CPAPtalk.com

wongnog wrote:

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?

They told me in a previous communication they have not set replacement frequency, but I'm not going to push my luck and purchase a new mask monthly. Right now I'm looking to get a new hose, filters and another Quattro mask.

I"m interested in giving the Ultra Mirage FFM a go but first want to get a 2nd Quattro so I have some spare parts on hand for it. The Quattro has been working decently for me.

There is no way I would continue to support the local DME with my purchases if the group plan was not reimbursing me 100%. They charge $300 for the Quattro compared to the $165 CPAP.COM charges. Everytime insurance is involved everyone lines up at the cash trough... <sigh>.

Hello and welcome on board.
I'm in Ontario Canada and I bought my CPAP equipment at Shoppers Home Healthcare.
The government paid $780.00 and I paid $260.00 for the equipment plus $200.00 for the R.R.T. services. (Total of $460.00)
The machine I have is a Respironics Remstar Plus. I was told that this machine would cost $1040.00 if I wouldn't have O.H.I.P. I'm happy with the equipment but there might be other people who would prefer more bells and whistles.

I think $1040.00 is outrageously expensive for a "bare bones" machine like the Plus even with a humidifier and mask! Without the government help, it would be a total ripoff. I got my first machine ( bare bones with humidifier and mask) that way 6+ years ago. I had another sleep study last year. It was "no go" for a new machine since I only needed (they thought) a pressure change and my old machine was still working. I bought the auto setup online with my own money. There are so many new comfort features,etc available now to have a bare bones machine. The ones will new comfort features, etc can also run in straight cpap mode.

I know buying on your own is not always a financial possibility. It makes no sense, to me though, for the Supplier to give you a non data capable machine these days. I expect the Suppliers gets more profit if you get a "bare bones" machine but what about the patient?

I can get an Auto with A-Flex plus humidifier AND software and reader online for just under $1000.00. I actually got that setup for about $750.00 when I bought it online before the manufaturers raised the prices but I do know you can get the same setup as I have (Remstar Auto, humidifier and software with reader) for about $1000.00 online now. A mask is extra online but you pay about 1/3 of the price you would pay in Canada for a mask.

I know, for $1040.00 you get a machine (Plus - bare bones),humidifier and mask but still it is too much, in my opinion, even if your are getting R.R.T. services with that (which you don't get online).

You can't get an auto in Canada without a special prescription from your doctor. Online, I can get an auto with my 6+ years old cpap prescription only.

For a first time user, that Government help is useful. If you want a data capable machine they might have given you a Pro (with a prescription for a cpap), which is not an auto but, if you want to get the software sometime later you can get detailed data on the Pro. You can't on the Plus.

You will have that Plus for 5 years now, unless you have another sleep study and changes are found in your situation. Even then, they will just adjust the pressure and you keep the same machine, unless the new sleep study indicates a need for an machine with more bells and whistles or your doctor is more reasonable than mine was. If your machine has a problem in that 5 years, that will cost more to repair than is worth, you will get another machine under the warranty. It will probalby be a Plus again, although you MIGHT get a Pro should that happen. Otherwise, you have it for 5 years anyway, maybe more.

Even after 5 years, you can't get a new one unless your old one is broken beyond repair, You also have to have another sleep study then to get a new prescription. If there is no change (or just a change in pressure) and your original machine still works, you will only get an adjustment in your pressure. That is, unless you have a reasonable doctor who knows about the new features on the machines and how helpful they might be.

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'm with Great West Life, too. They pay 100% for masks, hoses, and parts for the xpap but 0% for filters, hose covers and that sort of thing.

They also do not reimburse for shipping costs when things are purchased online, and their calculation of the exchange rate to US$ from Can$ may not be what you had hoped. This is sad given that you can save them a lot of money by buying online instead of going back to the DME.

Payment from insurance companies likely depends on the plan that you have through your employer. I'm certain that there are differences in plans, even with the same insurance company.

Hose_Head 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'm with Great West Life, too. They pay 100% for masks, hoses, and parts for the xpap but 0% for filters, hose covers and that sort of thing.

They also do not reimburse for shipping costs when things are purchased online, and their calculation of the exchange rate to US$ from Can$ may not be what you had hoped. This is sad given that you can save them a lot of money by buying online instead of going back to the DME.

Payment from insurance companies likely depends on the plan that you have through your employer. I'm certain that there are differences in plans, even with the same insurance company.

Wow, interesting your experience with the filters. Great-West paid for an extra supply of filters when I initially purchased my machine.

OptimisticChap wrote:Hello and welcome on board.
I'm in Ontario Canada and I bought my CPAP equipment at Shoppers Home Healthcare.
The government paid $780.00 and I paid $260.00 for the equipment plus $200.00 for the R.R.T. services. (Total of $460.00)
The machine I have is a Respironics Remstar Plus. I was told that this machine would cost $1040.00 if I wouldn't have O.H.I.P. I'm happy with the equipment but there might be other people who would prefer more bells and whistles.

