Newbie looking for help on first Auto CPAP

[Lemmy]

Hello everyone, I've recently been diagnosed with sleep apnea. My doctor has recommended an auto CPAP. I wanted to join the forum and introduce myself in hopes of making the most of this new life adjustment.

I've had some degree of apnea all of my life, but as I've gotten older it's gotten worse. When I was young, I didn't really know this wasn't normal, so it was just a basic part of life. As I've gotten older I rarely wake up feeling rested and like most, my energy to just power through the day has slowly dropped off with age. I decided I just can't take being tired all the time anymore and it's time to make a change, which will hopefully have a positive impact on my life. After my second sleep study (the first take-home test was inconclusive), I was able to get a better idea of how severe my particular problem is. This is all new to me, so I'm trying to learn as much as I can from others and through educational videos and websites. I thought coming to the forum and talking directly with others who have experience in this area would be a great way to learn more.

I typically like to research things before buying to ensure I am buying a quality product from a reputable company. I was hoping that some of you could tell me about your own experiences finding a machine and dealing with insurance.

The doctor's office has referred me to a local company here in Columbus, Ohio, called OhioHealth at Home. They have said that I would receive a Resmed Airsense 10. Today I spoke with them regarding the machine. They said with my current insurance the cost would for CPAP rental to be $180 for the setup (including supplies) and $87 per month after. The rental period is for 10 months. They also said that my insurance does require that you meet compliance (using on average 4 hours per night) during the first 3 months in order to continue the rest of the rental period. I was told that after the rental period, I would own the machine.

The company, OhioHealth at Home, has a lot of negative reviews online. The office worker who referred me to them from the doctor's office said they were their preferred provider of equipment and would definitely recommend them over others in the area. The poor reviews mostly mention problems with service and pricing, and customers feeling that had been taken advantage of.

There is another retailer in my area called C-PAP Central that seems to have a number of positive reviews. I wondered if there are any forum members in my area who have experience with either of these companies or others in the area? Also if forum members have other recommendations for reputable sellers online?

It seems that most of the online retailers advertise why it is often better to buy a unit yourself rather than going through insurance. I'm sure some of them have a vested interest in this method, but the primary positives they mention are data privacy, choosing your own machine, and no fear of it being taken due to lack of usage by your insurance company.

I was hoping to hear more about this process from other CPAP users. Have any of you found that buying your own machines has been better or worse than going through insurance? It seems like the price that I am paying just in the monthly rental fee alone would be enough to purchase the machine through several online companies (The Resmed Airsense 10 by itself seems to be available around $500 online).


Thank you for taking the time to read this. I appreciate any guidance or personal experience shared.

[rdfry]

Wow, that pricing is outrageous. No way should you should be paying that much if you have insurance.

[Okie bipap]

The cost of the rental is more than buying the equipment out right. Get a copy of your prescription and send it to the forum sponsor, cpap.com
Right now both Respironics and ResMed machines are reduced because of the release of new machines. The older models are both good and much cheaper than what they want to charge you through your insurance.

[zonker]

The cost of the rental is more than buying the equipment out right. Get a copy of your prescription and send it to the forum sponsor, cpap.com
Right now both Respironics and ResMed machines are reduced because of the release of new machines. The older models are both good and much cheaper than what they want to charge you through your insurance.

+1

[clownbell]

Among the current generation of machines, I believe the machine usually preferred by the experts here is the ResMed AirSense 10 Autoset, which is an APAP machine. I got mine from Kaiser. They did not offer a choice of rental vs purchase. They said purchase was better for patients. I made a one time payment of $223 for the machine (Medicare paid the rest) and initial supplies including F20 full-face mask, N20 nasal mask, air tubing, and carrying bag. I am very happy with the machine and with the price.

[Pugsy]

I got mine from Kaiser. They did not offer a choice of rental vs purchase. They said purchase was better for patients. I made a one time payment of $223 for the machine (Medicare paid the rest) and initial supplies including F20 full-face mask, N20 nasal mask, air tubing, and carrying bag. I am very happy with the machine and with the price.

Kaiser is a different animal and yeah good deal for you but what the OP is looking at isn't such a good deal. Comparing Kaiser to the rest of the companies doesn't compare well. They do things a lot differently.

To OP.....

180 bucks up front plus 87 a month for 10 months (870) is a lot more than what the machine can be found online for at this time.
At this point OP didn't mention what his/her insurance was but I assume not Medicare because Medicare has a 13 month rent to own and not 10 months. Also the 10 month deal will very likely involve another deductible (if the person has to meet a deductible) this coming January that they may not realize before the insurance will pay the remaining monthly expense.

I always tell people to check with their insurance company directly and never rely on the DME (equipment supplier) to know the ins and outs of all insurance plans and then do the math as to which is a better deal for them from a money perspective.
Not everyone has the funds for a big purchase up front to go buy the machine themselves even if it is a better deal.
Sometimes the monthly way is all they can afford to do.

