Saw the sleep Dr. for the first time today...

Well Hello!

I hope your study goes well for you. I just called Yale the other day to inquire about a support group...they are starting one but it will be in Guilford, yikes! Maybe we need to start one around here!! (Even if it's just you and me at Starbucks! LOL)

Thanks for the Anthem info. I have spoken to them 3 times now and not gotten that from them...how did you get it, I'm curious. And if you know what the 'failure' requirements are I'd appreciate it if you'd post them. Thanks!

Good luck again, let us know how it went!

Actually, it's the Guilford office that I'm going to tonight for my titration. I had my initial study/diagnosis done at Temple Medical, but they couldn't give me an appt until June 20. I was glad when they said Guilford could fit me in now. It's about a 45 min drive for me, and I suspect that office will be nicer than the one in New Haven (which was kind of grungy).

I just went to the Anthem site to see if I could get the coverage documents and send them to you. They've changed their site, and now I can't seem to get access. It may be on a plan-by-plan basis, though, so if you want to see if you can get them, log in to your Anthem account, and on the overview page, click on "View Coverage Documents". When I do that, it says coverage documents are not available on line.

If I remember correctly, the APAP would be approved if certain numbers were over a certain level (sorry so vague!) or if compliance was an issue.

I'd love to know what DME you end up using, and what equipment you get, since I'll be in the market soon, too. (I hope I can easily get my prescription from them!) I'm leaning towards the REMstar with C-flex and heated humidifier, with the Breeze nasal pillows.

Hmmm...I have been on the Anthem site and scoured it...I see my coverage for DME (no copay, no deductible and they pay 100% of 'allowed amount') but could not find any kind of schedule for how often they replace, what items are covered, etc. The first time I called they said to call them with a code and they'd tell me if it was covered. But as I understand it all CPAPs including autos are the same code. I'll keep you posted...if DME #2 comes through I will hopefully know on Monday! (And I'll forward you their info if they do...they are in Watertown but cover the whole state, they told me they'd come to the house, or to work in Trumbull or wherever I wanted.)

BrensTiredMom wrote:The first time I called they said to call them with a code and they'd tell me if it was covered. But as I understand it all CPAPs including autos are the same code.

Yes, the same code is used for an autopap as for the simplest cpap machine:

HCPCS billing code - E0601

An autopap is a CPAP machine. An autotitrating CPAP machine. Same billing code either way...whether it's a straight cpap or an autotitrating cpap.

A "bipap" machine would be different and would use a different code. The BiPAP Auto, for example, would not fall under the "cpap" billing code. It is first and foremost a "bi-level" (bipap) machine and would use the same billing code as the simplest bipap machine - E0470.

E0601 is the code I got off one of the posts here and is the one I called insurance with the other day...and that code IS a covered item. Someone also posted E0602 (I think that's what it was) as the code for APAP but Anthem said that was a breast pump! LOL That was a useful item for me for many months but not what I'm needing right now!

So I think there was no problem with my insurance nor with the code being used. I think the problem was the amount of profit that DME #1 was NOT going to make since the machine I need is more expensive than the basic ones they usually send out under that code...as many people have mentioned on here!

But, people have been able to get APAPs billed to insurance and I assume with that code so I'm still hoping for success with DME #2!