Intro from newbie in Canada

tyropita wrote:

Hawthorne wrote: The Ontario Government will pay $780 under the Assistive Devices Program. If you have an Extended Health Care Plan they MAY pay some or all of the rest of the cost. If you don't have that you will pay all of the difference yourself. THE PROVDER SHOULD DO ALL THE NECESSARY paperwork and you should get (right away or very soon ) your machine, with a humidifier, tubing and a mask.

Prices are outrageously high for this equipment in Canada. I'm talking $2000- $3000 for that beginner package).

Not my experience -- Resmed Elite II plus H4i humidifier plus Mirage Swift LT mask will cost me about $300 over the $780 ADP payment. I'm between you and Toronto.

I'm between London and Toronto. My dme said I would have to pay 730.00 extra to exchange my cpap for an auto. I think they must think we don't have access to the real cost of these machines and don't know better. I used ADP also. Later I got an auto from cpap.com which cost less than the cpap cost from the dme.

Anne

tyropita wrote:

Hawthorne wrote: The Ontario Government will pay $780 under the Assistive Devices Program. If you have an Extended Health Care Plan they MAY pay some or all of the rest of the cost. If you don't have that you will pay all of the difference yourself. THE PROVDER SHOULD DO ALL THE NECESSARY paperwork and you should get (right away or very soon ) your machine, with a humidifier, tubing and a mask.

Prices are outrageously high for this equipment in Canada. I'm talking $2000- $3000 for that beginner package).

Not my experience -- Resmed Elite II plus H4i humidifier plus Mirage Swift LT mask will cost me about $300 over the $780 ADP payment. I'm between you and Toronto.

I got the Resmed Elite II plus H3i humidifier plus Mirage Swift LT mask through MediGas, it cost me $905 over the $780 ADP payment. Thankfully my group insurance (Sun Life) covered the rest. Others are right that the DME's in Ontario make no followups with patients -- they are simply there to sell you something. I feel I was almost "pressured" into getting a device but honestly I didn't do much research on the different machines, but knew I had OSA and wanted therapy ASAP. Looking back I should have inquired about a loaner machine so that I could get used to it and do more research. I've only been on CPAP for 2 months now and I think if I wasn't an internet-savvy person who reads up on things like via this forum, I would feel completely lost adjusting to this very alien device. There are many sleep disorder clinics in the GTA which are far and away greater than any of the hospital sleep labs. I don't think they are technically private clinics as everything is covered by OHIP, but the facilities are built like a motel -- you don't feel like you are sleeping in a clinic at all. The one I go to is in Richmond Hill and is called the York Region Sleep Disorders Clinic. I was originally scheduled a sleep study 4 months in advance at the local hospital but cancelled when this clinic could see me within the same week! I have a followup appt with the Dr there tomorrow following my titration study so I'm very anxious to see how my findings are.

I live about 1/2 hour outside of the Toronto area and these were my results. I had three sleep studies, once at Princess Margret Hospital, (slept for about 20 minutes). Second was years later at Western General Hospital and was told I had to return a second day but couldn't take more time off. The third time.... during my physical I told my GP that I couldn't take it anymore in that I was always so tired. He made an appointment at Credit Valley Hospital about 4 weeks later for my third sleep study. After the sleep study I was told to see a specialist the next day which I thought was odd. The specialist scolded me about why I had let my severe sleep apnea go for so long, before I left his office an appointment was made at my discretion (two days later) to pick up my equipment. I met up with the specialist to do a breathing study and get my prescription for my settings. All my equipment and appointments was paid for by my wife’s insurance company which is Sun life. The only thing I ended up paying for was parking during my sleep study which I didn't even bother to see if the insurance covered.

SunLife is one of the best Extended Health Plans in Canada! My husband has it and, while he doesn't have sleep apnea, everything is covered 100%. If you have Sunlife for Extended Health Care, at least the group plan, making use of the Assistive Device Program in Ontario is really worthwhile because you end up paying nothing out of pocket. Even when you get replacement masks, and probably other items, they cover 100%. I was in my husband's Sunlife plan for awhile ( when I got my first cpap I was in his plan). Unfortunately, when he retired, I was put on a "life time" limit" in his plan. I had some really expensive arthritis drugs and was not yet 65 (when these drugs might be covered) and so my lifetime limit was used up pretty quickly. I had to switch to another Insurance company which does not cover 100% of anything!

With the cost of cpap equipment being so high in Canada, if you have Sunlife it's great!

Hawthorne wrote:With the cost of cpap equipment being so high in Canada, if you have Sunlife it's great!

I have to agree, SunLife has been amazing -- I feel like I should never leave my current company (although they could easily switch insurance providers at any time which would really suck). They cover a new machine once every 5 years, but all other parts (mask, nasal pillows, hoses, filters) are once every 12 months. I was able to exchange the two nasal pillow sizes that I don't use for my Swift LT with other users on this forum, so now I have 3 nasal pillows of the same size. This will let me switch them out once every 4 months before getting a replacement mask at the end of the year. I think this is a great option because it means I never have to let my mask get "old" and I can always keep one as a backup once I get the new one.