Do the math...factor in any new deductibles next January if applicable...check your wallet to see if you can afford an up front purchase...check with insurance company directly and then decide which way is more suited to your particular needs.

[Miss Emerita]

At the moment, you can get a ResMed Airsense 10 Autoset, brand new, for $598.00. Get your prescription and shop on line.

[ChicagoGranny]

They said with my current insurance the cost would for CPAP rental to be $180 for the setup (including supplies) and $87 per month after. The rental period is for 10 months.

The price is too high. Talk to your insurance company about this price. Ask them for a referral to a network provider near you.

They also said that my insurance does require that you meet compliance (using on average 4 hours per night) during the first 3 months in order to continue the rest of the rental period.

This sounds suspicious. Like, maybe, they want you to pay for everything and save themselves the trouble of filing with your insurance company.

They have said that I would receive a Resmed Airsense 10

You want a ResMed AirSense 10 AutoSet!

[ChicagoGranny]

Have any of you found that buying your own machines has been better or worse than going through insurance?

Buying from a local brick & mortar DME using my insurance benefit has been cheaper than buying from an internet DME. There have also been some service advantages from having a local DME. I did buy a used machine from an internet DME because I wanted a backup machine. Of course, insurance companies offer no benefit for backup machines.

[Lemmy]

Thank you everyone for your replies. I thought that the pricing they were offering seemed absurdly high. I’m glad I asked. I believe the Resmed Airsense 10 Autoset was the unit they were talking about giving me.

My insurance is through Anthem. I’ll check with my insurance company and about a DME. I see what local options there are to compare with online options. I’m not “made of money” by any means, but $600 to help resolve what has been a lifelong challenge for me certainly seems like money well spent. It’s definitely less than what I thought these machines cost (I thought they were more like $3k before I started looking).

Do any of you have strong opinions about the data from the machine being used by the insurance company? Or the insurance company’s ability to take the machine based on usage? I don’t know much about this yet, but I think that struck me as a bit odd. I’ve never heard of that with another piece of medical equipment, though I’m sure it happens.


I have a few questions that perhaps some of you could help me with based on your personal experiences. I have never worn a CPAP before so I don’t really know what to expect.


1. I have a medium beard. How much is a mask’s effectiveness is affected by facial hair? Does it prevent a proper seal? Can you wear a mask effectively with one?

2. I often have a slightly stuffy nose due to allergies and a deviated septum, so I believe I often end up sleeping with my mouth open. Have any of you found that a nasal mask allows you to overcome something like this due to the pressure and/or the humidifier?

3. What supplies are essential and should I make sure I have to get started? (E.g., Cleaning supplies, filters, extra parts, etc)

4. I’m sure masks come down to fit and personal preference, but are there any pointers you can offer regarding finding a good mask? Are there any popular models?




Thank you all for responding. It’s very kind of you and I truly appreciate your help and guidance.

[GrumpyHere]

Thank you everyone for your replies. I thought that the pricing they were offering seemed absurdly high. I’m glad I asked. I believe the Resmed Airsense 10 Autoset was the unit they were talking about giving me.

Make sure you specify exactly what you want. And you want the ”Autoset for Her” with the extra algo. They will try to screw you every which way.

/Rant On/
I just found out last night that my uncle was diagnosed with sleep apnea a year ago. Cardiologist treating his AFib asked him to take a sleep test.

His DME gave him the AirSense 10 CPAP brick which isn't compatible with OSCAR.

He isn't compliant ... He was an engineer, I am sure with feedback from OSCAR he would had been compliant.

This model shouldn't even exist now days.
/Rant Off/

[Julie]

Having beards has been a problem for many men but it comes down to finding the right mask (which I can't advise on), so hopefully one or two will show up to help there.

If you can afford it, it's best to buy your own machine and so avoid some of the games dealers and insce. co's play... just be sure of what you want. Cpap.com (in Tx) sponsors this forum and are good to deal with, but so is e.g. Secondwindcpap.com where you can get new or refurb'd machines etc. without a script (but check on that plse if I'm wrong) and service is great.

[Pugsy]

Most insurance adopt the criteria that Medicare uses for meeting "compliance". I don't know Anthem's requirements but I do know Medicare's and I suspect Anthem's will be similar. You need to check with Anthem to be sure though.

Medicare's requirement so that they will continue to pay for the machine and masks...
Patient has 90 days to complete a 30 day block of therapy nights where they use the machine for at least 4 hours a night and 70% of the 30 nights. So 21 nights out of a 30 consecutive block of nights the machine is used for at least 4 hours.
That's all that is required. Some people can meet that 30 consecutive night block within first month and others might take longer just because they can't sleep so great with all this new stuff on their face and head.
Medicare also has an additional requirement of the patient having a face to face with the doctor prior to 91 days after starting cpap.
Telemed visit does count. All it means is the doctor says you are using the machine and it is helping.

So there is some wiggle room there to meet criteria for the insurance to keep paying for the equipment.
Exact specifics you need to get directly from your insurance company you need to get from them but it is going to be close to Medicare's criteria.

