Another newbie from Canadia

[hopper]

First off I'd like to say what a wonderful forum this is. Its just jammed full ultra-supportive people with really useful information.

I've been diagnosed with 'moderate' apnea....still trying to figure out what that means. All i know is my wife complains of me periodically stopping breathing and then finally gasping for air...and i often don't feel well-rested.

Anyway, i did the overnite titration study, had my follow-up appointment (all of 2 minutes long) and walked out with a script for a 1 month trial on CPAP, pressure level 10. The sleep clinic referred me to a local supplier that specializes in OSD (directly across the street), so i went in there and walked out with a loaner of a Resmed S8 Elite II and the basic trimmings. I had a lot of catching up to do on OSD and i quickly realized that getting adequate treatment can be an uphill battle. I was determined to keep an open mind and a positive attitude. However things have not gone very smoothly. I have tried 4 different masks, finally settling on the Swift LT with chinstrap as the least uncomfortable But i just can't get used to the pressure. Most nights i only make it 2 to 3 hours before i rip the thing off my face and try to get back to sleep (i've tried, but failed, to do the ramp-up again). I also toss and turn a bit, which causes the mask to shift and air inevitably leaks, usually waking me up. And several nights i have swallowed copious amounts of air ...and wake up feeling like a blowfish.

But i have persisted, and after getting the mask thing settled, i have progressed little by little. Now i usually make it 4 hrs and once i made it 5 whole hours.
Then, somewhat out of the blue, the DME leaves me a message that they are going to charge my credit card at the end of the day for the equipment that i have been using. Fortunately i got the message and was able to put the brakes on that! To tell the truth, i was pretty miffed about their new, ultra-pushy, attitude and i told them so (and got an apology). I asked them about trying (rent if necessary) an APAP machine and they told me that i could not without a prescription. So off to the sleep doc again, fortunately i was able to convince him to write me a script for an APAP, and i swapped machines for a Autoset II that afternoon....which is where i am at right now.

The DME told me that i could try the APAP for a few days, but after that i had to make a decision and buy one or the other.

I've pretty much already decided on the APAP before knowing if it works any better for me, due to its added flexibility and well as the data capabilities. The problem is, i think i'm being hosed.
The quoted price for the S8 Elite with H3i heated humidifier is $1040 which qualifies for the $780 ADP discount (so $260 for me), but their price for the Autoset II with the same humidifier is $2038. They told me that ADP still only covers $780 which means $1258 for me. (they're also asking for $300 for the Swift LT).
Firstly do these prices seem reasonable?
The Autoset II is currently listed at $995 USD on one popular on-line retailer.
Should the APAP be double the price of the comparable CPAP?

Is it true that ADP only covers the first $780 of the APAP? According to their website, they cover 75% of the cost which would be $1528.50. Furthermore, ADP's list of qualified devices states that the maximum price that a vendor can charge for the Autoset II is $1585 (the S8 Elite is already at the allowable max of $1040)

Doesn't this all sound a little fishy?

Are they just out to get my money and are hoping that i will just pay whatever they ask?

How do these prices compare to what others have experienced in Canada?

I have found some other Resmed suppliers in Ontario (no thanks to ADP who apparently have a list of registered vendors but don't make it available on their website) and I'm going to do some calling around tomorrow.

I'm frustrated and i feel like i am being forced into making a decision on a machine before i am fully ready. I do not appreciate the vendor's pushy nature but i feel trapped. If i walk away they will most likely try to stick me with rental fees, though the trial period was supposed to be just that, a trial, not a rental.

grrrrrrr

[Mtnviewer]

5 years ago I too felt pushed into a corner by the only supplier at the time in the closest city (270 kms one way) to my rural area here in B.C. (and who only carried one brand of machine & few masks which you had to buy to try), and because of them and their horrible prices, attitude and poor service (and not knowing about this forum to learn from) I did give up on CPAP and only recently started PAP therapy again, but now completely on my own (after 2 sleep studies in those years). I also couldn't afford the high prices of several DME's that I've researched the last 8 months. in several even more distant cities, nor did I like their limited choices. One DME's seemed nice and promising but was just too far away to be workable. Being self employed I don't have group health insurance to help pay for any of it.

