Newbie with 2 questions

[mags0615]

Hi everyone I am a newbie with two questions.

1. My insurance covered my original sleep study in which I was diagnosed with OA. However, the doctor wanted me to come back and spend the night to do the titration study and my insurance declined it. They said I would just have to do the APAP test at home to figure out my pressure. I did the Resmed S9 Apap for 2 nights with nasal pillows but my nostrils broke out in painful zits (has anyone else had this happen?) so I had to take a few days off until they could get me a nasal mask and then did another 2 night with the nasal mask. I brought the machine back the next day and they called me and told me that my pressure should be set at 10. I was okay with this but then I read somewhere that using an Apap at home to determine Cpap pressure is not a great idea because it is not that accurate. Any thoughts? Also, if the Apap and Cpap are going to cost me the same thing because I haven't met my deductible would it be better just to go with the Apap so I don't have to worry about setting the pressure? Or is the Apap less effective than the Cpap?

2. Also, I am so confused as to the insurance situation. I have BCBS of GA and they are telling me that I have to rent to own it for $101 a month for 10 months. If that is the case what is insurance even paying for because I have found the same machine on line for $600-700. Also, the DME says I have to pay for the tubing, mask and humidifer up front before they will even let me rent the machine. I am just really confused as to what benefit it is to have insurance, what are they covering? Also, the office staff at my sleep doctors office keep saying "oh you don't want to buy your machine online, who will service it?" How does that work if you get one on line?

Thanks for any help or advice you can give me!

Maggie

[Pugsy]

http://maskarrayed.wordpress.com/what-y ... me-part-i/
If you haven't read the above...read it.

Get the APAP machine from the onset...it has 2 modes of operation..straight cpap mode and apap mode...it's like 2 machines in one.
If you get a straight cpap machine...you can't have an auto adjusting (APAP) mode.

There are some people who do better with auto adjusting pressures and some people do better with straight cpap. You have no idea which way you are going to be until you try it and use it for a while.

You have already done the math...it would save you money to buy online (and maybe even more money if you have a deductible that kicks in again in January).

I don't know what "servicing the machine" they think they will do that can't be done by yourself. Mainly it amounts to changing the filters. Should a problem arise online sellers like our forum hose cpap.com have procedures to handle warranty work. Downside is time involved getting the machine back to them and their sending you a replacement machine. Upside to the DME supplying the machine is they will usually have a loaner available more quickly. Failures are rare though.

Software is available that is easy for you to understand the data...see my signature line for links explaining software options and examples. Finding an optimal therapy on your own is not rocket science...just about anyone can do it with just a little instruction.

It is a common practice for the mask, hose and humidifier to be an up front purchase (but insurance normally pays their share of these items) because they typically are considered non returnable items. Insurance companies have all sorts of different plans...some better than others in what they pay for.
You need to check directly with your insurance company to find out exactly how they handle things and don't rely on what the DME might say.
It is common for the blower unit to be a month to month rent to own thing with length of time for the contract varying between insurance companies. Example...Medicare is 13 month rent to own for the blower unit but humidifier, hose and mask are upfront one time purchases but again Medicare will pay their normal share of those items.