Novice Questions

Well, I just got the call from my Dr. with my sleep study results and I have been diagnosed with . . . ta da - apnea. So here I am beginning my research into the wild world of CPAP. I have an appointment with the specialist next Monday, and I want to be prepared and know what I want in terms of machine, mask, etc. So I have some questions.

1) Needless to say I am hoping that my insurance (Aetna PPO) will cover a chunk of the cost, but out of curiousity anybody else here have Aetna and can advise on how this works with them?

2) Any clear preferences or recommendations for machines & masks? I want something I can travel with as easily as possible (International 1x/yr) and as small as possible for camping on battery.

Mask wise, I have a tendency to get very dried out at night (even with a room humidifier running), and often end up breathing through my mouth due to frequent sinus congestion. From what I've read so far I think I'd prefer the nose (pillow or mask) type attach mask from a comfort perspective, but perhaps I'll need the full nose/mouth mask?

Any hints or advice greatly appreciated, but I am guessing this is a lot like trying to ask someone else to advise you on the "best" car, pc, (insert complicated device of choice here). i.e. No clear Bests to be universally applied.

Thanks in advance.
Chuck (who although not thrilled about having to wear one of these devices, is really looking forward to getting to much needed rest!)

I have Aetna... mine's an HSA PPO. The DME said that it was really good insurance (whatever that means). The HSA means that I have a really high deductable. Aetna does cover apnea and does start with a rental first.

I have Aetna as well. I have the type where I have to have referrals from my primary care provider, not sure if that is epo or ppo. Anyway, I am covered 100% on the cpap stuff, and my regular co-pay to see the sleep doctor or spend the night at the sleep lab for the study.

Aenta rent's a Remstart Auto for me, and it should be mine in a few months. They also paid for my mask. So the equipment was $0 for me. For the mask replacement they do not have a 90day or 6 month policy. They replace the mask as needed.

Hope your insurance experience with them is as good as mine was. The only drawback is that they don't deal with cpap.com so I had to go trough a DME they sent me to for the equipment.

Best advice is to go back and look at several topics.
Your questions have been answered thoroughly.

Look hard.

I vote for INSIST on an autopap instead of plain cpap.
I highly suggest you call the billmyinsurance.com and see what they can do for you.

Be very careful dealing with the DME- they are not famous for honesty or integrity.

I vote for a breeze mask.

Thought for the day:
Fat people are harder to kidnap.

Looks like you're getting your homework done, Edgerunner.......A few snags.....even discouragement is to be expected, but hang in there......(and hang in HERE!).......it can be quite a ride.......Good luck......ask these folks about any problems........ and don't forget to laugh....even if it's at yourself.

I have a tendency to get very dried out at night (even with a room humidifier running), and often end up breathing through my mouth due to frequent sinus congestion. From what I've read so far I think I'd prefer the nose (pillow or mask) type attach mask from a comfort perspective, but perhaps I'll need the full nose/mouth mask?

Your congestion may be part of the vicious cycly created by obstructive apneas: your mouth opens in order to snore, everything drys up, your nose congests, you do even more mouth breathing.

Insist on a heated humidifier with any machine you buy, that makes sure you breathe humid air, and many of us have discovered that this, in combination with no snoring, clears up their congested sinuses. The humidifier in your room is not relevant, since the your nose and mouth will be dried by the air pumped into your nose and mouth (Think of sticking you head out of a car window).

For years I used to wake up with a dry mouth, stuffy nose, slight headache, and I assumed they were an aspect of having - to quote the doctor "a slight allergic tendency". Breathing humidified, filtered air at night, for a year has done wonders: no dryness, no stuffiness, no vague headaches.

O.

Hi, and WELCOME!

The fact that you know enough to ask questions is already a great thing. There is tons of info on this forum and others. Scroll backwards and read what sounds interesting.

I think of the equipment on a few levels. There is the machine. The brand, and the type. Personally, my situation did not seem to require an APAP, but many if not most can benefit from APAP, so ask your Sleep Doc about this. Also, make sure you get a machine you can self-monitor. One that you can download and see the data.

Choosing the machine is relatively easy. It is the mask that is usually the challenge. Like you said, just need to try and see what works. If you get it narrowed down, there are lots of tips on the forum about how to make small adjustments to make different masks fit/work better. The mask choice is a whole project unto itself.

Now, regarding the humidifier. What I would recommend, and others may not agree, is to wait until the second week to add the humidifier. The reason I feel this way is that the humidifier, while a great theraputic addition, can have some adjustment issues too, especially regarding "rainout" which is the accumulation of condensation in the hose or mask. So better to get past the first adjustment of the machine before adding the humidifier. However, if your sinuses are going to be an issue, then maybe it would be better to take the humidifier from the start. If so, wrap the hose in a fleece scarf, including the small hose leading to the mask.

The later stages include the accessorizing. That is the fun part! You can think of fun hose covers, pads to cover the straps, extra masks to play with, a heated hose from Down Under - the possibilities are endless! By the time you get to this stage you will be so in love with your machine that you will want to buy it lots of toys!

Good luck, keep postin'

AII

Aetna can be a pain, but stick with it and you will get paid. Sometimes you'll be talking with someone that really has no clue, don't worry, it happens, just ask for someone else, or call back later.

A few things to arm yourself with: Aetna's policy document on OSA http://www.aetna.com/cpb/data/CPBA0004.html, and their policy on replacement frequency of various consumables http://www.tricenturion.com/content/Doc ... stem%2Ehtm

Also you may already know that coverage for DME varies widely, even with Aetna PPO, as there are various insurance riders that companies can purchase to increase the coverage.

I bought my CPAP gear from cpap.com and submitted the invoice to Aetna, after about eight weeks I received a check. It was held pending review for quite a while, and showed a ridiculously low level of payment for a long time. But after some firm letter writing, including my pointing out that I ordered exactly what the doctor had specified they came through with a full check. Didn't even ask for compliance numbers, and successive claims have sailed through.