I'm feeling a bit overwhelmed now that i have insurance

[firefoxsilver9]

Hello All,

To start off, I was diagnosise with Sleep Apnea in November of last year after a sleep study and started CPAP therapy shortly after. I was 'uninsured' at the time (I had work insurance, but it was a joke so basically uninsured). I bought a used CPAP machine on Secondwind and bought masks and supplies on cpap.com. After a few months of experimenting with mask after mask and not really getting any of the results i would have liked (I still feel the affects of poor sleep) I recently got a new job with much better insurance (United Health Care). My employer has a plan that has no pre-existing conditions with UHC so they will now cover CPAP equipment and supplies with a $300 deductible and $600 out of pocket maximum.

What's starting to overwhelm me is not knowing where to go from here. I have to choose a DME, which i'm not sure what i should be looking for in one (Apria and Lincare are 2 that my insurance covers). I also don't know if I have to pay upfront for my equipment and supplies or if i can be billed monthly for my purchase for my portion (If i do i'll have to save up money first). I'm a young guy who really doesn't understand much about health insurance so i think my first step is to call my UHC again with my additional questions but if anyone has any suggestions or advice i'd really appreciate it very much.

[Pugsy]

What sort of supplies are you planning on wanting to purchase from the DME?
You might want to go ahead a read this.
http://maskarrayed.wordpress.com/what-y ... me-part-i/

Your insurance will pay their portion after you have met your deductible in allowable charges.
The DME may or may not ask for whatever you are going to be paying up front or they may elect to bill you.
You will need to verify that with whichever DME you choose to use.
Some will wait and some will figure up your out of pocket expenses when they call up to verify insurance coverage and expect that amount at the time you pick up the equipment.

[firefoxsilver9]

What sort of supplies are you planning on wanting to purchase from the DME?
You might want to go ahead a read this.
http://maskarrayed.wordpress.com/what-y ... me-part-i/

Your insurance will pay their portion after you have met your deductible in allowable charges.
The DME may or may not ask for whatever you are going to be paying up front or they may elect to bill you.
You will need to verify that with whichever DME you choose to use.
Some will wait and some will figure up your out of pocket expenses when they call up to verify insurance coverage and expect that amount at the time you pick up the equipment.

Thank you! I was planning on getting a new machine with humidifier, mask and possibly some other supplies if needed.

[Pugsy]

Thought you might be going to stock up and get a new machine also.
Be sure and read this also...so that you get a machine that offers full data that is easy to access.
Of course your S8 offers full data but you need that smart card reader. These new machines use a SD card and there is no need for special card readers.
Make sure you get a full data machine. The DME might still try to give you a brick.
http://maskarrayed.wordpress.com/

[firefoxsilver9]

OK so i called and spoke with reps from my insurance carrier and Apria today. They were both very helpful with my questions. The lady from Apria stated that I could get the ResMed Auto S9 machine (which i want) but its best to have my Dr. modify my prescription with the specific model name so they won't try and give me a machine that i don't want. Now i called my Dr.'s office to get this changed however they want me to come in for a visit in order to do so. I was planning on making an appointment for a annual checkup anyways but i wish they would have just modified the prescription without the visit. We got this hurricane coming at us soon so next week is probably best.

[ChicagoGranny]

The lady from Apria stated that I could get the ResMed Auto S9 machine (which i want)

Be very, very careful with the name. What you want is the ResMed S9 AutoSet !

Have a look at the exact model names - http://www.resmed.com/us/products/s9_se ... c=patients

It is very tricky. Don't fall for the ResMed S9 Escape Auto - it does not record the efficacy data on a card that can be used with the software.

[firefoxsilver9]

The lady from Apria stated that I could get the ResMed Auto S9 machine (which i want)

Be very, very careful with the name. What you want is the ResMed S9 AutoSet !

Have a look at the exact model names - http://www.resmed.com/us/products/s9_se ... c=patients

It is very tricky. Don't fall for the ResMed S9 Escape Auto - it does not record the efficacy data on a card that can be used with the software.

yes thats what i meant. i made sure that's the model i was referring to when i spoke with her.

[chunkyfrog]

Just make sure that's the machine THEY are talking about!
See what I have--just click on the highlighted text that says ResMed S9 Autoset.
Avoid anything that has 'escape' in its name.
You may need your doctor to write the prescription for the specific machine and a RANGE of pressures.
The RX should also say, 'Patient must have access to full efficacy data' .
Then you look carefully at all the labels on the machine before you accept it.

[archangle]

Some DMEs (or doctors) confuse "Escape Auto" with "AutoSet."

Some DMEs do this honestly, some will deliberately lie to you about it. All S9 machines have the model name next to the power button.

[firefoxsilver9]

i probably already know the answer to this but should i wait to get my prescription modified to list the Resmed Autoset S9 before going through Apria to order it or do you think it should be fine as long as i make sure they get that machine for me? i hate i have to setup a Dr's appointment to do so as i'll have to take off work and use a few hours on my sick leave next month as i got other stuff to take care of and my leave balance at work isn't that much since i started working there 2 months ago.

[mary1898]

My husband just got that same machine (I'm not a CPAP user). I've worked in healthcare for a number of years so I take care of all of his insurance issues, dealing with doctors, etc. He didn't have a prescription for that specific machine but I told the DME supplier what the doc said she wanted & that's the one they got us. I did have to have the doctor's office fax both the prescription & the sleep study. This machine is working great for my husband & is much better than his old one.

[firefoxsilver9]

I have my appointment with my physician on Friday for the new prescription. Is there anything specific i should tell him other than which specific machine to list on the prescription like the model number or product code etc.? I would also like to get the humidifier and the climateline tubing that comes with the S9 AutoSet. Does he have to list that on the prescription as well?

[BoomersRock]

You need to have them specify the humidifier and Climateline hose in the prescription. I had to go through this recently myself also. They need specifics otherwise they will give you what the ins co says ( or they want).

[ChicagoGranny]

You seem to be doing it backwards.

I would go to the DME with the script you already have and demand what you want. You may well get it and be able to avoid an extra trip to the doc.

If they try to give you the wrong thing leave it sitting on the counter and walk out. If Apria says the doc has to write it on the script then you can go to the doc on Friday. (In which case the doc may still screw it up.)

Are you meek? Time to learn to kick ass for what is rightfully yours!

[firefoxsilver9]

You seem to be doing it backwards.

I would go to the DME with the script you already have and demand what you want. You may well get it and be able to avoid an extra trip to the doc.

If they try to give you the wrong thing leave it sitting on the counter and walk out. If Apria says the doc has to write it on the script then you can go to the doc on Friday. (In which case the doc may still screw it up.)

Are you meek? Time to learn to kick ass for what is rightfully yours!

My insurance is demanding a newer prescription since its almost a year old so i have to go to get it updated.