I'm curious. What service did the R.R.T. provide for the $200 that you paid? Were they upfront with you about this charge or did they surprise you with it at the end of the transaction?

I didn't pay any R.R.T. charge when I got my APAP through ADP. I would have walked out the door had the DME tried to charge it to me. My take on this is that the R.R.T. services are already built-in to the padded prices that they charge for these machines.

I hope that you have insurance that reimbursed you for that extra charge!

I'm surprised you got charged for services on top of your machine, mask and so forth. When I was in getting my machine from Medigas, I was told the two-hour meeting I had where we went through masks and the workings of the machine and all that were including in the $1040 and were required by Ontario as part of the ADP funding.

Weirdness.

But then again, I got the Resmed Elite II as my $1040 machine and I've met a number of people who have more recently been denied that machine at that price point. It just doesn't make sense.

After watching that Michael Moore movie "Sicko" I was already to marry a Canadian and move up to Canada for the health care. (Just kidding! No one would have me with my central sleep apnea and hypersomnia!) Moore made it seem like the health care up there was terrific. It doesn't seem any better than the health care you get here in the US. What do they do with people like me, I wonder. The sleep doctors tell me I need a ResMed VPAP adapt SV for the central sleep apnea and they aren't sure that will cure the hypersomnia. The machine costs around $5000 online and I never could afford it. If you're lucky and had cash to bargain with you could probably get the VPAP adapt SV at a lower cost, but I don't think many folks in the US or Canada have that much cash just lying around. If the Assisted Device payment is only around $700, what would happen when you find out it costs $5000. I wonder how much more the VPAP costs in Canada too. It might even be twice that cost since it seems like they are doubling the price of everything else.

What do poor people supposed to do in Canada? I know, here in the US, they just tell me to live without... and just suffer without... and all I do is sleep all the time even though I never really sleep a nice deep refreshing sleep. How does anyone ever afford a VPAP that costs $5000? Are all the governments just trying to decrease the surplus sickly population by not providing necessities for sick people? Is there any way, besides being independently wealthy, to afford to by a $5000 machine? What do you supposed to do when you are so poor you have to count change to buy food, and you have hypersomnia so you can't stay awake and alert enough to work and you can't buy the machine to help??? Does this mean that even if I lived in Canada I'd end up homeless and living on the streets because I can't find funding to buy the machine I need? I guess unless I marry a wealthy husband I'm just out of luck to ever stay awake all day or to drive or work again. This doesn't make any sense to me. Somewhere in the world they must treat sick people better. I just can't figure out why it is such a crime to be sick... and tired.

I wish everyone luck getting your machines at reasonable prices. I guess Canada is out of my future completely too now. I can't shovel snow anyway because I have a bad back too. Oh well, thanks for reading my rant. I'm starting to wonder if the world just wants me to commit suicide so I can stop being a burden on everyone. It doesn't seem like there is help anywhere for someone like me (poor and sickly.) Oh well, I'm too old and ugly and sickly for anyone to marry me anyway, be it a Canadian or a US person. That was my only hope... getting on someone else's health care plan. What do people do when they are alone in the world and sickly and poor? If you don't have family or friends what is a person supposed to do? This world is in bad shape when the best thing for sick people to do is to die off and decrease the burden on the taxpayers and the systems. Sorry, I gave up on having a positive attitude when I heard the machine I needed was $5000.
Karla

General health care isn't all that bad up here... but the apnea side of it seems to be equally bad everywhere.

I can generally get in to see my family doctor within a week of calling for an appointment. When I arrive for the appointment the most I have to wait is 10 minutes... sometimes I'm escorted into the examination room or his office before I have removed my coat. lol I'm never charged a penny except for those rare services that are not covered and considered optional.

But if you lose your family doctor up here good luck in finding another one... you will end up like many others visting clinics and perhaps seeing a different doctor each time... so the continuity of care is lost. I very much appreciate my doc who I've been going to for well over 20 years. In 2 or 3 years his plan is to retire... at that point I guess I will become like many others up here making do with clinics... although I may not still be here. Company has relocated to San Antonio so I may be down there by years end... we will see.

I'm also not a heavy user of the medical system so my experience may not resonate with all Canadians.

