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SleepWrangler wrote:

ShelaghDB wrote:Curious what the price of APAP machines work out to if ones insurance pays all but 25%? Or at least a rough area quote?
I emailed the seller of the S9 AutoSets and Elits I have mentioned here about the price of an APAP and he told me unfortunately they were much higher, $1800.

Have you gone through the Ontario process at all? Your posts come across as someone not familiar with apnea diagnosis, equipment choices, vendor selection, ADP and vendor billing but does contain a lot of information related to selling electronics and hawking equipment for a practicing doctor active in the medical field. In Ontario this is unethical and possibly illegal. Are you aware that your statements about this particular seller are so persistent that they come across as astroturfing?

My curiosity is piqued so I will ask directly "Are you astroturfing?". Astroturfing is the practice of masking the sponsors of a message or organization to make it appear as though it originates from and is supported by grassroots participant(s).

BTW, insurance does not pay "all but 25%". The ADP program pays all but 25%. Private employment or group insurance may pay all or a portion of the remaining 25%.

She is new and working with a clinic and having a hard time of it. It may be that she is just using insurance or may not qualify for ADAP (not a "real" Ontario resident) or she is just being screwed over by her provider.

ShelaghDB wrote:Curious what the price of APAP machines work out to if ones insurance pays all but 25%? Or at least a rough area quote?
I emailed the seller of the S9 AutoSets and Elits I have mentioned here about the price of an APAP and he told me unfortunately they were much higher, $1800.
I don't know if they are just $3k machines and $1800 is still a good deal OR whether he is unable to get a deal on them and $1800 is the rough going rate for everyone wishing an APAP machine?

/just looking ahead at the possibility of needing an APAP machine at some point

You already have an APAP machine which is a single pressure machine. The S9 AutoSet is what we call an APAP machine because it has the ability to have auto adjusting pressure mode as well as fixed pressure (which is cpap mode) but in both instances it's considered a fixed single pressure even if EPR is used. I think you maybe confused about people's need for a bilevel pressure machine....bipap is Respironics model term and VPAP is the ResMed model term but both refer to a bilevel pressure machine and the person whom you bought your AutoSet from was likely quoting $1800 for the ResMed S9 VPAP model. They are more expensive and harder to find.

And yes, bilevel pressure machines are often used when pressure needs are in the upper teens or when aerophagia issues (at any pressure as aerophagia can be a problem with even as little as 6 cm pressure) create problems that can't be overcome so easily with a single pressure machine. I call those models "plain" bilevel machines because they are really not much more than glorified cpap/apap machines but to confuse you even more there's the high end bilevel machines used to treat central apneas....those are really pricey.

SleepWrangler wrote:My curiosity is piqued so I will ask directly "Are you astroturfing?". Astroturfing is the practice of masking the sponsors of a message or organization to make it appear as though it originates from and is supported by grassroots participant(s).

I personally don't think she is astroturfing. I think she doesn't understand all the various machine models as she is new to all this and she was given a brick initially and found out she was stuck with it so elected to buy a machine (the AutoSet) privately at a fair price and just wants to make it known that they can be found, like she found, and offer that option to people.
I think she is just trying to help.

Just a follow-up to my original post:

I've spoken with a CSR and claims assessor with ADP and they both have told me that the $860 is the maximum a vendor can charge me for a machine. I've taken the issue right up to the program co-ordinator and I'm waiting for a call back.

Called the vendor and outlined what I've been told, and what the documentation says. I was told that ADP cannot tell them what machines to carry, or what machines to sell, and if I only want to pay $860, then I can only have a "basic" machine like an Escape. If I want an "upgraded machine" with more features (like an s9 elite), then I have to pay the $200 upgrade fee on top of the ADP price.

When I pointed out that the ADP documentation says that the only way a vendor can charge more is if the patient is buying a mask/services, she pointed out that there are services included with the machine (like free downloads of data). I told her I had the Resmed software and a card reader and had been doing my own downloads for years, she didn't believe me. "We paid over $700 for the software. That's incredible that you managed to get it."

I ended the call by laying it out that I was waiting to hear from the Program Co-ordinator, and that I didn't want them to get in trouble for not following the rules. She said that the new ADP rules meant that they sell machines at less than cost if they don't charge the upgrade fee. I don't buy it.

I'm glad I came across this thread.

Living in Toronto, received a cpap prescription just a couple of months ago. I've had a loaner F&P since the middle of June or so. Much longer than expected because there were delays in whether or not I should have a cpap or apap, doctor on vacation, poor communication from clinic, etc.