Then I came across this forum and learned of CPAP.com and other online suppliers and CPAPauction.com. I ended up being patient and after much reading and learning what I thought would work for me, using the tools on CPAP.com, such as videos, user reviews and measuring info for masks, I opted to look for equipment on cpapauction.com and in very short order got most of what I needed, either brand new or very lightly used, FAR below what I would pay here in Canada from a DME. The few missing items from cpapauction I bought from cpap.com (but with a few glitches & a loooonnnngggg delay, which I think was a one off mistake on their part). It sounds like for a nearly new APAP machine (25 hrs on it) and a brand new ff mask, that I paid what your portion would be outside of insurance and I was in control. The extras that I bought new were software, a data reader, a soft hose cover and an extra light 6 foot hose, (both which I recommend as I don't even know this ultra light hose is even there, but I do notice the weight of the normal and non covered hose).

While it's great to get on to PAP therapy, IMO don't rush into it, do your homework and maybe tell them that you can take your business elsewhere if they keep rushing you. Knowing that you can and that there are many options out there, can give you strength. If you have to use them, then realize they want your money and that even with insurance paying, you control where you want to spend it. Unless your situation is grave, finding the right supplier shouldn't delay your PAP therapy much.

A starting pressure of 10 for me would be very tough to get used to immediately. I use an APAP machine and do hit 10 occassionally, but when I've tried to just stay at 10-11, it's been tough for me and I've found that at these higher pressures that my mask leaks more or needs to be on very tight, both of which are also hard for me to get used to, though I would force myself to get used to sooner than later, if I needed the higher pressures all the time. With APAP, I'm moving from 6-10 very comfortably and I don't notice it during sleep. As for APAP, I'm beginning to wonder how APAP can keep up with "events", and from the data I'm looking at, it seems that APAP is reactionary to Apneas than really preventative. I'm sure that it does prevent some apneas, but maybe not as many as needed or as one would think/hope. Still, with APAP I'm more easily getting used to the pressure and also feeling better more days than not and sleeping more and more. I also found that I was losing sleep by starting at and trying to stay at higher pressures, than by working up to it. Over time and when 9-10 feels like a soft breeze as it does to long time users, I may switch to CPAP mode to try and prevent more events with one pressure setting than I'm thinking that APAP can at 6-10? Others with more experience may have more accurate advice.

Good luck.

Correction re: APAP: Via cpapauction.com I paid A LOT less than your portion of insurance for an APAP, but maybe closer to what your portion would be for CPAP. I had written that I paid near the same (which for your APAP seems to be over $1,000 correct?). I did not pay near that much. The prices that you show from the DME are obscene IMO. For my 25 hr. Sandman Auto APAP & a brand new Quattro FF Mask, I paid $459.43 CDN including shipping for both (but seperate auctions). That's a HUGE difference in price and no DME, no hassles, no pushy sales person, no greedy company inflating prices. You have options to go elsewhere, even if you pay out of pocket, so perhaps shop around and or negotiate with them. Personally I'd tell them that their prices are too high, their service is poor and I'd go elsewhere, and even with insurance, I'd take the route that I did, get what I want, not what they want me to have and like you'll find with PAP therapy, it's necessarry to take control of YOUR needs and PAP Therapy as no one else will. Which is why many folks are here, because the medical system isn't doing a great job for us and probably can't.

[One Tired Puppy]

Hi Hopper,

I'm also from Canada. Have to tell you that yes it is true that ADP will pay 780.00 and you pay the rest.

What I did, was get the cpap machine from them and a mask is covered every six months, plus filters. Then later, I purchased an auto machine from cpap.com. They will give you a good price if you email them for a price quote and they ship via Canada Post to your door. They mark it as medical so you don't have to pay duty. They are also very fast and very good if machine should need repair under warranty. You get a two year warranty with them.

I also tried to get an apap rather than the cpap and asked the dme if I could exchange the cpap for an apap and pay the difference. When he said the difference would be another 760.00 (forgot exact amount) I thought it was way too high and that is why I went to cpap.com. Cpap.com is a trustworthy site and a caring site. They are the ones who birthed this support group.

If you get a machine from the DME they have to supply you with a mask every six months. That is covered in the 780.00

You could buy a mask for less than half the price on cpap.com Don't pay the dme 300.00 for a mask. It's supposed to be included in the 780.00.

Welcome to the forum,

Anne

[MoneyGal]

Hi from another newly-diagnosed, now SLEEPING Ontarian. The ADP will cover 75% of the *approved* price for a CPAP or APAP machine. I just spoke to my supplier on Monday - the approved price for an APAP is higher than the approved price for a CPAP (or so they say), so the amount paid for an APAP is more than for a CPAP (I think it is in the $900 range).

[Polysomno-man]

I read your story, and this happens quite a bit, and it isn't right.

