APAP Prescription Required for APAP Machine?

Can I use a CPAP prescription to order an APAP or auto-adjusting CPAP machine?

rockncountry101 wrote:Can I use a CPAP prescription to order an APAP or auto-adjusting CPAP machine?

CPAP and APAP share the same insurance billing code, E0601, so as long as the prescription doesn't specify a particular CPAP machine you should be able to use your Rx to buy an APAP machine.

Thanks!

rockncountry101 wrote:Thanks!

You're welcome.

I say it depends on the DME. They could actually give you what YOU want using that prescription or give you what THEY want. It seems that if you want something else that they have in mind... then they will say you can't get it unless the prescription that specifically requests an autopap. You don't know how many times a forum member has had to specify an autopap... to get one. Don't accept anything you don't want, and know that dealing with the DME ain't gonna' be pretty!


Sheriff

Sheriff Buford wrote:I say it depends on the DME. They could actually give you what YOU want using that prescription or give you what THEY want. It seems that if you want something else that they have in mind... then they will say you can't get it unless the prescription that specifically requests an autopap. You don't know how many times a forum member has had to specify an autopap... to get one. Don't accept anything you don't want, and know that dealing with the DME ain't gonna' be pretty!


Sheriff

Correct! If you are using your own money, it's easier, but most people want to use other people's money, for everything. When dealing with a DME, bring your guns, and maybe the Sheriff's too. Jim

So there are two considerations here: First is what's written on the prescription. CPAPs and APAPs share the same insurance billing code so if the Rx only stipulates a machine by the code E0601, that Rx is good for either machine. So if you're buying online, for example from our forum host cpap.com, then you'll have no trouble ordering the APAP machine you want.

Second consideration (assuming your Rx covers either machine) is dealing with the DME. Some have a strict practice of issuing the least expensive machine that is authorized by your prescription and will refuse to issue an APAP even if it is covered by the billing code on your Rx. In that case, you can find out which other DMEs your insurance will work with, or ask the doctor to rewrite the Rx stipulating APAP specifically and a Min and Max pressure -- fixed pressure CPAP machines can't be set up with a Min and Max pressure, so then the DME has to issue the APAP.

Jim; I hope you don't mean my insurance benefit is "someone else's money'?
When I pay my premiums, I have a RIGHT to expect what was promised--when I need it!
It's criminal to make us struggle for something we have ALREADY PAID FOR!
Welfare patients often have a different, more limited formulary, and fewer providers,
But when I am responsible for my insurance, I better damn well get what I paid for.

Even if your prescription says CPAP rather than E0601, you can get an APAP technically. But your DME will not want to provide an APAP because the profit margins is less. See my blogpost "What you need to know BEFORE you meet your DME" to get an idea of what you are up against.

rockcountry, get ALL the info you can from this support group before u go, when I got my cpap I was clueless as to what anything was, it was ALL new to me and my doc didnt explain anything. Fact is I have never heard from my doc that ordered the sleep test OR the people that did the test. I have learned a lot from these folks on this forum, going on 5 years now. So learn all about the different machines and masks so you can tell the sleep people what u want.

chunkyfrog wrote:Jim; I hope you don't mean my insurance benefit is "someone else's money'?
When I pay my premiums, I have a RIGHT to expect what was promised--when I need it!
It's criminal to make us struggle for something we have ALREADY PAID FOR!
Welfare patients often have a different, more limited formulary, and fewer providers,
But when I am responsible for my insurance, I better damn well get what I paid for.

Insurance is a collective, we pay our money, and expect the care we need. That's how it's supposed to work, but by always having to have the best of everything to the point excess, raises the cost for everyone in the collective (group).

Example: Being given a CPAP or APAP that collect full data, and still keep working the system until they get a AVS and even BPAP's that they don't really need for good treatment. Or bumping thru 2 or 3 machines, hunting for the "Golden Fleece"

Everyone should be given a APAP, that collects full data, and access to the software to read the data, that only makes sense. We all should try to stay as healthy as we can, it's our bodies and lives, but taking more than we need hurts everybody on the ins plan, raising the costs for all on the plan.

I won't comment of Government forms of ins. That's a can of worms even a fish shouldn't eat! Some people need and deserve help, many on the dole don't. Jim