Insurance question - humidifiers

engrdad · Post by **engrdad** » Thu Nov 29, 2007 9:34 am

Does insurance typically pay for heated humidifiers (if on the script). I assume that they will.

Also, are they more likely to pay for an integrated humidifier? I was leaning toward the Respironics M-series AutoPAP w/Aflex machine but considering the F&P HC 150 heated humidifier. Even now, without CPAP therapy, I almost always wake with a very dry mouth. Constantly keep a bottle of water on my nightstand.

Note: I go for my second sleep study tonight. Looking forward to another night of none-sleep.

KansasRT · Post by **KansasRT** » Thu Nov 29, 2007 9:39 am

I don't think that insurance cares if your humidifier is integrated or seperated. Most insurances will cover a heated humidifier if the sleep study indicates mouth leaks or there is documented airway dryness, sinus issues or dry airway.

rested gal · Post by **rested gal** » Thu Nov 29, 2007 9:43 am

engrdad wrote:Does insurance typically pay for heated humidifiers (if on the script). I assume that they will.

I'd assume that, too. Haven't ever read of anyone saying their insurance did not.

engrdad wrote:Also, are they more likely to pay for an integrated humidifier? I was leaning toward the Respironics M-series AutoPAP w/Aflex machine but considering the F&P HC 150 heated humidifier.

It shouldn't make a bit of difference to the insurance company which heated humidifier you get. They're going to pay one set reimbursement fee to the DME for "heated humidifier" no matter what which brand humidifier you choose, as far as I know.

Now, the DME might prefer to give you one humidifier over another, based on what they have to pay to get them in the first place, and the fact that they will receive a set amount from insurance whether the humidifier had cost the DME a lot or a little. I don't think insurance cares which humidifier it is. Insurance is going to pay one set fee, just like they do when it comes to cpap/autopap.

That's a good combo choice you're leaning toward, imho.

Have fun at your second study!

lvwildcat · Post by **lvwildcat** » Thu Nov 29, 2007 11:24 am

OK I live in Las Vegas(desert). When I had my study done I had an awesome tech who was very aware of documentation and insurance guidelines. She said that a lot of insurance companies will balk at the added expense of a humidifier(seriously-they run approx.$250!) She fully documented that I had woken up after about 1 hour with severe cotton mouth which was justification for humidifier. Ask the tech who is doing your study-they should know how to justify humidification to your insurance co. A member of my A.W.A.K.E. group had to fight with his insurance for a couple of months before they approved his heated humidifier.(I think they finally got tired of him calling every day-LOL) I think it all falls back on how well the tech DOCUMENTS!!!!!

Guest · Post by **Guest** » Thu Nov 29, 2007 11:34 am

What happens if when they start the test, they already have the heated humidifier turned on. No way to prove you need it... Perhaps they just go with the thinking that everyone should be using one...

6PtStar · Post by **6PtStar** » Thu Nov 29, 2007 12:09 pm

Every Doc, especially ENT's I have talked to has insisted that you use one. If it humidity falls and you don't turn up your humidifier often time will cause nose bleed.

Jerry

Goofproof · Post by **Goofproof** » Thu Nov 29, 2007 12:19 pm

Make sure your Dr. specs the equiptment you want. Get one that has full data, then get the software and reader for it, and you may consider a FF mask first as you may breath through your mouth, and that causes dry mouth and treatment failure, due to not holding your airway open. Jim

Wulfman · Post by **Wulfman** » Thu Nov 29, 2007 12:30 pm

MOST of the insurance providers have come to recognize that the humidifier is an essential part of this therapy and will pay for them when included. However, there are some DMEs who will NOT supply one unless it's on the prescription. This is not an issue with online suppliers, however.

Best course of action is to get all the essentials on the prescription.
(especially if going through a local brick & mortar DME)

Den

Snooze_Blues · Post by **Snooze_Blues** » Thu Nov 29, 2007 2:52 pm

I was about to start a new thread, but since this is so close...

Just talked to a fairly new DME near me that I will attempt to get my sleep lab to work with rather than the much older, normal DME they use that is twice the drive for me. I also talked at length to the respiratory therapist there. They seemed friendly and cooperative and are looking to do more business with my sleep lab and "get their name out" since they are a young business (3 years old, IIRC).

I told them I wanted a "Respironics M Series Pro C-Flex CPAP" and the "Fisher Paykel heated humidifier". They said they had thus far always sold the integrated humidifier with that unit and they'd need to "look into" whether getting a humidifier other than the integrated "M Series Humidifier" might VOID THE Respironics' WARRANTY!

They mentioned there is the possibility of getting water into the CPAP and damaging it. The assumption being, I suppose, that an integrated humidifier is less likely to do that "by design". I further suppose another assumption might be that limiting the warranty that way would likely sell a lot more integrated humidifiers for Respironics', but that's a bit cynical of me, and may not be how it is anyway.

Anybody know anything definitive regarding the Respironics' warranty if you buy a non-Respironics' humidifier?

Goofproof · Post by **Goofproof** » Thu Nov 29, 2007 4:01 pm

Snooze_Blues wrote:I was about to start a new thread, but since this is so close...

Just talked to a fairly new DME near me that I will attempt to get my sleep lab to work with rather than the much older, normal DME they use that is twice the drive for me. I also talked at length to the respiratory therapist there. They seemed friendly and cooperative and are looking to do more business with my sleep lab and "get their name out" since they are a young business (3 years old, IIRC).

