Newly Diagnosed

[macmermaid]

Hello,

I was diagnosed three weeks ago with Sleep Apnea (AHI 22). My husband has had a CPAP for 10 years now. When he was diagnosed, I did all the research and became his support person, so I was pretty up to speed and educated by this board. I have become a bit foggy since them (perhaps lack of sleep?). So coming back here to get some support.

I have asked my doctor for the ResMed APAP, and he says that is what the prescription has been written for. The weird thing is that it has taken forever. It will be three weeks tomorrow since the sleep study. Granted, we tried to get authorization for dental device first, which took a week and a half, and then failed, but it feels like they dropped the ball.

I called them a few days ago and left a message asking if they had contacted the DME yet (they are closed Mon and Fri and never answer the phone). They took two days to call back, and had JUST forwarded my prescription to their DME choice, CPAP Services in San Jose. They said that the DME will come to me, however, that may limit my options to consider for a mask. So I had asked them to find a DME close by to me and they did not. It is about 1 1/2 hours away. I live near Oakland, so I imagine there is a DME closer by.

Here are my questions (thanks in advance):
1. How many options will I have for a mask? I am going to start with the nasal mask, and I want it to be Res Med, so how many more options would I have if I were to drive 1.5 hours to their offices?

2. Is normal for them not to give me a copy of the prescription? I asked.

3. Do I have to go to the DME that they send me to?

4. Will I be responsible to pay for the visit if they come to me, even if I do not decide to buy the equipment from them?

5. I have Anthem Blue Cross. Does anybody have any experience with them on this? I am planning on giving them a call, but any tips on how to have the conversation with them (what should I ask them), would be greatly appreciated.

6. If I take my sleep study to my primary care doctor, can she write a CPAP prescription for me, or does it have to come from a "sleep doctor"? BTW, my "sleep doctor" is a psychiatrist. Is that normal? I only went to him because he is my husband's doctor. My husband went to him because it is near where he works.

Thanks!

[Okie bipap]

1. How many options will I have for a mask? I am going to start with the nasal mask, and I want it to be Res Med, so how many more options would I have if I were to drive 1.5 hours to their offices?

You have as many options as your DME carries, or is willing to special order. Smaller companies usually have less masks on hand.

2. Is normal for them not to give me a copy of the prescription? I asked.

You are entitled to a copy of your prescription. Federal HIPA rules say you can have complete access to your medical records including your prescriptions. Get a copy of your prescription so you can purchase items from other places if you want to.

3. Do I have to go to the DME that they send me to?

No Contact your insurance company and get a list of DMEs they do business with. Also ask them if they will reimburse you if you purchase yout equipment your self.

4. Will I be responsible to pay for the visit if they come to me, even if I do not decide to buy the equipment from them?

You will need to ask the DME that question. If you do not purchase from them, they may charge you for the technician's time and mileage.

6. If I take my sleep study to my primary care doctor, can she write a CPAP prescription for me, or does it have to come from a "sleep doctor"? BTW, my "sleep doctor" is a psychiatrist. Is that normal? I only went to him because he is my husband's doctor. My husband went to him because it is near where he works.

Any medical provider authorized to write prescriptions can write a prescription for your machine and equipment.

[chunkyfrog]

"Any medical provider authorized to write prescriptions can write a prescription for your machine and equipment."
---But some may not.
Ask nice, and point out that you need it in case of breakdown when you are traveling.

[D.H.]

I know that here in New York, prescription rules are more stringent than anywhere else (at least in the US). However, I don't think that CPAP machines or accessories are affected.

As far as I know, you can use any DME on your insurance.

[D.H.]

The OP has an atypical situation. She was quite knowledgeable about Sleep Apnea and CPAP due to a spouse who has been using CPAP for some time.

Therefore, I presume that she recognized her own symptoms at a much earlier stage than most of us. Also, she has a good example of a compliant patient with whom she lives.

[macmermaid]

I finally got the prescription. I am wondering if I can just order the machine from CPAP.com. I'm going to call my insurance company. I'll let everybody know how that goes.

[jamesbond007]

I am in a similar boat as you are. I live in the SF Bay Area too. There is a good DME in San Leandro (Close to you. Just a few miles south on 880) called Timberlake. Could you try talking to them? I have heard good reviews and my doctor's office highly recommended them because their patients love Timberlake. Timberlake called me and they had the equipment ready in 2 days. They invited me to their office so they could walk me through. They were very responsive and caring. OTOH, I had to go through Cigna and they set me up with Apria and dealing with them has been a PITA. They received everything they need to process the order last Friday and still no call from them. It apparently takes 7 to 10 business days. They said they'd ship the device and I have to set it up myself? You probably don't mind that option as you are already aware of setting this up. YMMV, but worth a try.

[macmermaid]

So I called the insurance company, and they said if the machine I bought online was $1,000 or less, it would be covered. I asked if that as the all-in price including the mask and other accessories and the agent didn't know!

Having still not even heard from the DME that I was referred to by my doctor, I took the plunge and called CPAP.com and ordered the Airsense 10 for her, a gel pillow mask (respironics), heated hose and some replacement filters. The total was $!,026. I had to email them my prescription, but that was easy, I just took a pic of it on my phone and then sent to their email address. While I was still on the phone, they set the machine up with the prescribed titration, and put it in Fed Ex, so I should have it tomorrow. Very impressive. They also sent me a link which had another link to a "superbill" insurance claim form and a formal itemized receipt and an instruction sheet with some good tips, including to include a copy of the sleep study in the claim.

I realized I had no idea how to submit an insurance claim. I went to my Anthem Blue Cross online account, and could not find a button anywhere "submit claim". So I called them, and long story short, I am mailing my claim including: the ABC form filled out with my signature, the docs from CPAP.com (superbill, itemized receipt), prescription and copy of sleep study.

I will probably be back here tomorrow, when I unpack the machine and try to figure out how to put pillows in my nose.

Thanks everybody for the support.

[Sheriff Buford]

Cpap.com is a great place to do bitness'. I'm not sayin this because they sponsor this site. They are knowledgeable, nice, easy to work with and you get your stuff fast.

Sheriff

[macmermaid]

LOL, I did not realize this site was sponsored by CPAP.com. I think they owe me a discount or something!

[palerider]

LOL, I did not realize this site was sponsored by CPAP.com. I think they owe me a discount or something!

Compare their prices to your local some, and then figure the "discount"