When it comes to the machines I'm pretty perplexed at what happens with the ADP program.

• 1) They want to charge $300ish for a mask (Airfit P10) where the prices online are $100ish.
  2) The F&P Icon+ Premo w/ heated tube looks to be available stateside for $509, through the provider here they want to charge somewhere around me $600 to $700 (hard to get a solid price out of them) in addition to what they will bill the ADP program. The Respironics 460 I'm looking at has a similar price from the provider but not the very low cost the F&P seems to have stateside.

My main issue is that if I can purchase an F&P Icon+ Premo stateside for less than what the provider is charging me directly AND not end up billing ADP(taxpayers) for another chunk of change… why wouldn't I buy online from the states?

There is the issue of how long they've let me hold on to the loaner (though I offered to return it over a month ago they said to hold on to it), they've provided decent service I'm just not convinced they've provided a level of service that is worth the exorbitant prices they seem to be charging.

Your collective insights are most appreciated!

ChrisC wrote:I ended the call by laying it out that I was waiting to hear from the Program Co-ordinator, and that I didn't want them to get in trouble for not following the rules. She said that the new ADP rules meant that they sell machines at less than cost if they don't charge the upgrade fee. I don't buy it.

Thanks for the update. I think this vendor is full of crap too. Well at least you know that many here have reported success in getting an S9 Elite for the ADP mandated $215 fee.

bogzlot wrote:There is the issue of how long they've let me hold on to the loaner (though I offered to return it over a month ago they said to hold on to it), they've provided decent service I'm just not convinced they've provided a level of service that is worth the exorbitant prices they seem to be charging.

You should not feel obligated to pay for a process that inflates prices and provides unnecessary hand holding. Some people need guidance and mentoring from the vendor and ought to pay for the extra services. If you're here then you are likely not one of those people.

The Ontario government did a great job at capping taxpayer obligation to on-line equipment prices but left the patient to the mercy of a heavyweight doctor and vendor driven process. A lot of the early activity puts a burden on the vendor to manage the trial and provide a loaner machine. This activity is part of a sales strategy that the vendor willingly accepts because of possible employment insurance funded "upgrades" and overpriced supplies. Not everyone is in a position to provide the vendor with insurance money.

Have you gone through the Ontario process at all? Your posts come across as someone not familiar with apnea diagnosis, equipment choices, vendor selection, ADP and vendor billing but does contain a lot of information related to selling electronics and hawking equipment for a practicing doctor active in the medical field. In Ontario this is unethical and possibly illegal. Are you aware that your statements about this particular seller are so persistent that they come across as astroturfing?

My curiosity is piqued so I will ask directly "Are you astroturfing?". Astroturfing is the practice of masking the sponsors of a message or organization to make it appear as though it originates from and is supported by grassroots participant(s).

/sighs
/kicks self for once again coming to a forum that within the first minute always finds someone being negative, every single time i come here....and forever getting it wrong.........and not even close to what they are insinuating.


Not ONCE have I hawked any equipment for ANY doctor here.
I have simply on several occasions, mentioned a vendor I purchased my S9 AutoSet for on Kijijij who just happens to have been a respirologist or something along those lines and when dealing with operations and patients that had Sleep Apnea, he happened to carry masks........at some point, I guess he decided to branch out into machines.
This is what i was told when i purchased from him.

For $650 I got my S9 AutoSet.....everything else that came with it, SD Card, Carrying Case, upgraded climate control hose, etc etc, etc PLUS the buyer is given a choice of one of two different style masks and in my case i took the Wisp Nasal that comes with 3 sizes of mask in one package and since I don't wear nasal masks and FF masks were not part of the offer, I sold it on line for $75........bringing the cost down of my machine in full to $575........the same offer with the mask applies to the ELITE for $425

How on earth you would think i was astro turfing from that is beyond me, but not surprised whatsoever that you did.

Apparently 2 others did not see any astrosurfing and asked me for the guys name and number...........whether they purchased is beyond me b ut only trying to offer someone here in Toronto, the same deal I came across........and yes, I sell electronics online but NOT CPAP equipment and because I am online 24/7 due to what i do, I just happen to find a lot of great deals but that one so far has been the best I have seen for I do see a lot of second had AutoSets selling for more......whereas the one i bought and am telling people of is BRAND NEW in the box and no i do not make any money for giving out the guys number, only trying to help anyone here that needs to buy a machine and can't find one for that price


LAST BUT NOT LEAST, I am a newbie here and keep saying so in my posts. Repeatedly I say so, I repeatedly mention i am not qualified to give advice and for the most part am here ASKING questions.
Is that not the point of being here, to ask questions, to learn?