Just got my titration study results and the doc tells me I had an AHI of only 0.7 at 7 cm H2O, but at 8 cm H2O my AHI was 0! I was surprised because I've been checking my AHI every morning on my Resmed Elite II and it is usually at least 6.0. My doc confirmed that many machines (including the Resmeds as well reported here) overestimate HI. He said many people have a disturbance in their breathing when they are waking up or other periods during sleep, which the machine will record as a hypopnea event. However at the sleep lab they get their AHI numbers only from your sleeping hours

With my group plan, Great-West covers 100% of the xPAP equipment up to a maximum of $2,000.

The equipment listed in my profile was billed to me at $2,038 by VitalAire... so I paid $38. Funny how VitalAire wanted to load me up with supplies right off the bat... 2 masks, 2 hoses, 5 year supply of filters. I suppose they felt the chances I would quite the treatment was high so they might as well cash in early on... but I knew Great-West would have declined all that back then

But, now it has been well over the three month mark so Great-West will pay for a new mask, hose and another set of filters with no out of pocket for me. I need to check with them to see if equipment/supplies purchased from cpap.com would be covered or if they only cover purchases from a DME.

Paul56 wrote:But, now it has been well over the three month mark so Great-West will pay for a new mask, hose and another set of filters with no out of pocket for me. I need to check with them to see if equipment/supplies purchased from cpap.com would be covered or if they only cover purchases from a DME.

Does Great-West cover new mask, hose and filters once every three months???

wongnog wrote:

Paul56 wrote:But, now it has been well over the three month mark so Great-West will pay for a new mask, hose and another set of filters with no out of pocket for me. I need to check with them to see if equipment/supplies purchased from cpap.com would be covered or if they only cover purchases from a DME.

Does Great-West cover new mask, hose and filters once every three months???

Great-West told me they have no set time limit for replacement of those items... but I expect if one was to ask them to reimburse for replacements every month they would balk at that.

In Canada, it really does depend upon whether or not you have a good extended health plan or even one at all! Without an good extended health plan, it is way cheaper to buy online.

I miss having the Sunlife coverage for everything, not just cpap equipment.

The individual one I have now is worthless for sleep apnea equipment. I would have to pay way too much out of pocket, with the cpap equipment prices in Canada ,so it's online for me!

Hi,
I'm from Prince Edward Island (eastern coast of Canada) and I WILL be purchasing my own machine after I have my last appointment with Sleep specialist in 2 weeks.......it takes 2 years to get an appointment!! Yes, 2 years. I have to take a two day trip to see him. Ayway, that being said- I work for the Federal Government and have Sunlife as my Insurer and I 'hear' from you guys that they are great! I hope so. I'll keep you all posted.
Thanks everybody for your continued support in all this NEW stuff.
CFJ

Wow that is CRAZY, in fact my sleep specialist was telling me about that -- basically we're really lucky in ontario. People in other provinces sometimes fly to the Greater Toronto Area to get a sleep test done. It makes absolutely no sense that someone would need to suffer without treatment for TWO YEARS for a medical condition that is so easily diagnosed and treated. I'm so glad you'll finally be getting the help you deserve!

Paul56 wrote:With my group plan, Great-West covers 100% of the xPAP equipment up to a maximum of $2,000.

The equipment listed in my profile was billed to me at $2,038 by VitalAire... so I paid $38. Funny how VitalAire wanted to load me up with supplies right off the bat... 2 masks, 2 hoses, 5 year supply of filters. I suppose they felt the chances I would quite the treatment was high so they might as well cash in early on... but I knew Great-West would have declined all that back then

But, now it has been well over the three month mark so Great-West will pay for a new mask, hose and another set of filters with no out of pocket for me. I need to check with them to see if equipment/supplies purchased from cpap.com would be covered or if they only cover purchases from a DME.

I think you'll find that your insurance's maximum of $2000 is for a period of 5 years (it is with my Sun Life plan). Therefore you may have spent it all up front

I'm not certain but if Sun Life has a $2000 limit I think that is for the machine alone (which is once every 5 years). All other accessories are once every 12 months so I think you can buy a new mask, filter, hose, etc at that time.

hopper wrote:

Paul56 wrote:With my group plan, Great-West covers 100% of the xPAP equipment up to a maximum of $2,000.

The equipment listed in my profile was billed to me at $2,038 by VitalAire... so I paid $38. Funny how VitalAire wanted to load me up with supplies right off the bat... 2 masks, 2 hoses, 5 year supply of filters. I suppose they felt the chances I would quite the treatment was high so they might as well cash in early on... but I knew Great-West would have declined all that back then

But, now it has been well over the three month mark so Great-West will pay for a new mask, hose and another set of filters with no out of pocket for me. I need to check with them to see if equipment/supplies purchased from cpap.com would be covered or if they only cover purchases from a DME.

I think you'll find that your insurance's maximum of $2000 is for a period of 5 years (it is with my Sun Life plan). Therefore you may have spent it all up front

Well, I just heard back from Great-West on this issue... they will cover replacement supplies at 100%. The $2,000 maximum is every 5 years for the machine.

Paul56 wrote:Well, I just heard back from Great-West on this issue... they will cover replacement supplies at 100%. The $2,000 maximum is every 5 years for the machine.

Do you know how frequently GWL allows you to buy replacement supplies?