Self Adjusting CPAP

[HHNurse]

Hello,

I have been wearing CPAP for a little over 8 years and am still using my original machine. I adjusted it up one time from 8-10 and have used several different masks over the years. I purchased my machine on my own as at the time, my medical linsurance was not in effect. Over the years, my health insurance has paid for replacement masks and tubing. I would like to get a new machine and change to the self adjusting. My current insurance carrier, has never been charged for anything related to CPAP for me and I don't want to have to do another sleep study. I am seeing my internist this Tuesday. Any suggestions for how she needs to write the scrip for what I want?

Thanks

[echo]

Here is a nice post from Slinky outlining what should go into a script:
our-collective-cpap-wisdom/CPAP-machine ... ption.html

IMO, your best bet is to get a data capable APAP. I assume you are referrring to an Auto-CPAP (also called APAP) when you say "self adjusting CPAP).

Now the key is to get one that is data capable, if you truly want to avoid the sleep study. Then you will be able to chart your AHI yourself. You already seem to have plenty of experience using a CPAP so probably you already know that

[cflame1]

What's your DME coverage... will it pay full cost? Or is it a partial payment on your end?

Check your coverage because you may find that you would get a better deal paying for it and then getting your insurance to reimburse some or all of it. If you're getting reimbursed... online places (cpap.com is a good one) will usually just take your original script (for straight CPAP) and will sell you an auto with that script (it never expires online).

You'll want a data capable machine... have you been using some kind of exhalation relief? If so you'll want either the Repironics M-Series CFLEX or AFLEX (newest) or the Resmed S8 Auto Vantage (if you can get series 2 it'll be better).

If you haven't been using exhalation relief get a Sandman Auto or look at a Devilbiss (sp?) as they are now supposed to also have full data capabilities..

[Snoredog]

Your current CPAP pressure you are used to is 10 cm with no exhale relief, so you are probably used to that.

I would suggest the Sandman Auto:

[HHNurse]

According to BC/BS my DME coverage is as follows:

DURABLE MEDICAL EQUIPMENT
Covered at 90%
Institutional – Not Covered
Professional – Pay as In-Network. Subject to In-Network deductible and coinsurance

What's your DME coverage... will it pay full cost? Or is it a partial payment on your end?

Check your coverage because you may find that you would get a better deal paying for it and then getting your insurance to reimburse some or all of it. If you're getting reimbursed... online places (cpap.com is a good one) will usually just take your original script (for straight CPAP) and will sell you an auto with that script (it never expires online).

You'll want a data capable machine... have you been using some kind of exhalation relief? If so you'll want either the Repironics M-Series CFLEX or AFLEX (newest) or the Resmed S8 Auto Vantage (if you can get series 2 it'll be better).

If you haven't been using exhalation relief get a Sandman Auto or look at a Devilbiss (sp?) as they are now supposed to also have full data capabilities..

[cflame1]

The Brick and Mortar DME's will end up with a bill of 2K or more... 90% of $2500 is $2250... which leaves an out of pocket of $250... will your insurance reimburse you at that rate?

If they'll reimburse you... your out of pocket could be less (because your starting figure will be less), though your initial outlay would be higher... you'll have to do the math.

[rested gal]

I am seeing my internist this Tuesday. Any suggestions for how she needs to write the scrip for what I want?

If you know exactly what brand autopap you want and think you might have any problems getting your DME to give you an exact brand, you should have your doctor write out the full name of the machine -- brand, model, and any other words in the name that would require the DME to give you that machine, and that machine only.

Otherwise, all the script needs to say (for example) is:

autopap @ 10 - 15 cm H2O



If you want a heated humidifier also, then the script should say:

autopap @ 10 - 15 cm H2O and heated humidification


Here's a list of the full names of quite a few machines. The DeVilbiss now does have software. I need to edit my list to mention that:
viewtopic/t35685/viewtopic.php?p=307168#p307168