Just a follow-up to my original post:

Good luck. Good someone is looking into it. In my case i just couldn't be bothered to waste the time and I was fortunate in that I now understand that not everyone on CPAP is working, or retired, whatever the case might be and just can't throw $650 down like i am able to do but this is my thinking partly from having spent more time in the other forum which is full of Americans and no Canadians and down there many more are willing to just go to Craighslist or Kijijij than it seems Canadians are so I am more familiar with the American mindset than the one here pertaining to the purchasing of equipment.
I now understand that Canadians as a rule seem forced to deal with whatever insurance company they are dealing with and whatever rules they are.......I just prefer to pay cash and get it done with.
I shall take into consideration in future that Canadians as a rule have a different mind set and will no longer bother to let anyone know where they can purchase them online for inexpensively. (yes, that is inexpensive to many of the companies that charge far more) Figuring if anyone wants to know, they will find out in a search and if they wish to ask i will tell them then but no longer bother to offer the info unasked

She is new and working with a clinic and having a hard time of it. It may be that she is just using insurance or may not qualify for ADAP (not a "real" Ontario resident) or she is just being screwed over by her provider.

Actually no but i do understand why you would have come to that conclusion.
I began my CPAP route in another forum that was mainly filled with Americans, whereas this forum also has a lot of Canadians.
The other forum pushes only the Auto Set, whereas this forum pushes more often the Elite, as an option rather than just the Auto-set which i believe is the right thing to do. As it turns out, the Elite was all I needed. I don't like the change in pressure the AutoSet offers.

But in my case, having gone to the other forum first, I was led to believe by many there that I was being screwed over by my provider because i was not given an AutoSet and was given a Brick only.
I was given plenty of advice on what to say to the doctor and only now as i know better do I realize that I self sabotaged myself at that doctors, becaUse i listened to the advice of others.
The questions, comments, etc, I was told to ask or tell him, did not even qualify for Ontario residents.
In any event, the doctor told me i was wrong in the information I was giving him and when I asked if I could just pay for an AUTO SET outright, he wrote on my prescription that I MUST PAY FULL PRICE for the auto set.....obviously the information I had been given wasn't correct.
I suppose i could have fought it, in hindsight but for me it was simply much easier to go hand someone $650 and be without any aggravation for life is too short.

My doctor handed me an FF mask by prescription. Quattro Air. As I first had a brick I used for 5 weeks, it was hell. What I did not know until i got the auto set was that the DME had set my machine incorrectly at 10, instead of 13 where my prescription stood.

I bought the AutoSet.
Got the clinician manual.
Through this, setting up the machine, I discovered the mistake and 3 pressure points in my place made a huge difference on whether it worked or not.
Secondly, through the same forum, not this one, I read a long thread and was advised by someone that mouth breathers should never be given FF masks but that the doctors always do that and its a mistake, yadda yadda yadda and suggested I try the nasal mask I happened to also have.
At the same time I was instructed to keep my Auto Set at 10, rather than 13 and not to move it forward until I felt better which was good advice but I just never did feel better.
I was just getting, I believe, a lot of bad advice and strongly today believe that there are too many people giving advice that shouldn't be.

Unfortunately, not everyone is Pugsy or RobySue but at the same time, my experience led me to understand that I will NEVER try to advise anyone but ONLY give my experience in case there is something in there that they see as possibly something that might work for them OR on very simple matters that one can't go wrong on.
But I spent about 4 months in total with all the wrong information, doing all the wrong things, when in the very end, it was RobySue that came to me and pointed out what I was doing wrong and how to easily fix it.
That very night i went back to the FF mask, upped my pressure to 13 and haven't looked back.
Its only been about 4 weeks now but i was consistently under an AHI of 3 or 2 until 2 nights ago when it went higher but i discovered something this morning that leads me to believe that i adjusted my mask to tightly when I took the whole thing off to wash and will check that out tonight but generally speaking, her advice was dead on and of tremendous help but proof that there are too many out there either giving bad advice, or lonely online and just chatting but when chatting about personal things, I don't mind but if chatting about CPAP issues off the top of the head without thinking, it can cause great problems to newbies who read it and put into practise what they have heard.