First off, Moderate apnea means you stopped breathing between 10-29 times a hour. I know thats a wide margin, but by the pressure of 10 cm, I would say you probably were somewhere between 10-15 events per hour. The APAP is a great feature, because when you go into your REM sleep, your apnea (on most people who have OSA) is usually about 2-3 times worse than your NREM sleep. (NON REM sleep)

You will be more comfortable with the APAP. They do cost more though. Your insurance will only pay for it if you can prove that you really need it. For example, if you stopped breathing 4 times a hour in NREM sleep, but stopped breathing 40 times a hour in REM sleep, the doctor could write an appeal stating that your pressures do not need to be at 10 cm all night, just when you are in REM. Most of the time, you can find a good DME that will bite the cost and not send the extra bill to you. If you are still having trouble with the Swift LT sliding around, try the Swift II. This mask tends to stay in place better at night. Most people want the latest and best, but the Swift II advantage of the LT is that it doesn't move around as much. (LT is newer)

I don't know how Canada works their DME's though. If you go to CPAP.com they usually have cheaper masks. I have heard of my patients only paying $75 for a Swift. At my lab, we get them for $12 a piece, but we are a lab. The bottom line is, once you get your machine from the DME, it doesn't matter where you get the maks, provided its never been used. Don't ever buy a used mask. There are too many pieces that could show up broken, or missing.

If you haven't bought your machine yet, you could look for a company that sells Respironics instead of ResMed. While ResMed are technically slightly better, Respironics have a machine called a Cflex. Its like a CPAP but the pressure drops when you exhale, almost like a BiPAP but not quite. If you are only at a pressure of 10 cm, I think the Cflex would be right up your alley, and they are much cheaper than the APAPs, and you don't need a special script, just your CPAP order.


I've been diagnosed with 'moderate' apnea....still trying to figure out what that means. All i know is my wife complains of me periodically stopping breathing and then finally gasping for air...and i often don't feel well-rested.

Anyway, i did the overnite titration study, had my follow-up appointment (all of 2 minutes long) and walked out with a script for a 1 month trial on CPAP, pressure level 10. The sleep clinic referred me to a local supplier that specializes in OSD (directly across the street), so i went in there and walked out with a loaner of a Resmed S8 Elite II and the basic trimmings. I had a lot of catching up to do on OSD and i quickly realized that getting adequate treatment can be an uphill battle. I was determined to keep an open mind and a positive attitude. However things have not gone very smoothly. I have tried 4 different masks, finally settling on the Swift LT with chinstrap as the least uncomfortable But i just can't get used to the pressure. Most nights i only make it 2 to 3 hours before i rip the thing off my face and try to get back to sleep (i've tried, but failed, to do the ramp-up again). I also toss and turn a bit, which causes the mask to shift and air inevitably leaks, usually waking me up. And several nights i have swallowed copious amounts of air ...and wake up feeling like a blowfish.

But i have persisted, and after getting the mask thing settled, i have progressed little by little. Now i usually make it 4 hrs and once i made it 5 whole hours.
Then, somewhat out of the blue, the DME leaves me a message that they are going to charge my credit card at the end of the day for the equipment that i have been using. Fortunately i got the message and was able to put the brakes on that! To tell the truth, i was pretty miffed about their new, ultra-pushy, attitude and i told them so (and got an apology). I asked them about trying (rent if necessary) an APAP machine and they told me that i could not without a prescription. So off to the sleep doc again, fortunately i was able to convince him to write me a script for an APAP, and i swapped machines for a Autoset II that afternoon....which is where i am at right now.

The DME told me that i could try the APAP for a few days, but after that i had to make a decision and buy one or the other.

I've pretty much already decided on the APAP before knowing if it works any better for me, due to its added flexibility and well as the data capabilities. The problem is, i think i'm being hosed.
The quoted price for the S8 Elite with H3i heated humidifier is $1040 which qualifies for the $780 ADP discount (so $260 for me), but their price for the Autoset II with the same humidifier is $2038. They told me that ADP still only covers $780 which means $1258 for me. (they're also asking for $300 for the Swift LT).
Firstly do these prices seem reasonable?
The Autoset II is currently listed at $995 USD on one popular on-line retailer.
Should the APAP be double the price of the comparable CPAP?

Is it true that ADP only covers the first $780 of the APAP? According to their website, they cover 75% of the cost which would be $1528.50. Furthermore, ADP's list of qualified devices states that the maximum price that a vendor can charge for the Autoset II is $1585 (the S8 Elite is already at the allowable max of $1040)

Doesn't this all sound a little fishy?

