I have my presciption! Now what??

I just my ENT physician to go over the results of my auto-titration study that I completed last week. Thankfully, I have a MD that is well versed in sleep apnea and has suffered with it himself.

He has prescribed a Respironics M series APAP machine with A-flex, a heated humidifier, a Swift II mask and a chin strap. My study showed that I need APAP with pressures mostly in the 10 cm range. He has prescribed a range of 4-10 cm. Does this seem appropriate? I am to return to see him in one month to bring in the Smart Card so that we can see how I am doing and what adjustments need to be made. I will continue to see him monthly unless I feel that I don't need to see him. I am to bring the card in monthly even if i don't make an actual appointment. This seems to be very reasonable.

Do I contact the insurance company or will they call me and tell me which DME I can use? He said it would most likely be Apria and that they were not a good company.

I am also wondering if I can buy masks, etc and use my Flex Spending account? I have quite a bit of money left for the year. If I want to buy something on-line, do I have to provide a copy of my prescription?

Any advice is greatly appreciated. Have a great day!

You probably need to contact your insurance and ask who are local DME providers and contact them about carrying what you want. Not all DME's provide CPAP. You will need to take in your script and arrange for the doctor to send the paperwork they need (sleep study). Depending on the DME and your insurance, there might be a delay in all of this.

Or you can take your script and send it to cpap.com and buy out of pocket what you want. Your insurance may or may not reimburse you. You have to check with them and find out what paperwork they want.

Only the cpap machine needs the prescription when you order online from cpap.com. You can order masks and tubing etc. without a script from cpap.com.

As far as using flex money, you need to check with that plan on what they do and don't allow.

I would send the script to cpap.com so they have it BEFORE someone else decides to take your only copy. Once they have it on file you're good for life.

btw - Your doc did you right on the machine, tho I think the pressure is way too low. If you can tolerate it, I'd bump it to 8-12 until you do your 1st download. You may not get enuff air @4cm waaay to low. You can set your ramp to 6 for a few mins if you can't tolerate it but if you can go right to 8.

You may want to get your 1st one or two downloads done a bit early too. I think your doc would understand why.

Good Luck,
GumbyCT

It all starts with you knowing _exactly_ what your insurance allows -- or doesn't allow. Some policies require you to go to only one DME, for instance (no choice). Unfortunately, getting the information you need is not always easy. Many insuranse CS reps don't have much experience answering questions about DME issues. Call back a day later, hopefully get someone else, and ask again too double check. Ask them to send the answers to your questions in email, so if they are wrong you aren't the one who gets penalized later (after you've spent a lot of money that they don't want to reimburse).

If you're stuck with a difficult DME like Apria, go back to your doctor and have them 1) write a specific _model number_ on the script and 2) write "do not substitute" on it. Get a photocopy for you to keep.

Jules, Gumby, and XYZ have given you good advice.

To what they've said. I'll add the suggestion that you purchase a card reader and software that'll allow you to read your own card. You'll do much better if you can immediately (the next morning) look at your charts.

The machine your doctor is recommending is first rate and will allow you to run it in five different modes....at least one of which you'll find very comfortable.

I also agree that 4 cm is WAY too low.....You'll find that an auto setting of about 8 cm low and 12 cm high wiill help you find your "sweet spot".

Probably the biggest difficulty you'll have will be the mask. Be prepared to go through a bunch of different masks before you find the one that'll be right for you.

Finally, sit down and have a long talk with your subconscious....and convince it that this therapy is vital to your health and longevity. Your subconscious runs the show while you're asleep....and if it isn't in favor of this project, it'll find a bunch of ways to make you take the mask off while you're asleep.

You're off to a great start....better than most of us got. You'll do well.

Gerald

The company that administers my organization's Flex Spending Account gives us a 'benefits card' that works like a debit card and it has the MasterCard logo on it. I use it just like a 'credit/debit card', but know that I only contributed $x for the year and can only charge up to that amount for the year. I purchased my cpap from cpap.com and used this credit card. If the flex spending company would have had a question about the purchase, they would 'audit' my receipt from cpap.com. I made my cpap purchase back in March--no audit to this date. Note: they recently audited charges from dental work within 2 weeks of when I used the card at the dentist. I sent the requested information, they approved it, and that was it. (I guess many people are putting cosmetic dental procedures on their flex spending account and they are not elgible for flex accounts/tax laws. Dental work is often audited.)

Make sure you call the company that administers your flex spending account and ask about it.

Thank you, thank you, and thank you all. I jut love this forum. Everyone was such a big help when I was doing the auto titration study and now with helping me figure out how to maneuver through the next big steps. I know everything will be easier if I have everyone's collective experiences to help me.

Jules: I will call my insurance company in the morning and figure out who will be my assigned DME or if I have the option to choose who I use. I had been looking at the cpap.com site and I already know that I will want to order a second mask. I will ask my insurance company if I can purchase the equipment myself as you suggested.

GumbyCT: I agree with you about the ramp settings. I was quite uncomfortable on the machine I used last week when it was in the ramp mode. It was set to stay at 4 cm pressure for 15 minutes. I never felt like I was getting enough flow and pressure until it came out of ramp mode. It was easier to control the leaks though while it was in ramp. I will take your advice and send my scrip into cpap.com before the DME gets it.

xyz: Great idea about getting the insurance company to respond via E-mail. It is always good to have a paper trail. Luckily, my scrip does list the exact model, type of humidifier, mask, etc and says "no substitutions" so I gather the DME will have to comply with the physicians orders. My MD said that they will still try to make things difficult. He said that they will often say that they have to order the equipment in and that it will take a very long time. They then try to talk you into taking other equipment that they have on hand. Maybe I will get a good DME and there will not be problems.

Gerald: Thanks for the support and the PEP talk. I am planning on ordering the card reader and software. It seems that my Flex Spending plan will even cover it. I am a data junkie so I will want to know what is going on long before a month is up. Not sure I will understand what I am looking at but I will learn. As far as masks go, I did try three different ones during my week long trial and I liked the Swift II the best by far. I will just need to figure out how to stop my mouth from leaking.

You have all been great and thanks for taking the time to respond to my post.

as you gather information, also do the "math" on how much your insurance will and won't cover and how much you have to pay