Tips/expectations for APAP in Toronto Ontario?

Hi I was just diagnosed with sleep apnea and my doctor gave me a prescription for an APAP machine. I have an appointment to loan a machine next week so I can trial before buying.
I am aware that Ontario reimburses up to 75% of the cost of the machine. My insurance does not cover the remainder though so I want to keep costs down.

How does the ADP program work? Do they cover only the machine or the mask too? Do they cover all machines?
Are there price differences between clinics? Is there a recommended site/clinic that has competitive rates?
Any other tips/suggestions?

Thank you so much!

Have you called OHIP or anywhere else to ask your questions? While there are a few Canucks here (like me) it's mostly U.S. and most wouldn't know those answers... you need to do some digging yourself to find out.

Even if someone here had gotten help with their machine - whatever type it is - it doesn't mean you will necessarily get the same.

Look in the phone book (at least) for clinics - there should be a Vitalaire there, and they might be able to help.

Pay919 wrote: ↑

Fri Apr 09, 2021 6:56 pm

Hi I was just diagnosed with sleep apnea and my doctor gave me a prescription for an APAP machine.

Be sure that the prescription actually states it's for APAP, and not just APAP for titration purposes. You definitely want an APAP or better and if ultimately it's determined you only qualify for CPAP there's still a way to get an APAP machine.

Pay919 wrote: ↑

Fri Apr 09, 2021 6:56 pm

How does the ADP program work?

The equipment vendor (DME) will likely take care of the bureaucracy and paperwork, creating an invoice with the 75% discount.

https://www.health.gov.on.ca/en/pro/pro ... 131218.pdf
https://www.ontario.ca/page/respiratory ... d-supplies

Pay919 wrote: ↑

Fri Apr 09, 2021 6:56 pm

Do they cover only the machine or the mask too?

They cover 75% of the machine and a "basic mask", unfortunately a basic mask is an ambiguous term and not well defined. My experience with my DME was they had me try on a few different masks, which qualified as Basic Masks, I originally went with the ResMed N20 Nasal.

Pay919 wrote: ↑

Fri Apr 09, 2021 6:56 pm

Do they cover all machines?

No, LDP keeps they have a list of machines that qualify for class of machine (CPAP, APAP, BiLevel). DME's do not necessarily stock all models, They also might try to steer you towards a model that they purchase cheaper and make more money as the LDP pays a fixed amount.

https://www.health.gov.on.ca/en/pro/pro ... manual.pdf

Pay919 wrote: ↑

Fri Apr 09, 2021 6:56 pm

Are there price differences between clinics?

The LDP program has a fixed cost for the machine, which you can see on the provided list. But beyond that DMEs costs vary, expect them to steer you towards options and services for a fee, of course.

I didn't know any better and I was talked into an "upgrade" pack that included:

• A spare humidifier tank, heated hose, 2 filters, and non-sense hose cleaner for about $200.
• ResMed SD Card for $32

My insurance paid for 85% of that so I'm not that upset. But, that move cost my DME as, now that I know better, I buy all my supplies online.

I am glad I got a heated hose though.

Pay919 wrote: ↑

Fri Apr 09, 2021 6:56 pm

Are there price differences between clinics? Is there a recommended site/clinic that has competitive rates?

There have been reports of pleasant and unpleasant experiences in Ontario. Take advantage of the DME to fit you for a mask to find one you can work with. This is one area that is difficult without them.

Pay919 wrote: ↑

Fri Apr 09, 2021 6:56 pm

Any other tips/suggestions?

• Work with the DME for initial mask fitting and selection
• If you qualify for CPAP, insist on the ResMed AirSense 10 AutoSet for Her, even if you are male. It's an APAP device but for some strange reason qualifies as CPAP.
• If you qualify for APAP, still try to get the ResMed AirSense 10 AutoSet for Her, but the ResMed AirSense 10 AutoSet is a very close second.
• Don't be talked into a decision you're not comfortable with. If your not sure, tell them you'll think abut it, then come back here and ask.
• After your initial purchase, buy all your supplies and upgrades online, but don't share that with the DME.
• You will NOT need to replace your supplies on the schedule they suggest. I'm on my original humidifier tank (over 3 years old), original heated hose (over 3 years old) my current mask is over a year and half, and nasal pillows over a year.
• Don't let them scare or intimidate you into an excessive cleaning regiment, especially if they want to sell you a cleaning device sure as SoClean
• Masks are very personal and finding a good (leak-free) fit is one of the toughest things about adjusting to CPAP. My initial CPAP was a disaster until I eventually moved to nasal pillows. If you can use nasal pillows, strongly consider them. The comfort level and unobtrusiveness is light years ahead of Nasal or Full-Face masks.

I buy all my supplies at CPAPOutlet.com, they are online and located in Markam. Fast shipping, competitive prices and good customer service.

I originally had success with the ResMed P10 Nasal Pillow mask, now use the ResMed P30i Nasal Pillow mask

All though this post may sound like an advertisement for ResMed, it's not. The devices I list are easily the most popular and supported systems here and the masks also very popular, but due to the individual nature not the hands-down winner as there simply isn't one.

Wow this is an amazing response! Thank you so much!! Really appreciate your time This really helps