Need help deciding course of treatment/OHIP coverage

Hi guys,

I'm from Toronto, Ontario, Canada. I just completed my first sleep study and was diagnosed with sleep apnea, having around 30 apneas per hour. I met with the ENT at the sleep clinic and he gave me three options 1. Mouth Piece ($2000) 2. CPAP machine 3. Tonsilectomy (I have pretty large tonsils, so there is a good chance it should help). I decided to go through with the tonsilectomy first, however, I will not be able beto get the procedure for a few months because its not an "emergency". I have been suffering from severe morning headaches, and significant fatigue throughout the day and I'm finding it hard to study as I am a student. I'm not covered for the mouthpiece so its not an option for me, but the CPAP machine is, through OHIP and my private insurance so I was thinking about getting a machine while waiting for my procedure (good idea ?). I was wondering if anyone would be able to give me some information about getting the CPAP machine in Ontario, who do I get prescription from (family doc or specialist), where do I get the machine, how much is covered, what machines are covered, if there is a wait time, etc.

I did some research and I think I want to get the ResMed S9 with the Swift FX Nasal Pillow if its covered by OHIP, any ideas if it is ?

Thanks for the help guys

search OHIP - there should be many threads about it - people's experiences and costs

HI!

That machine and mask are a popular combination! I have a resmed machine, the s8 escape 2 and it works very nicely and juts recently got the swift fx mask and it is so light on your face you don't really notice its there.

As for the CPAP, the doctor in charge of your sleep study usually writes the script ( make sure he puts w/heated humidifier on on actual prescription as some insurance companies won't pay for it if it is not prescribed)

As for the machines themselves, your sleep clinic would probably have suggestions, barring that look in the yellow pages under Medical equipment or Oxygen.

In Ontario, if you do not have a health insurance plan through work, you pay for the machine yourself and prices vary starting at around 400 bucks and up to the price cap of about 1, 000 dollars. If you are on social assistance, ODSP or are a senior citizen the Ontario government "Asstsive Devices Program" or ADP will pay part or all of the cost of a machine provided you meet the criteria. Check the Ontario Government website for more info. (if you are on social assistance or ODSP and go to a place, make sure you tell them specifically which machine and mask you want and insist on it, as they will try to get you the cheapest machine going. refuse it and demand the one you want. they'll feign having to " talk to management" but will get it for you, especially if you threaten to contact ADP/OHIP.)

Oh and most of the DME's (place you buy the machine) will try to shove a 300 dollar extended warranty down your throat. turn it down, in Ontario they have to give you a 3 year warranty on it anyway and it's juts a way for them to make some profit on the sale.

i agree with most of what everyone has let you know. i am in ontario too. they cover part of it usually 75% for a cpap machine. the ones u mentioned a auto cpap and apparently what i was told by the assistance devices program that pays for that portion there are things to qualify for in order to get one. of them is a pressure rating of at least 10 or more. the other one is with your REM sleeps however i can't really understand that one. your dr should know all this if you qualified for an apap.

getting your tonils out are no fun so i always feel surgery is a last resort. i too was prescribed mouth appliance but insurance doesnt pay for it so im trying for a cpap auto. good luck with your search

machines that are covered depend on your prescript. if he wants a cpap then u can choose what you want to get. if he puts auto cpap cause you qualify then u have a choice there. everyone around here likes the auto cause if you don't want to use the auto it can be switched to cpap mode.
you also want to get a machine that is fully data capable. i has a memory in it that you can record your numbers, any leaks, and how many events u were having that night. i think they are SD card formats. it's beneficial to learn for yourself if the treatment is working and why it's not instead of having to run into the sleep labs everytime u still seem tired.

this is all the info i have learned from these helpful people so i thought i would pass it along to you. there is a cpap wiki lightbulb at the top of the screen for you to read more info about it all.

Mike, I think you should get the cpap. The surgery could well help, but there's no guarantee that removing your tonsils will prevent all your events; many of us have had tonsillectomies but still have OSA. When choosing a machine, you want to pick a fully data-capable one; this means it reports daily AI, HI, AHI, and leak rate. This is NOT the same as compliance data. You'll probably want a humidifier also. My understanding is that in Canada there are certain requirements that must be met to be eligible for an auto-titrating machine. If you meed these requirements that sort of machine will give you the most options for treatment. Whether apap or straight cpap, the key requirement is full data. Read all you can on this site, and ask us any questions you have.

You do not need to be a senior to get ADP coverage for your machine. ADP covers 75% of the machine if you qualifies. The sleep clinic you went to will send the Px to the vendor you choose. They will set you up. ADP covers $750.00 your part $250. You will want to get a better mask than the one ADP provides. Your vendor will do the ADP forms for you. There is no wait time. Your vendor should loan you a machine until the Px is final. You are entitled to apply for a new machine every 5 years.

Mike,
Get the prescription from which ever doctor will give you want you want..

The resmed s nine and swift fx are an excellent choice if you can use a nasal pillow mask..

It would be a good idea to start therapy now, as you will proabably end up on it anyway..

However, I hope the tonsillectomy helps.. most of us have problems with our tongues falling back into our throat..

I have huge tonsils too, but my sleep doctor said, it would not matter if I had them taken out.

Till you can get your s nine, sleep on your side or tummy.. You are in the severe catagory, so this is affecting your health
in many ways you might not even realize..

The mouth pieces can be very uncomfortable, and cause jaw problems long term, some people like them though..

If you get the machine, and it works like a charm, you can always cancel the tonsillectomy!

good luck and keep reading!

elena