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Permalink Reply by sleepycarol on February 21, 2009 at 8:06pm

The reason the insurance won't cover your machine is that a score of less than 5 means normal as far as a diagnosis. Did you have destats (oxygen) during your study. If not you maybe out of luck getting them to approve a machine. Is your doctor willing to give you a script and you could purchase on-line for a lot cheaper than at a local DME.

Check the prices by doing a google search or going to www.cpap.com.

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Permalink Reply by Monica on February 22, 2009 at 6:32pm

My O2sat dropped to like 80% (the sugeon who did my gallbladder removal referred me to the sleep dr because I did the same thing on the table durig surgery). I don't know that they really got an accurate reading because I really didn't sleep much the night of the study. They wanted me to sleep on my back, but I couldn't fall asleep that way. I ended up on my side, but woke up about a thousand times. They said snoring occurences was like 1068 and every time I did, I woke myself up. And that was after taking the sleeping pill they had prescribed. Plus, I am used to my dog on the bed and music on the radio, which were both not possible. Now that I know what happens and what can and can't be in the room, I could probably adjust. I could bring my MP3 and headphones, for one. I doubt they would pay for another study to be done though. I'm not even sure they will pay for the first one yet - I haven't gotten the bill or the info from the insurance.

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Permalink Reply by Judy on February 22, 2009 at 8:12pm

I assume your doctor has written a script for a CPAP for you? If so, go to cpapauction.com and browse. You can find some darn nice lightly used CPAPs there at very reasonable prices. You must register to bid and provide a copy of your script for a CPAP to cpapauction. If you've never bid at an online auction try to find a friend who has, maybe someone who buys or sells on e-Bay. Decide on the amount you want or are able to spend and stick to it.

cpapauction.com has made provision for prospective buyers to ask the sellers questions. Be sure to do so. How many hours on the CPAP? Are there any odors? Smoking odors, disinfectant odors? Serial number, etc., etc.

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Permalink Reply by Judy on February 22, 2009 at 9:04pm

Figure 8 hours a night for 365 nights. You can expect about 2920 hours during a year of use. The life expectancy for these CPAPs is 5 yeras which is about 14,600 hours of use. Many are still going strong after 10 years of use. Just a little something to help you determine the use and life of any used CPAPs you check out at cpapauction.com. I've seen a couple of nice Respironics pre M Series Plus CPAPs go for about $50 w/less than 3000 hours on them. The Plus isn't fully data capable but the pre-M Series was a better CPAP than the M Series.

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Permalink Reply by Erineyes on February 23, 2009 at 3:37pm

I too was turned down by the insurance company a number of years ago. I went through the whole testing process and the CPAP trial and they said I definately had sleep apnea but that I did not meet the criteria to get a machine because I did not "stop breathing enough during an 8 hour period".Personally I think 1x in any period is enough. I wake up every morning with a dull headache, am tired all day, have high blood pressure, have fallen sleep while driving, watching TV etc. I snore so loud that my family, even in the next room with both doors closed, hear me. I have always had poor sleep patterns, even as a child. The doctors spoke to the insurance company but they would not allow it. I was given a prescription for a sleeping pill and that was it. I never took the pill but continued to have symptoms. Recently I went to another sleep clinic and repeated the test. I was diagnosed again with sleep apnea but it is now "severe". I am going tonight to get the CPAP machine. The insurance company has agreed to pay for it, thankfully. It is the same company and policy that I was denied the first time. What is the difference now as opposed to then? Beats me. My advice is to go to another clinic and do the test all over again. The clinic I went to this time cannot believe that I was ever turned down for a machine.Hope this helps you are not alone, these insurance companies don't want to spend the money on keeping up well, they would rather you be sick and treat you. Go figure. Ask around to get a recommendation from others about what clinic to go to.

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Permalink Reply by N Gardner on February 25, 2009 at 8:15pm

I don't know what insurance you have but I have BCBS and they cover it as long as it's medically necessary.

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Permalink Reply by Monica on February 26, 2009 at 1:19pm

That's who I have also - but they refused it because my number was only 4.1 and they won't cover unless it is 5.1 or higher. The DME sent all the info that was provided and they still refused it.
I had heard good things about this DME, but I'm not so sure I really want to work with them. It was almost like they were trying to talk me out of getting it on my own when I stopped in yesterday to find out if I could make payments, etc.
Thank you for the advice Erineyes - I may just do that. I don't know if the insurance will pay for a second one though - I still haven't heard from them about paying the first one.
And thank you Judy for the info - I may have to look into that if things don't work out with the insurance.

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Permalink Reply by Melissa on February 26, 2009 at 5:02pm

Depending on the insurance, if your Dr. can document that you have excessive daytime sleepiness they will cover.

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Permalink Reply by Monica on February 26, 2009 at 5:05pm

Really? I guess I need to call my doctor (whatever I am going to do). Maybe she can work with them. Thanks!

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Permalink Reply by Keith Hale on February 26, 2009 at 5:59pm

I wonder if anyone here got the same scam pulled on them that i did.

I'd been using my cpap all night every night for more than 6 years, so i called a sleep study clinic, and asked them what would be involved just to get it retitrated - and maybe replace some of the broken bits i had literally stuck back together with tape, hot glue and wire.

I had very limited insurance (I was a volunteer: VISTA and the US Govt gives us very little coverage, and won't let us work side jobs either!) - so i was floored when they said "We contacted your insurance, they will pay 100% for your sleep study, and if you need one, they will pay 100% for the machine, mask, hoses... everything you need." I wish i had listened to my gut, it said no possible way.

Well, i get my study, get a new machine (my old one died a couple of terrible nights before i got the new one).
The "D"ME ("D"urable my left buttock!) brought the machine, extra nasal pillows, and even gave me a part i hoped would resurrect my old machine so i could have a back-up. (No such luck.)

Fast forward more than 5 months, and the Sleep Study place is complaining my insurance company (Seven Corners) won't pay them. I call the insurance cmpany, they say they not only won't pay for ANY of this, but that they never told the sleep study people that they would! So now - my life depends on a machine and mask that they want to repossess.

I had no choice but to tell them they could pry it from my cold, dead NOSTRILS. I just wanted a tuneup - the study people lied to me so i would get into debt, and the DME sure didn't check the insurance first either!

Nice scam. If i had ANY income, i might have tried paying it down, but this is huge money, and VISTAs get no actual income, just a tiny allowance. So. My credit rating was already terrible, so i had to just tell the DME to ask the study people for the money, and told the study company they are damned lucky i can't afford to sue them

I still get collection agency calls, almost 3 years later.

Anyone else heard of this little con-game?

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Permalink Reply by sleepycarol on February 27, 2009 at 8:09am

I alway thought I would like to do VISTA work and have talked about it in the past -- makes me rethink that whole situation.

I have not had that happen and what they did was unexcuseable -- for others out there call your insurance yourself to find out what is covered.

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Permalink Reply by Monica on March 14, 2009 at 9:55pm

Amazing news!!! I talked to my doctor's office and they spoke with respiron (i think that is the name of the company) and got me a machine with smartcard and heated humidifier at no cost to me!!! I think my dr is awesome! she is very proactive. I got to pick up the machine yesterday (well worth the hour drive one way to pick it up) and met with the DME. I used it for the first time last night. I was up early this morning and, even though I only got about 5 hours of sleep, I felt GREAT this morning - more energy than I have had in ages - PTL!!!
Also - I told the DME about this forum - she said she wanted to look into it and was going to recommend it to her clients. She said it sounded like ya'll were a great source of info.

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