I think by and large Moore's documentary was pretty fair of our system. But it isn't perfect for everyone for sure, especially due to conservative types in our country that push harder and harder to make our system a "for profit" system like the USA. I live near a small rural town of less than 1,000 people and it has as very small hospital for the region. I can call my GP's office at 9 am and get an appt. that day, usually within an hour or two, though it takes me an hour to get there. I was told that PAP therapy can be covered by B.C. health if it is a serious medical condition determined by doctors, and I think that they mean really serious. My sleep specialist did not deem my situation serious enough to have our medical system pay for my machine and mask, but I had two sleep studies done in 5 years, one of which I waited 10 months for (again my situation wasn't deemed serious and it didn't interfere with my work, such as being a truck driver or commercial pilot, etc..) and the other I waited less than a month for. After the 1st study and my failed ignorant attempt at CPAP, I paid for my oral appliance out of pocket via a payment plan over time and I bought my PAP equipment out of pocket mostly via cpapauction, but I can claim all of this as medical expenses at tax time and either reduce my taxes owed or it may help me get a refund. I'm self employed, so any deduction is helpful. Also, if my annual earnings are lowish, then I can qualify for medical premium assistance or get complete medical coverage, which I've had for the last year due to a slow year of work. So for the last year, I've thankfully not had to pay any monthly public health care insurance premiums, which are low enough anyway, and I get complete medical coverage in the public system as if I were paying regular monthly public health care insurance premiums. We are never turned away from a hospital nor have to pay for most things or very often any, due to our financial situation. There are exceptions some times and horror stories some times, but in my 50+ years, I've never had a problem and my longest wait ever was for my 1st sleep study 5 years ago. I can't imagine a better system. When my income has been good, I pay an insurance premium, which as of now would be $130 every 3 months. If my income is low enough, I pay nothing and get complete coverage. It just never dawns on me that I'd need to worry about health care.

Unfortunately, it's not as easy as just marrying someone for health care or social insurance. Our immigration department is well aware of that type of situation and fiercely scrutinize marriage arrangements. Sadly again, legitimate marriages at times end up suffering due to immigration delays because of the microscope that the immigrations department puts couples under, but the situation is no different for those trying to marry into the USA.

In summary, I really hope that your situation improves and I sympathize with how difficult it seems to be for you. Getting healthy and struggling to get on one's feet is even more difficult when we're sleep deprived. But when you do have moments of energy and clear thinking, I hope that you can figure out some way forward. If learned for me that if I don't have my health, then I don't have much and I can't help myself or help others. I've also learned that my health is a priority for me above most things, and I take full responsibility for maintaining it the best that I can. I wish you peace and a way forward.

Karla1958 wrote:....The machine costs around $5000 online and I never could afford it. If you're lucky and had cash to bargain with you could probably get the VPAP adapt SV at a lower cost, but I don't think many folks in the US or Canada have that much cash just lying around. If the Assisted Device payment is only around $700, what would happen when you find out it costs $5000. I wonder how much more the VPAP costs in Canada too. It might even be twice that cost since it seems like they are doubling the price of everything else.

What do poor people supposed to do in Canada? .....
Karla

Actually, the payment from Ontario's ADP (Assistive Devices Program) is 75% of the approved price for the machine that's prescribed. For a cpap, that's 75% of $1040 = $780, as you've noted. For an auto-pap, it's 75% of $1585 = $1188.75. I'm certain that bi-paps also are covered, at their own approved prices. Every Ontario resident qualifies for these payments from ADP. Other province's plans likely will differ.

Also, in Ontario, people who are on disabilities qualify for 100% payment of their xpap. There may be other government assistance programs too.

Many employers offer supplemental medical insurance too. My employer's plan picks up the 25% balance, and pays for supplies too (see earlier posts in this thread.)

Hose_Head wrote:

Karla1958 wrote:....The machine costs around $5000 online and I never could afford it. If you're lucky and had cash to bargain with you could probably get the VPAP adapt SV at a lower cost, but I don't think many folks in the US or Canada have that much cash just lying around. If the Assisted Device payment is only around $700, what would happen when you find out it costs $5000. I wonder how much more the VPAP costs in Canada too. It might even be twice that cost since it seems like they are doubling the price of everything else.

What do poor people supposed to do in Canada? .....
Karla

Actually, the payment from Ontario's ADP (Assistive Devices Program) is 75% of the approved price for the machine that's prescribed. For a cpap, that's 75% of $1040 = $780, as you've noted. For an auto-pap, it's 75% of $1585 = $1188.75. I'm certain that bi-paps also are covered, at their own approved prices. Every Ontario resident qualifies for these payments from ADP. Other province's plans likely will differ.

Also, in Ontario, people who are on disabilities qualify for 100% payment of their xpap. There may be other government assistance programs too.

Many employers offer supplemental medical insurance too. My employer's plan picks up the 25% balance, and pays for supplies too (see earlier posts in this thread.)

There is no ADP program or equivalent in Quebec... no assistance whatsoever because the Quebec government do not yet recognize apnea.

So if you live in Quebec and do not have group plan coverage for xPAP equipment you will pay on your own.

The situation as far as cpap machines and recognition of sleep apnea is the same in other Provinces as it is in Quebec.

I think the Atlantic Provinces have the same attitude , as I understand it.

Hawthorne wrote:The situation as far as cpap machines and recognition of sleep apnea is the same in other Provinces as it is in Quebec.

I think the Atlantic Provinces have the same attitude , as I understand it.

Ahem... no. I live here and just went through the process in September.

Sorry Paul 56. Are you saying that sleep apnea is recognized in at least some of the Atlantic Provinces - possible all of them - and that there is Provincial funding for cpap machines as well?

I'm trying to clarify because I have friends there, recently diagnosed, who say it is not recognized and there is no help from the Province for cpap machines.

Do folks living there get some help?

Thanks.