and tested for leaks. I haven't gone in for my second sleep study yet, all my equipment is on loan. I'm severely claustrophobic, so my pulmonary specialist wrote a prescription for a loaner so I could get used to it before the sleep study. I'll be taking my own mask with me to the sleep study (not until 30 Dec). I've apparently been really lucky so far with a pulmonary specialist who listened to my fears and a DME who was willing to spend time with me to get my mask fitted just right.

Machine

Additional Comments: Resmed AirCurve 10 VAuto BiLevel with HumidAir