APAP again

Severeena · Post by **Severeena** » Wed Oct 05, 2005 8:35 pm

I was told again today that the APAP is to expensive and that is why my insurance will not pay for it

IF the doctor can show medical necessity as to why I need this HIGHER priced machine, and if they do it will only be for one week.

Talk about a DME blowing it for me with the my insurance company.

I wonder if Billmyinsurance will work with my doctor on this.

I am seeing RED.

chrisp · Post by **chrisp** » Wed Oct 05, 2005 8:51 pm

What are your out of pocket costs at the DME for a plain cpap ?

Severeena · Post by **Severeena** » Wed Oct 05, 2005 9:53 pm

I need the APAP because my CPAP is to high of pressure.

I need automatic pressure because I have sarcoidosis which has left me me 1/4 lung capacity.

Jan in Colo. · Post by **Jan in Colo.** » Wed Oct 05, 2005 11:10 pm

If you need APAP because of the 1/4 lung capacity thing, then I'm sure your doctor won't have a problem putting that in writing for you. But what's the deal with them giving it to you for ony one week? That does what?

Jan in Colo.

Flower51 Terry · Post by **Flower51 Terry** » Thu Oct 06, 2005 4:47 pm

How's your weight Severeena? I got my doctor to write a letter calling my apap a medical necessity based on the fact that I lost a lot of weight and am in process (unless I keep eating buttered popcorn ) of losing more which means my settings may need adjusting regularly. Since I explained that I can't afford, nor would my ins co go for, giving me expensive sleep studies every time I reached a new "low", and an apap would auto adjust to make the adjustment w/out necessitating a sleep study, he went for it and so did the ins co and the dme. Terry

Sleepless on LI · Post by **Sleepless on LI** » Thu Oct 06, 2005 4:51 pm

Sharon,

What about bi-level, which you sound like the perfect candidate for given you need high pressure and have 1/4 lung capacity. Sounds like you fit that perfectly. They can't deny you that.

NOzsnAZ · Post by **NOzsnAZ** » Thu Oct 06, 2005 4:59 pm

Severeena wrote:I need the APAP because my CPAP is to high of pressure.

It sounds like you might need Bi-PAP if too high of pressure is the problem. If your "required" pressure with CPAP is "too high" then it would seem that an Auto-machine would run at or near your "required" pressure as well...???

There is no prescription for an APAP - only for CPAP - as far as the insurance cos. are concerned. Also, most "Autos" can run as straight CPAPs as well. The DMEs will tell you any BS they can to "sway" you away from Auto machines because the insurance company will only pay them a fixed amt. regardless of how much the machine costs. The cheaper the machine they get you to buy, the more $$$ they make.

Billmyinsurance took my prescription for a CPAP set at 7cm H2O and sent me the 420E that I wanted.

chrisp · Post by **chrisp** » Thu Oct 06, 2005 6:09 pm

I'll ask again . What are your out of pocket (your share ) of the unit that the DME wants you to have ? You may be ahead going online and buying yourself or maybe billmyinsurance.com

:twis ted:

Severeena · Post by **Severeena** » Thu Oct 06, 2005 6:18 pm

The DME never said once he told me the insurance company will not pay for it.

I will contact my doctor tomorrow on this APAP issue.

There has to be a way to beat this system.

chrisp · Post by **chrisp** » Thu Oct 06, 2005 6:32 pm

There is > Its called http://www.billmyinsurance.com They will do all the work. They will also telll you if it would be cheaper to purchase it outright yourself.

Oh Buy the way. Your DME is a LIER ! There is only 1 code for CPAP. Auto or plain. They just want to pocket the extra $$$.

:twist ed:

Severeena · Post by **Severeena** » Thu Oct 06, 2005 6:37 pm

I was getting ready to type in the url for billmyinsurance.com

I think the S8 Advantage is one that I need. You can set it to Auto YEA.

chrisp · Post by **chrisp** » Thu Oct 06, 2005 6:48 pm

The GK 420E is an excellent unit and the software is less expensive than most others. Its said to be easier to use. 420E is also the smallest .

:twis ted:

Severeena · Post by **Severeena** » Thu Oct 06, 2005 7:10 pm

I am currently using Resmed S7 Lightweight.
I am not sure if Medicare will like the idea of paying rental for one machine and if billmyinsurance can get Humana to purchase the new machine how it will all work out.

Guest · Post by **Guest** » Thu Oct 06, 2005 8:00 pm

The s-7 can be converted to an auto (Spirit) for a small fee of $299 . The 420E is $525. And it the SMALLEST .

:twis ted:

Severeena · Post by **Severeena** » Fri Oct 07, 2005 5:37 am

Why should it cost that much to undo the programing?

The doctor has to write a script for that doesn't he?

If so then insurance should cover it. Medicare is renting the machine for me.

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