I told them I wanted a "Respironics M Series Pro C-Flex CPAP" and the "Fisher Paykel heated humidifier". They said they had thus far always sold the integrated humidifier with that unit and they'd need to "look into" whether getting a humidifier other than the integrated "M Series Humidifier" might VOID THE Respironics' WARRANTY!

They mentioned there is the possibility of getting water into the CPAP and damaging it. The assumption being, I suppose, that an integrated humidifier is less likely to do that "by design". I further suppose another assumption might be that limiting the warranty that way would likely sell a lot more integrated humidifiers for Respironics', but that's a bit cynical of me, and may not be how it is anyway.

Anybody know anything definitive regarding the Respironics' warranty if you buy a non-Respironics' humidifier?

It sounds like you need to keep looking for a supplier. They are trying to snow you already, winters onn the way, don't get caught in their Snowstorm, they are just trying to maxiumize profits and easier inventory. I suppose they don't know manufactures sell XPAPs with HH, and they still have full warrenty. It's time to RUN. Jim

differentdave · Post by **differentdave** » Thu Nov 29, 2007 4:22 pm

Goofproof if you go with that DME you might have to change your name. I am very new to al this but from all that I read and all that I have learned you must be stand firm, stand strong and do not buckle when it comes to dealings with dme.
I just got a a-flex machine with the exact humidifier you want from a dme. No voiding of warranty. The humidifier you want will cost most at the dme than the integrated one and therefore your cost might be higher, but that should be minor hopefully if you have insurance

Perchancetodream · Post by **Perchancetodream** » Thu Nov 29, 2007 5:25 pm

Snooze_Blues wrote:I was about to start a new thread, but since this is so close...

Just talked to a fairly new DME near me that I will attempt to get my sleep lab to work with rather than the much older, normal DME they use that is twice the drive for me. I also talked at length to the respiratory therapist there. They seemed friendly and cooperative and are looking to do more business with my sleep lab and "get their name out" since they are a young business (3 years old, IIRC).

I told them I wanted a "Respironics M Series Pro C-Flex CPAP" and the "Fisher Paykel heated humidifier". They said they had thus far always sold the integrated humidifier with that unit and they'd need to "look into" whether getting a humidifier other than the integrated "M Series Humidifier" might VOID THE Respironics' WARRANTY!

They mentioned there is the possibility of getting water into the CPAP and damaging it. The assumption being, I suppose, that an integrated humidifier is less likely to do that "by design". I further suppose another assumption might be that limiting the warranty that way would likely sell a lot more integrated humidifiers for Respironics', but that's a bit cynical of me, and may not be how it is anyway.

Anybody know anything definitive regarding the Respironics' warranty if you buy a non-Respironics' humidifier?

_________________

Are you dealing with SleepMed? If so, you may need to educate the local staff. Part of the problem of dealing with a rapidly growing operation is that the training and communication may be a little weak. At least I have found it to be that way with this company.

So, start by explaining to them the problems that Respironics has had with leaking tanks on the M series integrated humidifiers (you can do a search on this forum for humidifier leaks and can come up with more info). They have already had to replace mine.

And then explain to them that Respironics will not void the warranty on a product if it is used according to directions. The Respironics manual does not require an integrated humidifier manufactured by Respironics. (See the section on xPAP manuals under the red dot FAQs at the top of the page.)

Good luck,
Susan

Snooze_Blues · Post by **Snooze_Blues** » Thu Nov 29, 2007 8:28 pm

Perchancetodream wrote:Are you dealing with SleepMed?

I don't think I'm dealing with SleepMed, since I've never heard that name, but I'm actually leaning toward going back to the original DME company that was recommended by the sleep lab since they at least agreed to wave my deductible, which I just looked up and has me responsible for the first $900 and then hits me for another 10%.

At least dealing with the place my sleep lab has used for many years, they have some leverage. With a new place, I feel like I'd be a pioneer, swimming upstream, who knows what monsters I might encounter?

Why does this all have to be so complicated? Frankly, I'm feeling a bit overwhelmed and I'll bet my sleep lab thinks I'm losing my mind... maybe I am.

Wulfman · Post by **Wulfman** » Thu Nov 29, 2007 8:50 pm

Snooze_Blues wrote:
Perchancetodream wrote:Are you dealing with SleepMed?
I don't think I'm dealing with SleepMed, since I've never heard that name, but I'm actually leaning toward going back to the original DME company that was recommended by the sleep lab since they at least agreed to wave my deductible, which I just looked up and has me responsible for the first $900 and then hits me for another 10%.

At least dealing with the place my sleep lab has used for many years, they have some leverage. With a new place, I feel like I'd be a pioneer, swimming upstream, who knows what monsters I might encounter?

Why does this all have to be so complicated? Frankly, I'm feeling a bit overwhelmed and I'll bet my sleep lab thinks I'm losing my mind... maybe I am.

RUN, Forrest, RUN!!!

Those places COUNT on overwhelming you so you'll give in to whatever they want to do to you.
If you feel a hand on your thigh, it's probably theirs reaching DEEP into your pocket.

Do the math!

Den

snoregirl · Post by **snoregirl** » Thu Nov 29, 2007 11:29 pm

If you can't get someone to wave the deductable you can get the whole setup online for less. $900 plus 10%??? It is non-insurance.

Mask

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Insurance question - humidifiers

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