Also if a person has maybe some unusual difficulties getting that 70% of the 30 days usage....usually an application for an extension of time is available as well. So usually every effort is made to help the patient keep the machine.

Insurance companies only care that you use the machine the minimum number of hours. They don't care about anything else.
They don't even care that the settings are optimal or if you change them. They don't monitor anything but hours of use.

1. I have a medium beard. How much is a mask’s effectiveness is affected by facial hair? Does it prevent a proper seal? Can you wear a mask effectively with one?

Depends on the mask and the beard. There are people with full Santa Clause beards using full face masks successfully.....but it is a challenge for most. The full face masks will present the greatest challenges because of the surface area of the mask cushion needing to be kept sealed.
The easiest to be kept sealed with facial hair....the nasal pillow masks. Minimal mask area touching any hair.

2. I often have a slightly stuffy nose due to allergies and a deviated septum, so I believe I often end up sleeping with my mouth open. Have any of you found that a nasal mask allows you to overcome something like this due to the pressure and/or the humidifier?

The added moisture might help and it might now. Some people find that it does help keep the nose more clear and some people find that added moisture can cause more congestion. This is highly individual and just something you have to sort out.
BUT....sometimes people think they are mouth breathers because of the mouth breathing from gasping for breaths due to the apnea events and once the apnea is better controlled they no longer mouth breath.

3. What supplies are essential and should I make sure I have to get started? (E.g., Cleaning supplies, filters, extra parts, etc)

You don't need any special cleaning supplies. Soap and hot water is all you need unless you are a serious germophobe...and if you are we have some hints for you. Most of us use plain old dish soap/hand soap to clean our equipment. Dawn works great.
You will eventually want at least one spare of everything but for starting out don't worry about spares especially mask part spares until you figure out what mask you prefer.

Filters...you want a couple of spares and how long they last will depend on where you live. I live out in the country where it is dusty and my house is probably 70 years old...so lots of dust. I change the filter once a month.
I have a friend who lives in a newer house in the city who changes the filter once every 6 months and it's not real dirty even after 6 months.

Start with the basics and go from there depending on what your needs/wants are.

[ChicagoGranny]

Do any of you have strong opinions about the data from the machine being used by the insurance company? Or the insurance company’s ability to take the machine based on usage? I don’t know much about this yet, but I think that struck me as a bit odd. I’ve never heard of that with another piece of medical equipment, though I’m sure it happens.

All the insurance companies are interested in is hours of usage to meet the requirements. This isn't odd because many, many people "try" a CPAP one night and put it in the closet. This behavior drives up insurance premiums for all of us. Use the machine or return it right away. Don't waste the planet's resources. Return the machine and wait for a heart attack, a stroke and type 2 diabetes.

1. I have a medium beard. How much is a mask’s effectiveness is affected by facial hair? Does it prevent a proper seal? Can you wear a mask effectively with one?

Some do, some don't. You can only know through trial and error (and OSCAR).

2. I often have a slightly stuffy nose due to allergies and a deviated septum, so I believe I often end up sleeping with my mouth open. Have any of you found that a nasal mask allows you to overcome something like this due to the pressure and/or the humidifier?

Some can, some can't. You won't know until you try.

Why live with a deviated septum? It's unhealthy. Today's surgical methods are very good and easy on the patient. Mouth breathing is not nearly as healthy as nasal breathing - day or night. Correction of a deviated septum can also make it easier to use CPAP. Schedule a consultation and examination of the airway with an ENT. Discuss with her your apnea diagnosis.

3. What supplies are essential and should I make sure I have to get started? (E.g., Cleaning supplies, filters, extra parts, etc)

Add distilled water for the humidifier although tap water is also acceptable. Cleaning supplies? I wipe down the mask each morning with an alcohol swab (little ones than diabetics use). Occasionally, I will wash the whole mask in Dawn dish detergent. The hose doesn't need cleaning. Machine - just an occasional dustoff. SoClean - No! It's a scam

4. I’m sure masks come down to fit and personal preference, but are there any pointers you can offer regarding finding a good mask? Are there any popular models?

Go to cpap.com, find the masks and sort on most popular. Look at the photos, specs and star ratings. Start out with one of the most popular than seems to appeal to you. You might want to start with a nasal mask. If you can keep your mouth closed, you will prefer a nasal mask. Keep money in the budget for a full face mask.

Don't worry about the "For Her" feature. Very few users find it of value over the standard auto feature.

Until you get going, try to avoid backsleeping. OSA is usually worse on the back because gravity is pulling the tongue and soft palate directly into the airway. This effect is often mitigated by side or stomach sleeping. However, with a properly operating CPAP, backsleeping is OK.

As you move along, stick to this one thread so those helping you can easily see the history.

Call the ENT's appointment desk Monday.

Welcome!

[chunkyfrog]

The finer filters (hypoallergenic) fill up faster.
I replace mine at 3 weeks, when they look slightly grubby.