How do you upgrade/buy a new CPAP machine? need new study?

[Vincerama]

Firstly ... Hi! I joined this forum as I stumbled on it looking for options for camping with a machine, and founds some great info, thanks!

Yes, I will enter my cpap specs in my sigline.

A quick question. I have the Respironics M-Series machine. it's not bad, but it's loud. It seems to amplify my breathing. I had the even older Respironics machine before and that gave a steady sound. I actually dislike that the M-series broadcasts my sleep breathing sounds.

Anyway...the only reason I have the m-series now is taht I changed health care providers and got a new sleep study. i was issued a prescription and went and got a machine from the company I was told to get it from.

Now, say I want a new fancy, quieter machine. Do I need to do another sleep study? Would a newer machine be covered by insurance? Yes, I realize that's actually a question I need to ask my insurer...but in general is that something that might be approved ... an occasional upgrade, like a cell phone? Or would I just take my original prescription (I don't know if the expire) and go and buy a CPAP machine out of pocket? If I get stuck with too much Flexible Spending Account money at the end of the year, I might just do that (again, assuming it's an allowable FSA expense).

Thanks! If there is a link, please direct me to it, I've not been on this board too long so i've not explored every nook and cranny!

Vince

Oh, I've been on CPAP for like 10+ years, I think my pressure is 10, or that's what the machine shows when I start it up, it might ramp up, I've not looked if that's the bottom of a ramp.
And as stated, I ahve the M-series Respironics.

[Julie]

Hi - will let others tell you about which machine (most likely Resmed S9 Auto something) but so we can help you more quickly, go to the User Ctl Panel under the logo, then to Profile, and use that to list your machine (can always be changed) by model name, number and anything else identifying, plus the same thing for your mask, and you can add your pressure(s) etc. or anything else in comments. Please use 'text' rather than icons btw, makes it easier to see quickly what you're using.

[LSAT]

As a general rule, insurance companies may replace a CPAP after 5 years. Some companies may require that you show that your current machine is not working properly.

[SleepWellCPAP]

This is an excellent question, one heard quite often for sure.

Succinctly, no, you don't have to have another sleep study in order to obtain replacement PAP equipment through insurance. Your machine has to be over five years old or you have obtained a different insurance. The general requirement is a copy of the original study and a face to face office visit confirming that you're still using and benefitting from equipment and have the Dx OSA. No trial periods required.

That's the general answer. These days Insurances are denying PAP claims left and right for the most ridiculous reasons. The one I like most is when they say "not medically necessary" and here you have enough documentation to write a small book. Trust me, I know what it takes to get that done.

My suggestion Vince, as you've already mentioned, would be to see if a replacement device is a covered item from your FSA. If you're still using a M-series, it's time for an upgrade for sure. Make sure to try the heated tubing if you can.

Jim

[123.Shawn T.W.]

Or ... Craig's List ... That's where I got mine ... But you need to do some research ... As most people don't really know what they have, and you need to figure out what you want ...

Next newer version of what you have is the System One - I'd recommend the Auto cpap with A-Flex (model 550) ... The most recent is also called the System One but adds a "Series 60" ... Model 560 is the Auto cpap version.

[I Like Soup]

I'm very new to the whole CPAP experience. However, I've already had a positive experience with STL Mark here on the board with regards to getting a new machine. Depending on what your insurance covers, it could be a more cost effective way to go about getting something that you want. As an example, the charge for my current Remstar Plus CPAP (System One, the 260?) is $42.73 for 12 months and the heated humidifier portion is $425. A little quick arithmetic will tell you that is right around $938. I bought an auto CPAP A-Flex machine from Mark for about half that.

My insurance makes me eligible for a replacement machine every 3 years. But at those prices, well, I'll be returning my machine this week to the DME.

Good luck!

[Sheriff Buford]

When I started out, I got a Resmed S8 Escape from Praxair on July 22, 2010. As many of us... I realised I was sold a brick. I went back to my doctor, he wrote another prescription, and I received my S9 Autoset (from Apria... who bought out Praxair) on April 19, 2011. My doctor said that I could get a new machine with a good reason. The reason he gave was that he (the doctor) needed a machine that provides data. Worked for me.

Sheriff

[FattyMagoo]

I think this is the norm, but thought I heard some doctors were starting to time limit this.

Just make sure your prescription doesn't have an expiration date.

This is an excellent question, one heard quite often for sure.

Succinctly, no, you don't have to have another sleep study in order to obtain replacement PAP equipment through insurance. Your machine has to be over five years old or you have obtained a different insurance. The general requirement is a copy of the original study and a face to face office visit confirming that you're still using and benefitting from equipment and have the Dx OSA. No trial periods required.

That's the general answer. These days Insurances are denying PAP claims left and right for the most ridiculous reasons. The one I like most is when they say "not medically necessary" and here you have enough documentation to write a small book. Trust me, I know what it takes to get that done.

My suggestion Vince, as you've already mentioned, would be to see if a replacement device is a covered item from your FSA. If you're still using a M-series, it's time for an upgrade for sure. Make sure to try the heated tubing if you can.

Jim

[avi123]

It seems to me that you need a new prescription from someone authorized to write it. Then you could either rent or buy a machine by paying for it from your pockets, from a DME for example. Depending on your diagnosis, if it's an Rx for a plain CPAP you could then ask for a Resmed S9 Autoset costing about $1,000 (with humidifier). If your Rx is for one who suffers from a Central Sleep Apnea Syndrome or a Complex Sleep Apnea then the costs of suitable machines rise into the thousands. In such cases you also have the problem of qualifying for the upgrading time wise .