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cpapguru38 wrote:I'm new and all, but even I can see this this big scam. It does not need to cost what it does for all this. Is outright fraud in my opinion....

I went to a small town country doc, no insurance, he whipped out his prescription pad and wrote....."one cpap machine with mask" He expalined how I would need to go through some trial and error to get things adjusted and suggested I use an auto, with C flex. which I have done. So far I'm going into night #5 and feel like a I have not in twenty years! Today I had more energy then ever, no heart palpitations, brain fog, or sluggishness on 5 HOURS OF SLEEP, with the machine. Isn't this the point?!?!

I absolutely assure you, I will achieve my goals of good sleep and am already on my way. And I did not need to, nor will I get legally robbed by a sleep study, or DME!

I like your Doctor, keep him! Obviously he even knows the value of an auto...of course for some of us, some folks have more complicated apnea which may require a bi-level machine or other type...which I have no expertise nor idea what is used for what. All I know is that my home sleep study $150 Canadian, showed that I needed an auto. I had over 200 hypopneas in an hour! I think for some a sleep study by a good lab and a knowledgeable doctor could prove valuable....but agreed not at highway robbery prices.

I am now checking my own pressures and trying to learn what the results mean and the folks here are helpful.

Yeah, well, if your sleep disorder is NOT OSA, or if you have additional sleep disorders in conjunction w/OSA ..... there IS a place for a full in-lab PSG.

And the in-lab sleep accomodations, equipment to do a proper PSG, salary for a GOOD RPSGT to conduct that PSG and also to score it is a pretty healthy investment on the part of the sleep lab owner. Notice I'm not even including the cost of office staff and an accredited sleep doctor.

Slinky wrote:Yeah, well, if your sleep disorder is NOT OSA, or if you have additional sleep disorders in conjunction w/OSA ..... there IS a place for a full in-lab PSG.

And the in-lab sleep accomodations, equipment to do a proper PSG, salary for a GOOD RPSGT to conduct that PSG and also to score it is a pretty healthy investment on the part of the sleep lab owner. Notice I'm not even including the cost of office staff and an accredited sleep doctor.

In some rare cases that might be true. But when your wife tells you, that you snore light a locamotive and stop breathing due to gagging every 30 seconds, it is OSA. What treats it? Pressurrized air in the airway.

My point is, 99% of people never end up going with what specifically was prescribed. They have to adjust as they go until everything is fined tuned.

I think the sleep study is just another way for system to rip people off. 90% of people can simply buy an adjustable unit, find a mask that works and their done! People on here spending $10,000 a year, it's just nuts! The unit is nothing more then a mico-chip controlled mini air compressor and a plastic mask.

The therapy works and works well in its simplicity. All the other crap is just touchy feely stuff designed to control you, keep you in the"system" and rob you and your insurance blind!

This is so interesting! I was just thinking about this the other day...

Split-night PSG
Study
Charged $3,340.00
Ins. Paid $2,004.00
Dr.'s fee
Charged $1,257.00
Ins. Paid $807.25

Titration
Study
Charged $3,591.00
Ins. Paid $2,154.00
Dr's Fee
Charged $1,257.00
Ins.Paid $839.54

Sleep Specialist Consultation
Charged $529
Ins. Paid $228.54


I had to have the titration because I had 0% REM in the split. As it turned out my pressure recommendation from the split was 13 and from the titration (with REM) was 17. So that was a good thing, even though the doctor still prescribed 13 because "17 will be too hard" ?!?!?

And that doctor sounds like a grossly overpaid idiot.

Slinky wrote:And that doctor sounds like a grossly overpaid idiot.

Those grossly overpaid idiots really make the grossly underpaid layman idiots, like me, jealous!

Ain't that the truth, tho, jnk??!!!

My sleep study cost $3471.00 plus another $450 for asking the sleep doctor to simply review the results with me! This was a one night session, 1/2 normal, 1/2 with CPAP. My insurance covered none of this. I was at fault for not demanding cost info up front. Still, this whole thing shocked me as a over-priced con game. My health is important to me so I had to do it, but something is very wrong with the whole deal. Never assume that "insurance" will cover your costs. Demand the details up front, and expect to take it in the rear.

I live in Ontario, and it did not cost a thing to me or an insurance company. All paid by OHIP (Ontario Health Plan).

Provincial Health plan covers the doctor appointment, the specialist appointment, the initial sleep study (9pm to 6am) and the titration which is in about 3 weeks. In addition, they contribute up to $760 towards a CPAP machine, assuming one goes to one of their approved vendors. The approved vendors must sell the CPAP with 3 yr warranty, mask and other items. The end result is the DME's will sell you a basic setup for $260 out of pocket and if you want more than the basic, well they charge what they want it seems. The DME's make plenty of money out of the government program and sell the CPAP's at inflated prices, but from what I have seen that really is no different than CPAP machines in the USA being sold and billed to insurance companies. (I do have additional insurance via employer-that pays for things like dental, eyeglasses, prescription drugs etc, and they were willing to pay up to $2000 for a CPAP machine less whatever the government chips in.)

Now, of course OHIP is not "free". We pay higher taxes than the USA and there is a surcharge for OHIP added to our Provincial taxes. It is based on income and is zero if your taxable income is 20,000 or less up to 900 per year if taxable income over 200,000. I would imagine the average taxpayer pays about $450 a year. For anyone interested, the wait for the sleep study was about 3 weeks. There was additional waiting as they had to send the results to my regular doctor, who then had to send me to a specialist (respirologist) who was the one who actually wrote the CPAP prescription. It didn't help she took a 4 week vacation just when I wanted to see her. I got the machine from the DME within 2 days of getting the prescription.

In any event, I am glad they covered the study. In Canada government health plans are not federal, but provincial, so each Province has different rules. Looks like Ontario is fairly generous in what they cover.

Both were billed at $2400 and insurance approved ~$1200 with a $30 co-pay. My doc runs them out of his own office. There are 4 rooms. If the average insurance pays the same amount, that's nearly $5000 a night. He only has 2 techs on staff. I'd love to be making that kind of money while I sleep.

My sleep study was a 2 night study. My bill was not split out by different types of services like reading, study, etc. It was just one HUGE bill and I was shocked when I got it. The bill was for $8975.00!! I don't know what the insurance ended up paying for it and how much was actually "written off". I have no co-pays with my insurance. My husband had a sleep study the next month and by the time 2 sleep studies and 2 resmed cpap machines and 2 Mirage Quatro masks the insurance was billed a total of $21,650.00 for both of us. I have no idea what they actually paid of this - no wonder medical costs are so high. Do companies bill double or more knowing that some is going to be written off?[

I'm wanting the insurance and sleep doctors to pay me. I know more about their machines than they do. Many of us here could teach them a thing or two. It's amazing what they don't know about their own profession.

Billed $1800 paid $360. Where i work paid rest

kennasgrammy wrote:.....the insurance was billed a total of $21,650.00 for both of us...

Did you call the police?

Nothing, absolutely nothing can justify that. How a society can consider this as acceptable?
That would be a criminal abuse in most of the developed countries in the world.

Good to see some happy PAP users on here. This is a very interesting question. Even as a sleep tech doing the procedures, we typically know nothing about the insurance and billing; we're just focused on the best patient care we can provide. However, I believe we desperately need some transparency in our healthcare system, and a huge part of that is making prices available, and not price-discriminating between patients based on who's covering them. The fact that charges often seem to come down to bargaining power seems quite out of line with the goal of medicine, to help people live healthier and better quality lives.