It has been 4 months of me using CPAP. In this time, I have visited my doctor and the CPAP seller 6-8 times to get my CPAP pressure adjusted and tweaked and to retrain me on proper usage, because it just isn't working for me. I have these awful headaches in the morning, I am unable to sleep with CPAP on and I often rip the mask off in the middle of the night. Consequently, I am sleepier than ever. Before CPAP I would take a nap every day for about 2 hours, now I am sleeping for 3-4 hours. I am now looking to next options, such as a dental mouth guard appliance or a surgical option.
For surgical options in particular, my insurance requires that I be deemed CPAP non compliant before they consider paying.
I am not sure how to go about getting my insurance to agree that I am non compliant. I have CIGNA Open Access. Has anyone been through this process? What formal proof or procedure does insurance need for them to be convinced that I am non compliant?
Thanks in advance
Concerning insurance and formal determination of CPAP non compliance
Concerning insurance and formal determination of CPAP non compliance
I AM NOT AFFILIATED WITH NOR DO I REPRESENT THE FORUM CPAPtalk IN ANY WAY.
Re: Concerning insurance and formal determination of CPAP non compliance
Do not get surgery - the majority of people who've had it (e.g. UPPP) apart from those who e.g. had a turbinate reductoin that really was necessary and which never cured apnea in any case found their apnea returning within months and ended up back on Cpap again. You have obviously not had great luck (bad advice) with your therapy and there could be many reasons for that... almost all of which are dealt with every day here by knowledgable and experienced people. Too often doctors know the clinical side of apnea but are cliueless about the equipment and/or how to set it up. And here we all set our own pressures, or at least reset them when they've been badly done by DME's, using special software that allows us to track many important parameters of sleep overnight, and we learn about the various tyes of masks out there (very many) and how to find the right one.
What machine do you have (full name + model) and what mask. What are your pressure settings now? It's very possible they're just not adequate.
What machine do you have (full name + model) and what mask. What are your pressure settings now? It's very possible they're just not adequate.
_________________
| Mask: Ultra Mirage™ Full Face CPAP Mask with Headgear |
| Humidifier: IntelliPAP Integrated Heated Humidifier |
Re: Concerning insurance and formal determination of CPAP non compliance
Hi Julie, thanks for the reply. I use a ResMed AirSense 10 AutoSet machine. I have tried various masks of different sizes, including nasal and full face mask. I have attended a couple "CPAP workshops" as well. It automatically adjusts the pressure, but is always between 4 and 20 cm H2O.
In alignment with what you said, I have excluded the option of UPPP and other soft tissue surgeries. Although MMA is a big surgery, I happen to be conveniently close to a very well known surgeon for this procedure, Dr. Kasey Li. He is said to have a relatively low patient complication rate and upto an 85% success rate. My major concern with this option is the enormous costs of going to an out-of-network doctor and working with insurance for this.
Edit made: I use ResMed Airsense 10 Autoset, not the Elite
In alignment with what you said, I have excluded the option of UPPP and other soft tissue surgeries. Although MMA is a big surgery, I happen to be conveniently close to a very well known surgeon for this procedure, Dr. Kasey Li. He is said to have a relatively low patient complication rate and upto an 85% success rate. My major concern with this option is the enormous costs of going to an out-of-network doctor and working with insurance for this.
Edit made: I use ResMed Airsense 10 Autoset, not the Elite
Last edited by CPAPtalk on Wed Mar 14, 2018 10:56 pm, edited 1 time in total.
I AM NOT AFFILIATED WITH NOR DO I REPRESENT THE FORUM CPAPtalk IN ANY WAY.
Re: Concerning insurance and formal determination of CPAP non compliance
4 cm to 20 cm settings are designed for lazy doctors and DME's to promote XPAP mistreatment! Jim
Use data to optimize your xPAP treatment!
"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire
"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire
Re: Concerning insurance and formal determination of CPAP non compliance
The Elite is a fixed pressure machine, it does not auto adjust.
Get OSCAR
Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
Re: Concerning insurance and formal determination of CPAP non compliance
Oops, my bad. It's most likely the ResMed AirSense 10 AutoSet.
I AM NOT AFFILIATED WITH NOR DO I REPRESENT THE FORUM CPAPtalk IN ANY WAY.
Re: Concerning insurance and formal determination of CPAP non compliance
Hi Jim, thanks for the reply. It did strike me as odd that they wouldn't set the pressure to what was recommended and then adjust as needed but I went along with it thinking it was some kind of high-tech fancy new advancement. This thing comes with all kinds of bells and whistles ... it even picks up a phone signal!
I AM NOT AFFILIATED WITH NOR DO I REPRESENT THE FORUM CPAPtalk IN ANY WAY.
Re: Concerning insurance and formal determination of CPAP non compliance
Don't guess... and pick a different username.
Get OSCAR
Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.
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Jas_williams
- Posts: 1120
- Joined: Tue Dec 19, 2017 2:12 pm
- Location: Somerset UK
Re: Concerning insurance and formal determination of CPAP non compliance
Download sleepy head and post some graphs for us
_________________
| Mask: Bleep DreamPort CPAP Mask Solution |
| Additional Comments: Using sleepyhead and a pressure of 6 - 21 Resmed S9 Adapt SV with a Bleep Sleep Mask |
Re: Concerning insurance and formal determination of CPAP non compliance
I strongly agree - pick a different name, not copying the forum's - this one could well confuse some posters as you do NOT represent the forum in any way.
_________________
| Mask: Ultra Mirage™ Full Face CPAP Mask with Headgear |
| Humidifier: IntelliPAP Integrated Heated Humidifier |
Re: Concerning insurance and formal determination of CPAP non compliance
Must admit I thought I was going to read something from the Goodmans.
Not sure you can change a username though. Can you? Maybe Pugsy can do that... not sure about that either.
Not sure you can change a username though. Can you? Maybe Pugsy can do that... not sure about that either.
Resmed AirSense 10 Autoset for her w/humid air/heated Humidifier
Bleep/P10
Bleep/P10
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ChicagoGranny
- Posts: 14512
- Joined: Sun Jan 29, 2012 1:43 pm
- Location: USA
Re: Concerning insurance and formal determination of CPAP non compliance
I can't do it but Carolyn can and I sent her a PM about this not so unique name. Up to her now as to what she wants to do or not.
_________________
| Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
| Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/ |
I may have to RISE but I refuse to SHINE.
If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.
If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.
Re: Concerning insurance and formal determination of CPAP non compliance
Last edited by CPAPtalk on Thu Mar 15, 2018 2:41 pm, edited 1 time in total.
I AM NOT AFFILIATED WITH NOR DO I REPRESENT THE FORUM CPAPtalk IN ANY WAY.
Re: Concerning insurance and formal determination of CPAP non compliance
In my opinion, a good forum username is like prime real estate. I'm surprised no one took this username.
Last edited by CPAPtalk on Thu Mar 15, 2018 2:45 pm, edited 1 time in total.
I AM NOT AFFILIATED WITH NOR DO I REPRESENT THE FORUM CPAPtalk IN ANY WAY.