New here

Hello all! I am new here. I stumbled on this site while searching for information on apnea. My husband is so bad, I could hardly stand to sleep next to him He went in for his intitial sleep study and the results came back as severe apnea. I have requested a copy of the report. He will go in for his 2nd study with the cpap machine on Wednesday night (yep, day before Thanksgiving).

We are very blessed to have awesome insurance that covers all but $20 of each sleep study (yea!). They say they will cover 80% of the machine and mask. I have been trying to research how much everything will costs. If anyone can direct me in the general direction I'd appreciate it.

Nintfamily

nintfamily wrote:Hello all! I am new here. I stumbled on this site while searching for information on apnea. My husband is so bad, I could hardly stand to sleep next to him He went in for his intitial sleep study and the results came back as severe apnea. I have requested a copy of the report. He will go in for his 2nd study with the cpap machine on Wednesday night (yep, day before Thanksgiving).

We are very blessed to have awesome insurance that covers all but $20 of each sleep study (yea!). They say they will cover 80% of the machine and mask. I have been trying to research how much everything will costs. If anyone can direct me in the general direction I'd appreciate it.

Good luck on the second sleep study.

You will want to read the Wiki (the light bulb above).

The cost of the equipment will depend on the type of equipment your husband needs. CPAP is less expensive than APAP. However, your husband should probably ask about APAP, since it better adjusts to changes. For example, if your husband regains some energy, he could well lose weight, which would change his pressure needs. The APAP would better adjust to it. Of course, if your husband needs the next level up, a BiLevel Positive Airway Pressure (BiPAP) machine, then it will be more expensive.

You should request a heated humidifier be included on the prescription. It helps avoid drying out the nose, mouth and lungs. It is generally very helpful in the winter.

I also would recommend you request a fully data capable unit. That is, a xPAP unit that will track the number of apnea, hypopnea and snoring events it detects. It allows you to see how effective it is at reducing issues that disturb his normal sleep.

Since you have a good insurance company, you probably need to see if they require a specific set of DME (Durable Medical Equipment) suppliers in your area. Or can you purchase equipment (with a prescription from his sleep doctor) and then submit the expense. That is normally less expensive, since online vendors such as https://www.cpap.com can provide a much lower cost than if you work with a DME.

Check with your insurance company.

So, welcome and good luck to the both of you.

Welcome aboard. This site is I guess you could say a sister site to cpap.com which sells cpap equipment. Their are other sites out there that sell but the prices are all around the same and cpap.com has a price match guarantee. They also run this board for us so what else could you want. Anyway you will find out what his pressure requirement will be and what they fit him with a full face mask, nasal mask or nasal interface.

Up above you will see something for new people, you will want to go there and read some of that. You want to try and educate yourself as much as you can.

When you do get a machine you want to make sure it is a data capable machine that can have the data downloaded. That way you can download and keep track of things yourself.


Let us know how the second night goes. If you have questions that aren't answered repost them. Sometimes many of us still forget things after all we have sleep apnea. At least that's the story I give for fogetting things.

Best of luck to you.


Gerry

Here is a link to a list of Data Capable cpap's:

viewtopic.php?p=307168#p307168

It can be overwhelming because the names of different machines sound very similar, eg. S8 Resmed Elite which is data capable, and S8 Resmed Escape, which is not. Using this list, you can do a search on cpap.com to check out prices and the features of each. Also you can go to the manufacturers, eg. Respironics, Resmed (the 2 biggest), etc. for more information.

Welcome to the forum and good luck in your search.

nintfamily, your ultimate cost will depend a great deal on not only what machine and accessories are prescribed, but how the machine is paid for. It is common for DMEs to dispense the least expensive machine possible. Normally a straight CPAP with only compliance data. The insurance company will often "rent" the machine for up to a year to ensure the patient demonstrates therapy efficacy and compliance before they pay for the equipment. If this happens, your 20% of rental costs can quickly exceed the outright purchase price of equipment.
To avoid this scenario, you need to obtain the sleep study results and titration recommendations and work with your personal physician in formulating a written prescription for equipment. This prescription gives you the freedom of choice to use the DME identified by the insurance company, or to buy equipment online at significant discounts. That in turn gives you leverage with the DME to get the equipment you need under more favorable terms. Basically, you need to find out if rental costs will exceed $1000 in copay expenses. $1000 is about the full-price of a premium Auto unit (APAP) with data capability and humidifier, and they can be had for as little as half that amount.

Ideally, your prescription will be for an auto-titrating unit (APAP). This allows the titrated settings recommended by the sleep study to be set into the machine, with a margin for increasing and decreasing pressure to respond to changing needs brought on by sleeping in different position, and changes in day to day physiology and health that make a difference in the amount of pressure needed to achieve optimum therapy. The sleep study is a snapshot and may give a good approximation of the pressure needed. Unfortunately, it is a very artificial environment and people get colds, sore-throats and sleep in different positions. APAP is the way to go. All APAP machines on the market have data capability. That is the key to taking charge of your therapy, seeing the success in reducing the number of apnea event, or seeing if they are still occurring and why.

Good luck. Its a somewhat difficult journey, and the initial learning curve is steep. It won't be long before it all seems very simple.

Most insurance companies will not rent longer than 90 days prior to purchase. They will then require your physician or DME to provide proof of compliance, usually a 30 day download showing that your using your machine. Medicare will rent for 13 mos provided compliance is shown within the first 90 days. If your insurance pays 80% with a 20% co pay you can expect to pay approx 250.00 for your machine. Mask and tubing will be x-tra but payment will work just like your machine. Don't forget about your heated humidifier which will cost you approx 50-75 dollars. Take all these figures and add any rental charges for whatever time your insurance rents. Bottom line is aprox 215 for machine, 23.00 for mask, 60.00 for heated humidifier, 7.00 for tubing and 20.00 a month x 3 mos for rental. Total approx 365.00 (out of pocket)

can't add. change machine to 250.00, makes total approx 400.00

one more thing. Reimbursement is the same for fully downloadable machine whether it be auto or not. All cpap machines are reimbursed at the same rate, just like all bipap machines are reimbursed at the same rate. The bells and whistles don't change the reimbursement rate.