The horror - the HORROR!

Ok, total newbie here. After years of symptoms I self-diagnosed myself with sleep apnea, talked to my doctor, had a sleep study, and it was verified (AHI of 61.1). I recently had my CPAP titration trial but my doctor hasn't gotten the results back yet - she should get them any time now.

The HORROR I'm experiencing right now is that I'll soon have a prescription in my hot-but-sleepy hands, but I'm not sure what route I should take regarding equipment. I've been reading a ton, and talked to my insurance company. It works out like this - if I go in-network, I HAVE to deal with a single DME they approve of (Wright & Filippis), and they cover everything. If I go out of network, I'm subject to a $350 deductible, then they pay 80% after that.

I'm a technically savvy person, and I want all the bells/whistles possible so that I can find the right combination of features that will help me get the best sleep. I love the idea of software that'll let me observe/track my progress. I'm guessing the DME won't supply me with a machine that'll have those features. I'm also very interested in APAP.

I've tried calling the DME to find out about options, but so far they just take my name/number and say they'll call me back (perhaps they aren't in a hurry since I don't have a prescription yet).

SO - any recommendations? I'd hate to get a low-end machine from the DME, have them bill insurance, and I'm stuck at that point (or have to pay 100% out of pocket for a second better machine). Then again, going the DME route is probably much easier, as then I don't have to play the submit-receipts-to-my-insurance company game.

By the way, if I want to order an APAP on my own, I know I need a prescription - does the prescription have to specify APAP, or can it just say CPAP?

Also, if I want humidifier/heater, do I need that on the prescription for insurance purposes, or do most insurances pay for those options (or do most not pay for them).

Thanks for helping a confused newbie. Remember, I'm still suffering untreated, so be kind. zzzzzzzzzzzzzzzzzzzzzz.

Welcome to the club. Sorry you have it but glad to have you!

The cpap.com FAQ lays out their Rx policy pretty well. The short version is that yes, they'll sell you an APAP with a CPAP Rx and you don't need an RX for a humidifier but they will list on the invoice the proper billing code for the humidifier.

Here are my sources:

https://www.cpap.com/cpap-faq/Prescript ... l#FGID-130

https://www.cpap.com/cpap-faq/Insurance.html#FGID-101

FJC,

VERY unlikely that you will get ANY "bells or whistles" if you go through the DME.

You may be able to avoid having to file to your insurance yourself if you buy from billmyinsurance.com (a division of cpap.com, our hosts).

Have your Doc write the prescription for cpap and heated humidifier. You can get an apap from cpap.com with a prescription for cpap, I assume billmyinsurance.com is the same but you may want to check with them in advance. If you need to get an apap prescription and your doc is hesitant, let him know that if the auto adjusting feature does not give you good therapy, it can be set to a fixed pressure.

FJC wrote:I've tried calling the DME to find out about options, but so far they just take my name/number and say they'll call me back (perhaps they aren't in a hurry since I don't have a prescription yet).

Not a very auspicious beginning of a relationship with an entity that theoretically wants your business. Usually they wait until after they've got you in their clutches before they start ignoring you. This does not bode well at all.

RUN! RUN AWAY!!!! RUN WHILE YOU STILL CAN!!!!!

can someone hlp me in understanding what these numbers mean....it seems that before and after titration numbers seems to be a wide margine, is this normal?

SUMMARY: TOTAL INDEX
BEFORE AFTER BEFORE AFTER

AmIRDI 304 2 61.9 2.6
Arousais 380 13 77.4 11.2
ELMs 20 38 4.1 5.4

Lowest saturation 85% 90%
Mean saturation 94% 96%

( All values are during sleep)

RamblinMan, the wider the margin between the "before" and "after" numbers, the better. If they're going the right direction, of course. And your important numbers were.

The "before" are when you were being diagnosed...studied without a cpap machine to keep your throat open. The "before" numbers are how bad off your breathing was.

The "after" numbers were acquired while they applied cpap to you. The "after" numbers are with treatment actually going on right then and there...you wearing a mask and a cpap machine keeping your throat open to let you breathe freely.

Looks like you took to the treatment like a duck to water, or a bird to air. The "after" numbers for the most part look good...the way they should! The PLM's (I think that's probably what the initials were instead of "ELM") (periodic limb movements) went up a bit during the cpap phase, but I don't think I'd worry about those too much right now.

If you still feel worn out in the mornings after being on cpap treatment for awhile, I'd ask the doctor about the PLM's. They may have disappeared after you got settled in with cpap at home for awhile. I'm not a doctor, though, and I could be looking at it wrong. So if in doubt about any of the numbers stuff, do check with your doctor.

WELL THAT DIDN'T COME OUT TOO GOOD AS FAR AS ALIGNMENT...

SUMMARY: BEFORE

AUT/RDI 304
Arousals 380
PLMs 20
Lowest saturation 85%
Mean saturation 94%
All values are during sleep)



SUMMARY: BEFORE INDEX

AHIIRDI 61.9
Arousals 77.4
PLMs 4.1

All values are during sleep)


SUMMARY: AFTER

AUT/RDI 2
Arousals 13
PLMs 38
Lowest saturation 90%
Mean saturation 96%
All values are during sleep)


SUMMARY: AFTER INDEX

AHIIRDI 2.6
Arousals 11.2
PLMs 5.4

All values are during sleep)

FJC wrote: I've tried calling the DME to find out about options, but so far they just take my name/number and say they'll call me back (perhaps they aren't in a hurry since I don't have a prescription yet).

Ugh - the stories I could tell ......

Well my wife wasn't too fired up about paying the deductible, so I called the DME again - this time, not the closest office, but one just a little bit further away.

Got a REALLY nice RT on the line, who was very helpful. She checked and said my insurance would pay all expenses to rent (and eventually own if I want) a REMstar Pro unit. I can pick it up on Tuesday. Not an APAP, but I'll give it a try, and since it starts out as just a rental I can always shift gears and order an APAP online. She also said my insurance covers a new mask every 3 months.

Wish me luck! Hopefully it's just that one office that was really bad...