The point of the whole story, was although the guy in the DMEs office set my machine incorrectly, the doctor, after all was said and done, the doctor did prescribe the right mask for me, and he prescribed the right pressure number........if it had NOT been for the guy at the DMEs office, setting my machine at 10 instead of 13, then I likely would have got this CPAP thing right from the beginning without all the crap I had to deal with in-between ( as many do ).....and then made worse by advice from others elsewhere than this forum but bad advice nonetheless. If I had not been told what to say to the doctor which in the end did not apply at all as a Canadian and told to stick to my guns about it, the doctor would likely have given me the option for an Elite and a small payment that was extra that I would have had to make but I was told that the Elite was a POS and never accept it until all else fails and to this day i disagree with that advice wholeheartedly.

You already have an APAP machine which is a single pressure machine. The S9 AutoSet is what we call an APAP machine because it has the ability to have auto adjusting pressure mode as well as fixed pressure (which is cpap mode) but in both instances it's considered a fixed single pressure even if EPR is used. I think you maybe confused about people's need for a bilevel pressure machine....bipap is Respironics model term and VPAP is the ResMed model term but both refer to a bilevel pressure machine and the person whom you bought your AutoSet from was likely quoting $1800 for the ResMed S9 VPAP model. They are more expensive and harder to find.

And yes, bilevel pressure machines are often used when pressure needs are in the upper teens or when aerophagia issues (at any pressure as aerophagia can be a problem with even as little as 6 cm pressure) create problems that can't be overcome so easily with a single pressure machine. I call those models "plain" bilevel machines because they are really not much more than glorified cpap/apap machines but to confuse you even more there's the high end bilevel machines used to treat central apneas....those are really pricey.

Sorry, and yes you are right. I did mean a Bipap and don't know why i typed in Apap..............i will have to look back and see if I have made that mistake repeatedly or it was a one time thing.

I was not aware that there were 2 types of those machines as you have described. Im at 13 and fine but reading a lot of posters, it seems that at some point their prescriptions change and their numbers go higher.
Again, not on this forum but another one, I was told that my Central Apneas were too high and that unless I got them under control, I would be looking at at bipap soon, the expensive one.
This was also shortly after I discovered my machine had been incorrectly set at 10 and i was told to use a FF mask so my AHI was 57+ hence the high CAs.
I did however try to put my machine to 14 one night, figuring if 13 worked, well hell, maybe 14 might work better but that idea lasted one night only as i woke up with a sore tummy so I believe I was swallowing air. Combined with what i had been told and what happened at 14, I was concerned at some point it might happen but for now i am fine after all.
Thanks for the explanation.

If only everyone answered posts just like you do ( and a few others ) without all the negativity I see from others here, this forum would be perfect but the attitude, sarcasm + cliquishness which leads to more of the former that too many have here is a serious detriment. Just my opinion.

I personally don't think she is astroturfing. I think she doesn't understand all the various machine models as she is new to all this and she was given a brick initially and found out she was stuck with it so elected to buy a machine (the AutoSet) privately at a fair price and just wants to make it known that they can be found, like she found, and offer that option to people.
I think she is just trying to help.

Once again, dead on.
I rest my case!

ShelaghDB wrote:/sighs
/kicks self for once again coming to a forum that within the first minute always finds someone being negative, every single time i come here....and forever getting it wrong.........and not even close to what they are insinuating.

OK. That's a lot of drama. No, I am not piling on ... just bad timing.

So I guess the answer is "no" you are not astroturfing but just spamming to be helpful. Yes, I did catch the comment that you sell electronics and that is also a reason for my question. I get confused as to why contact info can't be listed or search terms defined that would allow prospective buyer to find your seller themselves. Can you understand why it otherwise doesn't sound completely legitimate?

ShelaghDB wrote:I now understand that Canadians as a rule seem forced to deal with whatever insurance company they are dealing with and whatever rules they are.......I just prefer to pay cash and get it done with.

Not really. Canadians are not forced into anything because the rules vary province to province. In Ontario there are three sources of funding: out-of-pocket, the ADP, and employment insurance. When going through ADP your doctor has to follow specific diagnostic steps when prescribing a particular class of machine. The steps are designed to lower taxpayer cost and also attempt to limit vendor gouging. The benefit is an automatic 75% funding grant from the government. If you decide to purchase outside the ADP just ask your doctor for a prescription to purchase from an American FDA source. Private sales require absolutely no documentation whatsoever. Employment insurance is yet another layer of bureaucracy and possibly yet another set of rules to follow.