Are they just out to get my money and are hoping that i will just pay whatever they ask?

How do these prices compare to what others have experienced in Canada?

I have found some other Resmed suppliers in Ontario (no thanks to ADP who apparently have a list of registered vendors but don't make it available on their website) and I'm going to do some calling around tomorrow.

I'm frustrated and i feel like i am being forced into making a decision on a machine before i am fully ready. I do not appreciate the vendor's pushy nature but i feel trapped. If i walk away they will most likely try to stick me with rental fees, though the trial period was supposed to be just that, a trial, not a rental.

grrrrrrr[/quote]

[Slinky]

Ooops, polysomno-man!!!! Resmed has EPR in place of C-Flex!!! The Resmed S8 II AutoSet has EPR in both APAP and CPAP mode. The Resemd S8 and S8 II Elites have EPR. And each EPR setting = 1 cm.

Was that a typo? From all I've read an AHI of 5 to 15 is mild OSA, an AHI of 15 to 30 is moderate OSA and an AHI 30 or over is severe. PLUS everything I've read indicates that there is absolutely no correlation between severity of apnea and the pressure needed to effectively treat our OSA.

I haven't tried the Swift II so am not speaking from experience w/it - BUT - I did start out w/the original Swift and I HATED IT!!! I HATED the side hose attachment, if I changed position to my other side, my seal was lost. The newest Swift, the Swift LT and Swift LT for Her both have the hose attachment at the center. GREAT IMPROVEMENT! You can sleep on either side, your back or even your tummy once you find the right fit for you.

[hopper]

Hi from another newly-diagnosed, now SLEEPING Ontarian. The ADP will cover 75% of the *approved* price for a CPAP or APAP machine. I just spoke to my supplier on Monday - the approved price for an APAP is higher than the approved price for a CPAP (or so they say), so the amount paid for an APAP is more than for a CPAP (I think it is in the $900 range).

I finally talked with somebody at ADP. It is true that ADP covers 75% of the price of approved machines. FYI The maximum price for an approved CPAP is $1040 and ADP covers $780 of that, the max price for an approved APAP is $1585 and ADP covers $1188.75. The problem is you only need a script for the CPAP, to get an APAP covered you need a script specifying APAP (which i have) and you also have to meet several other conditions based on your sleep study results (i don't meet these) and your doc has to submit the information to ADP before the claim is made (pre-approved).

The unscrupulous xPAP vendor that i have been working with has offered to still sell me an APAP (since i have the script) albeit at a greatly inflated price <$2000. Their reasoning is that since i don't qualify for APAP from ADP's point of view, they can charge whatever they want (according to ADP this is true). The hitch is that they have offered to sell me the APAP yet submit the claim to ADP as if it were a CPAP (that's the unscrupulous part). Actually it sounds perfectly reasonable to me, however it is contrary to ADP policies. ADP claims that the vendor would be breaking the law and, if caught, would be severely punished for this.

[MoneyGal]

Hopper - I don't know for sure but I think the place my sleep doc works with will also charge a price well in excess of the ADP-approved prices. I do know that you can purchase a machine only (no extended warranty or other extra services) from my DME, which the ADP specifies must happen. But I also think it would be difficult to find a DME charging only the approved prices, if that makes sense.

I don't yet have a xPAP prescription: my follow-up meeting with the sleep doc is next week.

[Hawthorne]

That "Canadia" may be a typo.

If the amount you have to pay out of pocket, is more than $700 and you don't have any Extended Health Plan to cover a good part of the amount over what the ADP will pay, I would buy an auto online. You can get one for about that amount with humdifier, I think. Check for the online suppliers "real" price not the "Manufaturer's Advertised Price".

I was under the impression that ADP paid more towards an auto if you had a prescription for an auto.

[hopper]

That "Canadia" may be a typo.

Nope, it was meant to be funny:
Canadia: Noun. The way Canada should logically be spelled, if its residents are to be referred to as "Canadians".

Example:
A: We were speaking to some Canadians.
B: Oh, and where do they come from.
A: Canadia, obviously.

I don't necessarily believe this to be true, its just a funny quirk. (anybody know what they call people from Halifax?)
Of course, technically, we are also Americans, North Americans that is.

I hope i didn't just open a big can of worms

If the amount you have to pay out of pocket, is more than $700 and you don't have any Extended Health Plan to cover a good part of the amount over what the ADP will pay, I would buy an auto online. You can get one for about that amount with humdifier, I think. Check for the online suppliers "real" price not the "Manufaturer's Advertised Price".

