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Response to your insurance inquiry plus other comments


Posted by Breezin' on February02, 2000 at 13:29:01:

In Reply to: Newbie here, with several questions! posted by Amy in TN on February02, 2000 at 11:47:09:

Hi Amy,

Welcome to the forum. You will find answers to all of your inquiries by reading past posts, but to help you speed things up, I will comment on a couple of things. However, your best investment will be to spend a few hours reading at least the past 3 or 4 forums, dealing primarily with issues that pertain to you. It isn't all that intimidating, really.

At some point you will need to peruse your insurance coverage closely to see how they cover the Durable Medical Equipment (DME) required for OSA therapy. Like you, I also have BC/BS, but a "standard managed care option" and it covers 90% of everything after an annual deduction of $150 has been paid. So in answer to question 2, my experiences with them have been very good so far. I hope you have similar luck!

Rent or buy? My policy required 3 months rental before they would pay for the CPAP, presumably because patient compliance is thought to be low. I wasn't sure myself that I would follow through and be on it all the time anyway, but after 3 weeks, I knew I wanted to buy it. Then, it's like a toilet. Do I rent it or do I buy it? Since I use it all the time, I buy it. The CPAP that is. (And yes I also own my toilet).

Your DME provider may recommend a CPAP (mine did), but if you read the past posts here you will find that there are many reviews by individuals. Information and pricing of all varieties can be found on Sandman's Sleep Mall. Most folks like a heated humidifier, but beyond that, it's up to you. My CPAP is a Sullivan V Elite. I'd get the best one you can.

Many folks with beards use nasal pillows (these things go in your nostril entry). I don't have a beard, so I easily use a nasal mask (fits over your entire nose). Works great. I think that other bearded gents use a Full Face mask (covers mouth and nose).

I had my "titration", where they determine your CPAP pressure, the same nite as the study. Your husband's study was split. Not sure if he needs a follow-up study unless he gains or loses a lot of weight, or if he gets no benefit at all after a month or two. I doubt that I'll need another one. It is a question he should ask in his follow up study and also to find out the severity of his condition. He may be able to use a "oral appliance" if he is a mild apneic. Ask the doc.

Many (most?) surgical procedures have poor success rates with regard to OSA recovery. I personally wouldn't do anything other than surgery to improve nasal breathing. Others on this forum have "been there, done that" and could comment better than I. A trach is a sure fix, but I participate in a lot of water sports and I think a trach is a bad idea for me.

Good luck, and keep us posted.

Breezin'



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