Ontario -funding for CPAP/APAP

[WillSucceed]

There has been some change in Ontario's Assistive Devices Program.

It used to be that the selling price of CPAP & APAP were both capped at $1040. with ADP contributing 75% of this. The patient would pay the remaining 25% out of pocket or, if he/she has is, would forward this 25% cost to the private insurance provder. Because the funding cap for CPAP and APAP was the same, the equipment supplier enjoyed less profit when selling an APAP machine to the patient. Needless to say, they resisted selling APAP.

Now, ADP has coded CPAP and APAP separately. The price cap for CPAP remains $1040. while APAP has been increased to $1585. ADP still contributes funding of 75% with the patient picking up the remaining 25%.
Hopefully, the equipment suppliers will be a little less snarly about selling APAP.

The other change, as mentioned in a different thread (if I knew how to do a link, I would give the info) is "individuals with polysomnographically documented OSAS where there is a change in pressure of a minimum of 4 cmH2O on a prescribed fixed CPAP level of 10 cmH2O or more. The change must occur between REM vs. NREM sleep or supine vs. sleeping on their side."

I found this a bit unclear so I spoke with the program manager at ADP who offered some clarity. As an example, if the patient is prescribed a CPAP pressure of 10 cmH2O or more, but only needs this pressure while in REM or on his/her back, AND requires a pressure that is 4 or more increments less when in non-REM or on his/her side, APAP can be funded.

So, as many have suggested on this forum, get a copy of your titration sleep study from your Dr., and/or get very clear answers from your Dr. regarding the pressure that was needed to keep your airway open while in REM sleep and/or on your back versus the pressure needed to keep your airway open while in non-REM sleep and/or on your side. If the pressure difference is 4 or more AND one of the pressures is 10 or more, your Dr. can, and should, prescribe APAP AND the equipment supplier should sell it to you, without hassle, at the ADP capped price of $1585. for a machine, heated humidifier, hose, filters and basic mask. If you want anything other than the basic mask, you will have to pay for it out of pocket.

[sharon1965]

thanks for the info will; here's a link to that discussion

http://tinyurl.com/36outa

[bdp522]

This thread will show you how to post a link;

viewtopic.php?p=29429&highlight=#29429

Brenda

[jabberwock]

I appreciate the information Will. I wonder if someone could get a reduction in the cpap replacement period if they could demonstrate that their needs had changed in less than five years and now need an apap ??

You must be a very important person if you managed to talk to a live person who actually knew what he was talking about

Bonnie

[m1k2s3]

What about replacements? Do you know how often you can replace your machine or mask and have part of the costs covered by the ministry?

[sharon1965]

i thought the ministry only paid for the basic setup and basic mask that comes with it...my interface 'upgrade' was covered by greenshield through my husband's employer