I do have extended health coverage and i am aware of the various on-line suppliers. At this point it is much less about what i will be out of pocket and more about being lied to / hosed by the medical supplies vendor.

I was under the impression that ADP paid more towards an auto if you had a prescription for an auto.

This is true, however you must also meet some very specific criteria, and be pre-approved. The script is not enough.

[carbonman]

First off I'd like to say what a wonderful forum this is. Its just jammed full ultra-supportive people with really useful information.

We may be from different countries......



...but, it appears we speak the same language.

Fat or skinney??

[Mrs. Tatis]

carbonman, I know this is off subject, but it looks like you are really into bike riding. I want to buy a new bike for my husband for our anniversary. I have about $400 saved up, and we go to Colorado every other year, and then to Northern California. We live in the flatlands though. What kind of bike would be good for moutains and regular riding? I am horrible at these types of things, I could ask my husband, but then it would give it away. He has had the same Trek (is that spelled right?) for about 16 years atleast, and the paint looks very tacky on it. He also complains saying it doesn't shift well going uphill, which is why I am concerned about what type to get him.

[Hose_Head]

Hi from another newly-diagnosed, now SLEEPING Ontarian. The ADP will cover 75% of the *approved* price for a CPAP or APAP machine. I just spoke to my supplier on Monday - the approved price for an APAP is higher than the approved price for a CPAP (or so they say), so the amount paid for an APAP is more than for a CPAP (I think it is in the $900 range).

I finally talked with somebody at ADP. It is true that ADP covers 75% of the price of approved machines. FYI The maximum price for an approved CPAP is $1040 and ADP covers $780 of that, the max price for an approved APAP is $1585 and ADP covers $1188.75. The problem is you only need a script for the CPAP, to get an APAP covered you need a script specifying APAP (which i have) and you also have to meet several other conditions based on your sleep study results (i don't meet these) and your doc has to submit the information to ADP before the claim is made (pre-approved).

The unscrupulous xPAP vendor that i have been working with has offered to still sell me an APAP (since i have the script) albeit at a greatly inflated price <$2000. Their reasoning is that since i don't qualify for APAP from ADP's point of view, they can charge whatever they want (according to ADP this is true). The hitch is that they have offered to sell me the APAP yet submit the claim to ADP as if it were a CPAP (that's the unscrupulous part). Actually it sounds perfectly reasonable to me, however it is contrary to ADP policies. ADP claims that the vendor would be breaking the law and, if caught, would be severely punished for this.

You say that you don't meet ADP's criteria for an APAP, but your first post indicated that your Doctor was willing to write you a script for APAP. It's the Doctor who has to fill out the ADP forms; has he changed his mind on APAP for you? Have you asked him?

I too live in Ontario. I went down this same road last March. While my Dr was initially unresponsive to my request for an APAP, he changed his mind after I had my titration study. He filled out the forms and ADP paid the quoted 75%. I'm uncertain whether he changed his mind because I met the ADP criteria for APAP or whether it was because I had complained to him (exit questionaire at the end of my titration study) about the conflict of interest in the clinic : a too-cosy relationship between clinic, doctor and in-house DME. Either way, I got what I wanted.

You've received some good advice from other posters here. Do the math and buy where it's cheapest.

BTW, the DME from the clinic was pushing me to buy a CPAP before I had my titration study. Their service was completely unprofessional, as well as unhelpful. I spelled it all out, with examples, in that questionaire. After my titration study, I dumped that DME and bought my APAP from a different, much more responsive one. Based on other's experiences here, I'm a fortunate one: I took to xPAP like a duck to water. I've been on the hose now since early March 2008 and have 100% compliance and an AHI of 1.8. Feeling MUCH better now.

[roster]

carbonman, I know this is off subject, but it looks like you are really into bike riding. I want to buy a new bike for my husband for our anniversary. I have about $400 saved up, and we go to Colorado every other year, and then to Northern California. We live in the flatlands though. What kind of bike would be good for moutains and regular riding? I am horrible at these types of things, I could ask my husband, but then it would give it away. He has had the same Trek (is that spelled right?) for about 16 years atleast, and the paint looks very tacky on it. He also complains saying it doesn't shift well going uphill, which is why I am concerned about what type to get him.

Some advice from another biker, if you husband is an avid rider he will want to pick out his own bike. We can be very picky. I would not dare try to select a bike for a fellow biker. After all, it's his cheeks that hard seat is going to be stuffed between for hours. Give him a gift certificate from his favorite bike shop.

[MoneyGal]

People from Halifax = Haligonians