lowest cost approach to get CPAP

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Figuring_it_out
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lowest cost approach to get CPAP

Post by Figuring_it_out »

I have a United Healthcare High deductible plan (80/20 after deductible) through work and don't see low cost way to get a CPAP even after the deductible was met.

I hear a few family members say they get their CPAP and accessories for free through their insurance. When I ask details of how my family members did it or which insurance they use I get a blank stare. "uh don't know, they just gave me the equipment and I walked out"
:oops:

Right now I have a 7 year old CPAP and it just quit on me. I called my previous DME vendor and they said my sleep study was too old and I need a new prescription. Now starting to look at seeing a sleep study doctor that will send me to a sleep study so he/she can write a new prescription for the replacement CPAP.

No major changes to me (weight, etc.) except for age so I don't expect my condition to have changed dramatically.

Am I missing something?

I've looked at the online CPAP.com type places and all of the units are near $1000. most still require a prescription.
Dfgdfg
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Re: lowest cost approach to get CPAP

Post by Dfgdfg »

My PCP wrote me a lifetime prescription for equipment and supplies. Cpap.com has the wording they need on its website. You upload it and you’re good to go. I’m convinced the whole sleep study industry is a scam and my original doctor took me to the cleaners for equipment.
Soon2BXProgrammer
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Re: lowest cost approach to get CPAP

Post by Soon2BXProgrammer »

Figuring_it_out wrote: Tue Aug 03, 2021 7:48 am I have a United Healthcare High deductible plan (80/20 after deductible) through work and don't see low cost way to get a CPAP even after the deductible was met.

I hear a few family members say they get their CPAP and accessories for free through their insurance. When I ask details of how my family members did it or which insurance they use I get a blank stare. "uh don't know, they just gave me the equipment and I walked out"
:oops:

Right now I have a 7 year old CPAP and it just quit on me. I called my previous DME vendor and they said my sleep study was too old and I need a new prescription. Now starting to look at seeing a sleep study doctor that will send me to a sleep study so he/she can write a new prescription for the replacement CPAP.

No major changes to me (weight, etc.) except for age so I don't expect my condition to have changed dramatically.

Am I missing something?

I've looked at the online CPAP.com type places and all of the units are near $1000. most still require a prescription.
Hard to say without seeing the details of your health plan. Have you called your plan?
Do you have a copy of your old sleep study? some sleep docs/PCP might prescribe a new one without an additional study, if you had been tolerating your equipment well. (both using it daily and it relieving your symptoms)
Earned 43 (and counting) credit hours of financial planning related education from a regionally accredited university, but I am not your advisor.
UpperNwGuy
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Re: lowest cost approach to get CPAP

Post by UpperNwGuy »

Most insurance companies require a new sleep study before covering a new CPAP machine if more than five years have elapsed since your last study.

Medicare requires a new sleep study soon after you enroll in Medicare. They won't accept the results of a sleep study prior to Medicare coverage starting.

Your lowest cost approach is to work closely with your insurer.
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SmallCityDave
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Re: lowest cost approach to get CPAP

Post by SmallCityDave »

Figuring_it_out wrote: Tue Aug 03, 2021 7:48 am I have a United Healthcare High deductible plan (80/20 after deductible) through work and don't see low cost way to get a CPAP even after the deductible was met.

I hear a few family members say they get their CPAP and accessories for free through their insurance. When I ask details of how my family members did it or which insurance they use I get a blank stare. "uh don't know, they just gave me the equipment and I walked out"
:oops:

Right now I have a 7 year old CPAP and it just quit on me. I called my previous DME vendor and they said my sleep study was too old and I need a new prescription. Now starting to look at seeing a sleep study doctor that will send me to a sleep study so he/she can write a new prescription for the replacement CPAP.

No major changes to me (weight, etc.) except for age so I don't expect my condition to have changed dramatically.

Am I missing something?

I've looked at the online CPAP.com type places and all of the units are near $1000. most still require a prescription.
Lowest cost...

Here is what I did, I found mine on CL it only had 20 hours I spent $100 for it.

I bought them online in the past with directhomemedical but cpaps are almost non existant (because of covid?), I recently bought a new back-up with 0 hours for $225 shipped it was also on CL.
Broken Man 1999
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Re: lowest cost approach to get CPAP

Post by Broken Man 1999 »

OP, have you been going to anyone to see if your various measurements indicate your machine is set up correctly? Things can change over time.


I have had two sleep studies, but the last one was at least ten years ago.