I asked my doctor for ADP documentation for a primary CPAP machine, and a prescription for an FDA licensed backup APAP machine. There was no forcing of anything. On the other hand I didn't get too dramatic or start a conflict with my sleep doctor She was very accommodating and helpful.

Completely agree that although Ontario vendors and Amercian DMEs are worse than used car salesmen the list of concerns are different because the funding rules are different. Still learning so I can't comment on APAP vs. CPAP but I no longer feel that CPAP therapy is automatically inferior.

Just to follow up: I spoke with the ADP Program Co-ordinator for respiratory devices and she said that this vendor is absolutely not allowed to charge a surplus for an 'upgraded machine'. I completely understand that it's "just another $200", but it's $200 that they literally should not be charging. She'll be calling the vendor today ahead of a visit that I have planned this afternoon..

.. wish me luck!

I just received a prescription for a APAP from my dr. I am an Ontario resident (OHIP coverage) and I have generous insurance benefits, under both my and my wife's employer. I do however, have an issue with being ripped off - or with my insurance company being rippled off.

Can somebody please confirm my understanding.

My APAP DME must sell me the Resmed AirSense 10 Auto Set including hose and mask for $1020, less the ADP reimbused amount. As such I should pay $255 for this machine. http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

As far as masks are concerned, if they want to offer me an 'upgraded mask', I have no obligation to purchase from them, if I feel the upgrade price is inflated. I can walk away with the basic package (Resmed AutoSet 10 with whatever mask they give me). I can then buy the mask from another supplier. However, I suppose I should be willing to pay an upgrade fee on the mask that is equal to or less than the cost of purchasing a new mask of my choice from another supplier.

Is this correct?

As a former Ontarian, I'm no longer familiar with the ins and outs of OHIP/ADP, etc, but I wouldn't worry about the poor insurance co. of all things - they can well afford whatever is settled on... however, I also wonder if they would be ok with your buying a machine on your own (using Dr's script) and submitting the bill for insce... I did that in NS when I started out and they were ok about doing that... but you do need to ask first. One thing to keep in mind is that ordering from e.g. Cpap.com, apart from the crummy exchange rate these days, means you can't get Resmed products here except through a local dealer - it's a Resmed thing, not Ont's or Canada's... they won't ship anything out of the US (even though home is Australia!). Not sure if any of this helps, but might as well throw it in.

newapapuser11 wrote:I just received a prescription for a APAP from my dr. I am an Ontario resident (OHIP coverage) and I have generous insurance benefits, under both my and my wife's employer. I do however, have an issue with being ripped off - or with my insurance company being rippled off.

Can somebody please confirm my understanding.

My APAP DME must sell me the Resmed AirSense 10 Auto Set including hose and mask for $1020, less the ADP reimbused amount. As such I should pay $255 for this machine. http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

As far as masks are concerned, if they want to offer me an 'upgraded mask', I have no obligation to purchase from them, if I feel the upgrade price is inflated. I can walk away with the basic package (Resmed AutoSet 10 with whatever mask they give me). I can then buy the mask from another supplier. However, I suppose I should be willing to pay an upgrade fee on the mask that is equal to or less than the cost of purchasing a new mask of my choice from another supplier.

Is this correct?

viewtopic.php?f=1&t=95962&st=0&sk=t&sd=a&start=15

newapapuser11 wrote:I just received a prescription for a APAP from my dr. I am an Ontario resident (OHIP coverage) and I have generous insurance benefits, under both my and my wife's employer. I do however, have an issue with being ripped off - or with my insurance company being rippled off.

Can somebody please confirm my understanding.

My APAP DME must sell me the Resmed AirSense 10 Auto Set including hose and mask for $1020, less the ADP reimbused amount. As such I should pay $255 for this machine. http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

As far as masks are concerned, if they want to offer me an 'upgraded mask', I have no obligation to purchase from them, if I feel the upgrade price is inflated. I can walk away with the basic package (Resmed AutoSet 10 with whatever mask they give me). I can then buy the mask from another supplier. However, I suppose I should be willing to pay an upgrade fee on the mask that is equal to or less than the cost of purchasing a new mask of my choice from another supplier.

Is this correct?

What you've written is correct.

If you're from the GTA, there are places such as CPAP Clinic and others where the mask prices are low.

Thanks for the info on the ADP.

My DME is quoting me $150 for a SDCard. Is this plain robbery - or is there something special about the ResMed card that the DME is providing? In other words, can I just go to Staples and buy a $10 SDCard and put it into the machine?

They have also quoted $200 for 6'hose. Now that I understand the ADP program, I am going to tell them where they can put that hose!!