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I have AETNA insurance and their guidelines were that I had to try the regular CPAP first - if that did not work, then if medically necessary (per my MD), they would authorize the APAP.
I guess it all boils down to $$$ - and what they are comfortable in their knowledge of - I called Aetna about the APAP, and I was transferred to 3 different people, who all told me something different about APAP. So, I guess that not too many are "in the know" about the differences.

I considered that possibility (that I would have to "try" the regular CPAP first to get the APAP under insurance). Problem is that it is my money too. How long will I have to try it, and pay rental, then start another rental period again with APAP with no real guarentee that the insurance company will buy the machine anyway?

Just sucks up more of my money in rental when I know my issues (weight flux and comfort) - I will gain AND lose weight, it is a given for me.

I sleep on both side, back and front) and I would most likely be so much happier if the pressure adjusts depending on my position. Can't really measure happiness and ease of use/greater compliance. And even then the major reason -- weight flux won't be immediate.

So to go through the trial of and have to complain about regular CPAP, visit my doctor and pay more copays to him, and extend the "rental" period is silly. Just to possibly get denied again.

Might as well try the appeal up front, then if I lose, use my money that I would have wasted on the rental and co-pay etc to buy my own machine. When the real difference between the two machines is about $180 or less seems like a huge crock of --Well you can guess what I mean -- that the insurance companies won't give the best thing for the patient. Might actually cut costs since I wonder what they do with the rejected "used" CPAP machine.

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, CPAP, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap machine, CPAP, APAP

No more updates about your Insurance & DME fights?

How did you all make out? Did you get the machine you wanted through I*nsurance and your DME?

Or, did you end up paying out of pockets to get the machine you wanted?

I'm in the same boat.... Fighting with Apria to give me a Remstar Auto.

My sleep Doc wrote the prescription for that machine specifically.

But Apria won't deliver it. They said I would have to pay 100% for that machine. Not even an offer of paying cash for, what they called, an "upgrade".

Ridiculous !!!!

Now I know why eveyone calls the the "EVIL DME's".

Tim

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME, Prescription, auto