I have a continuous RX and buy my supplies for three months at a time thru Apria. Shipped automatically, billed to a CC. Co-pay is between $25/$30 every three months. Those prices do not include the cost of a machine, obviously.

Each January I see my pulmonary doc, he looks at my data downloaded by the receptionist from an SD card the unit has (could be done remotely with the unit I have). He can tell how many hours I wear the mask, and other important measurements.

Sleep apnea can be a dangerous condition, and sleep studies can indicate the severity of the issue.

I can only sleep on my back, which probably exacerbates the issue. I mentioned to my PCP long, long ago that I was falling asleep at my desk. He set up a sleep study and it was unbelievable how poor quality of sleep/rest I was getting.

I kept my old machine as a backup, even though it was pretty old when I replaced it. It would get me through any time necessary to get a new machine should my one in use today fail.

Sometimes you just have to pay for what you need. Your expected savings from your high-deductible health plan should consider the costs of your medical needs, sometimes it might be a false savings.

Broken Man 1999
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TexasPE
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Re: lowest cost approach to get CPAP

Post by TexasPE »

UpperNwGuy wrote: Tue Aug 03, 2021 8:16 am Most insurance companies require a new sleep study before covering a new CPAP machine if more than five years have elapsed since your last study.

Medicare requires a new sleep study soon after you enroll in Medicare. They won't accept the results of a sleep study prior to Medicare coverage starting.

Your lowest cost approach is to work closely with your insurer.
Have to disagree with this one - at least in my case - Medicare covered a new CPAP for me based on a sleep study done before I joined Medicare. (My old CPAP also died).

If a new sleep study is required, there are now "at home" tests where you are shipped the equipment (about the size of a cigar box). You hook it up, sleep overnight, and return the equipment - check with your insurer. In my case Medicare's durable medical equipment model was for the supplier to 'rent' the equipment to me for a year, billing me with small (<$10) monthly payments (covered by my G Supplement), then giving the machine to me after the device is used consistently (letter from doctor). The new CPAP was also shipped to me - I worked with a Respiratory Therapist via email regarding mask selection, etc. [COVID had shuttered their facility].

My new CPAP has a cell phone link and sends results every morning to a central facility. Data/ plots are available to me and my doctor. The system is similar to Fitbit - emailing encouraging messages, comments ("looks like you may have a mask leak", remember to clean equipment, etc).

Good luck!
At 20: I cared what everyone thought about me | At 40: I didn't give a damn what anyone thought of me | Now that I'm 60: I realize that no one was really thinking about me at all | Winston Churchill (?)
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Watty
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Re: lowest cost approach to get CPAP

Post by Watty »

Figuring_it_out wrote: Tue Aug 03, 2021 7:48 am Right now I have a 7 year old CPAP and it just quit on me.
......
Am I missing something?
If the machine is just totally dead with no lights then have you checked to see if it is just the power supply that failed?

If you have a "brick" power supply in the cord between the wall plug and your machine then that could be prone to failure and it may be easy to replace.

A few years ago I was on vacation in Australia at the start of a long vacation and there was a lightning storm and there must of been a power surge and my CPAP was dead. There is a green LED light on the "brick" power supply and it was out so I was pretty sure that it was just a problem with power supply.

I started researching what to do and it turned out that my machine was made by ResMed which is based in Australia. The next day I was returning to Sydney anyway and would be practically driving right by their company headquarters! I called them up and they gave me the name of a local clinic and I was able to stop by there and get a replacement power supply for about $35 and then everything worked fine. The power supply actually cost less there then it would have cost in the US.

You may be able to take your machine into where you got it and try it with one of their power supplies to see if that is the problem.

It is a longshot but also try unplugging your machine from the power cord and plugging it back in. I have had that come partway unplugged and it was not obvious just by looking at it.
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midareff
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Re: lowest cost approach to get CPAP

Post by midareff »

I'm on my second CPAP machine. Pulminary specialist sent me to a sleep study and then sent the results to the people they use to supply the machines/masks etc., to their patients. Medicare covered all of it, both times.
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TexasPE
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Re: lowest cost approach to get CPAP

Post by TexasPE »

Just came across this. If your current CPAP was manufactured by Respironics, and you are in the US, they have a recall to repair/ replace the machine

https://www.usa.philips.com/healthcare/ ... src-update

Looks like there is a delay in repair/ replacement, but even if you get a new machine, a repaired/ replaced CPAP would serve as a spare.
At 20: I cared what everyone thought about me | At 40: I didn't give a damn what anyone thought of me | Now that I'm 60: I realize that no one was really thinking about me at all | Winston Churchill (?)
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oldcomputerguy
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Re: lowest cost approach to get CPAP

Post by oldcomputerguy »

TexasPE wrote: Tue Aug 03, 2021 10:28 am
UpperNwGuy wrote: Tue Aug 03, 2021 8:16 am Most insurance companies require a new sleep study before covering a new CPAP machine if more than five years have elapsed since your last study.

Medicare requires a new sleep study soon after you enroll in Medicare. They won't accept the results of a sleep study prior to Medicare coverage starting.

Your lowest cost approach is to work closely with your insurer.
Have to disagree with this one - at least in my case - Medicare covered a new CPAP for me based on a sleep study done before I joined Medicare. (My old CPAP also died).

If a new sleep study is required, there are now "at home" tests where you are shipped the equipment (about the size of a cigar box). You hook it up, sleep overnight, and return the equipment - check with your insurer. In my case Medicare's durable medical equipment model was for the supplier to 'rent' the equipment to me for a year, billing me with small (<$10) monthly payments (covered by my G Supplement), then giving the machine to me after the device is used consistently (letter from doctor). The new CPAP was also shipped to me - I worked with a Respiratory Therapist via email regarding mask selection, etc. [COVID had shuttered their facility].

My new CPAP has a cell phone link and sends results every morning to a central facility. Data/ plots are available to me and my doctor. The system is similar to Fitbit - emailing encouraging messages, comments ("looks like you may have a mask leak", remember to clean equipment, etc).

Good luck!
My experience was the same as UpperNwGuy's. I went on Medicare last year, and they told me that I had to get a new sleep study done before Medicare would cover my supplies. I don't recall exactly when my first study had been done, but it's been several years, long enough that I'm now on my second machine and have been for four years.
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UpperNwGuy
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Re: lowest cost approach to get CPAP

Post by UpperNwGuy »

TexasPE wrote: Tue Aug 03, 2021 10:28 am
UpperNwGuy wrote: Tue Aug 03, 2021 8:16 am Most insurance companies require a new sleep study before covering a new CPAP machine if more than five years have elapsed since your last study.

Medicare requires a new sleep study soon after you enroll in Medicare. They won't accept the results of a sleep study prior to Medicare coverage starting.

Your lowest cost approach is to work closely with your insurer.
Have to disagree with this one - at least in my case - Medicare covered a new CPAP for me based on a sleep study done before I joined Medicare. (My old CPAP also died).

If a new sleep study is required, there are now "at home" tests where you are shipped the equipment (about the size of a cigar box). You hook it up, sleep overnight, and return the equipment - check with your insurer. In my case Medicare's durable medical equipment model was for the supplier to 'rent' the equipment to me for a year, billing me with small (<$10) monthly payments (covered by my G Supplement), then giving the machine to me after the device is used consistently (letter from doctor). The new CPAP was also shipped to me - I worked with a Respiratory Therapist via email regarding mask selection, etc. [COVID had shuttered their facility].

My new CPAP has a cell phone link and sends results every morning to a central facility. Data/ plots are available to me and my doctor. The system is similar to Fitbit - emailing encouraging messages, comments ("looks like you may have a mask leak", remember to clean equipment, etc).

Good luck!
My first sleep study was five years prior to my enrolling in Medicare. Medicare refused to fund replacement masks and hoses for my old CPAP until I had a new sleep study. Fortunately I was able to stretch my supplies until the new sleep study could be scheduled. (Blue Cross had been my primary insurer before I enrolled in Medicare, and they had been paying for supplies, but once they became secondary to Medicare they wouldn't cover any more CPAP-related charges unless Medicare paid their share first.)

My sleep apnea is sufficiently severe that both my doctor and my insurers wanted a Type I study, and that has to be done in a sleep center with a sleep technologist in attendance. The home studies are Types II, III, and IV. Details are at this link:

https://clevemed.com/cms-aasm-guideline ... -type-iii/

The "rent for a year, own after thirteen months" model is the norm these days. In my case the durable medical equipment provider came to my home and provided on-site instruction. And, yes, all of the current generation of machines transmit their data to the cellular network to provide proof of regular use and to identify problems.
cmr79
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Re: lowest cost approach to get CPAP

Post by cmr79 »

As TexasPE mentions, there is currently a major recall on Philips Respironics machines due to potential issues with insulation foam degrading or degassing over time with uncertain clinical implications (but some reports of respiratory irritation). The end effect is that there is a major shortage of non-impacted Respironics CPAP machines and ResMed CPAP machines (the only other major competitor).

It's a pretty bad time to need a new device. I don't know what to tell you, as major sleep practices don't have great solutions for their patients either just to get a functioning, non-recalled machine, regardless of cost...many people are choosing to continue using recalled machines. Much like with computer graphics cards, houses and used vehicles, if you need a new machine right now, you might have to take what you can find at asking price.
Topic Author
Figuring_it_out
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Re: lowest cost approach to get CPAP

Post by Figuring_it_out »

Watty wrote: Tue Aug 03, 2021 10:36 am
Figuring_it_out wrote: Tue Aug 03, 2021 7:48 am Right now I have a 7 year old CPAP and it just quit on me.
......
Am I missing something?
If the machine is just totally dead with no lights then have you checked to see if it is just the power supply that failed?

If you have a "brick" power supply in the cord between the wall plug and your machine then that could be prone to failure and it may be easy to replace.

A few years ago I was on vacation in Australia at the start of a long vacation and there was a lightning storm and there must of been a power surge and my CPAP was dead. There is a green LED light on the "brick" power supply and it was out so I was pretty sure that it was just a problem with power supply.

I started researching what to do and it turned out that my machine was made by ResMed which is based in Australia. The next day I was returning to Sydney anyway and would be practically driving right by their company headquarters! I called them up and they gave me the name of a local clinic and I was able to stop by there and get a replacement power supply for about $35 and then everything worked fine. The power supply actually cost less there then it would have cost in the US.

You may be able to take your machine into where you got it and try it with one of their power supplies to see if that is the problem.

It is a longshot but also try unplugging your machine from the power cord and plugging it back in. I have had that come partway unplugged and it was not obvious just by looking at it.
I'm a DIYer with electronics skills so I tore into it to see what it could be. Fairly simple machines and it turned out to be the motor. Mine was not completely dead but it would try to start three times then appear to reboot. after three times of this it would quit and beep while blinking the ramp light. Opened it up and blow out all of the parts that the youtube videos call for. Mine was amazingly clean so no big job here.

I took the motor out and spun the impeller by hand it it was hard to turn. The more I spun it the easier it got. I applied a little olive oil to the brass counterweight on the back in an attempt to lube the spindle shaft of the motor with something I didnt mind breathing (not wd40 :) ).

Put it back together and it spins up now and works OK but it is making a light high pitched whining/squeaking noise. I ran it for a few hours before bed and it quieted down somewhat but is still there. I wound up putting towel over the top of the unit (leaving the air intake open) to quiet it down. That works fine and its not hot under the towels in the morning so i'm OK.

I suspect the bearings or bushing are worn out and not lubricated so making noise. I cant disassemble the blower assembly as it seems these parts are pressed together and I didnt want to break the unit since it is now working somewhat.

I'm just trying to limp along until I get a new CPAP. The nearest date for a neurologist to schedule a sleep study is Aug31. I don't expect a new device until end of september. Hope mine lasts that long. I find it hard to believe that they would let people go without a needed device that long to follow formalities. there should be an emergency loan/rent program or something.

I cant even find replacement motors or the old CPAPs on craigslist around me.
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TexasPE
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Re: lowest cost approach to get CPAP

Post by TexasPE »

Figuring_it_out wrote: Tue Aug 03, 2021 3:31 pm
I cant even find replacement motors or the old CPAPs on craigslist around me.
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Rudy Tooty
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Re: lowest cost approach to get CPAP

Post by Rudy Tooty »

I'm on a Medicare advantage plan. PCP sent me for a sleep study about 2 years ago. Diagnosed with sleep apnea. The contracted supply company sent me the CPAP machine. I paid a nominal monthly copay (less than $10) and after 1 year I owned the machine free and clear. No more copay. After using it I needed a slight increase in the air pressure. The PCP did it with a simple Rx by fax. I switched PCP's. The new one said that if I would ever need an adjustment I'd have to go back for another sleep study. That's disappointing. The place where I had the sleep study put me in a small room with no air conditioning and the room window would not open. Had to use a noisy fan. I only got about 2 hours sleep, but apparently they were still able to get enough data to make the diagnosis. The machine helps the quality of my sleep. No more waking up on occasion feeling short of breath or perspiring. Anyone who snores should consider getting tested.
Impy
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Re: lowest cost approach to get CPAP

Post by Impy »

Cpap.com seems to offer a home sleep study/telemedicine consult now, which obviates the prescription issue.

I have used secondwindcpap.com in the past (in my case, for a travel machine) and found them excellent. They sell both new and refurbished/open box machines.
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