OHIP/Ontario question for first device

Going to have my sleep study done in a week or so, didn't get around to making it to my first one a few years ago from an older doctor, but my dentist just said I should look - he uses a cpap himself and saw a lot of the same signs in my mouth that he was experiencing.

Basically, here's the issue. These things are really expensive, and I can't be shelling out this much cash. I understand that OHIP covers 75%, up to $780 (which I assume most places will charge) and I pay the remainder. I've spoken to 2 suppliers, and both are telling me that in addition to the ~250$ I'll need to pay out of pocket for the machine, I will also need to buy a mask. Does OHIP not cover the cost of a basic mask, or a basic mask not included with the machine? I understand that I might want to purchase one that would be more comfortable in the future, but having to drop $500 in one shot troubles me.

It's the Assistive Device Program in Ontario that will pay 75% of your first cpap setup but as I recall (and it's a long time since I used the Assistive Devices program so things may have changed) but they paid 75% of the first cpap setup which was a machine, mask and hose.

Someone who has recently got a cpap using the Assistive Devices program in Ontario will, hopefully answer, now that this thread is bumped.

I had assumed it would come with at least something basic...perhaps they're just trying to squeeze me

ironhands wrote:I had assumed it would come with at least something basic...perhaps they're just trying to squeeze me

Yes. When talking with the average DME (durable medical equipment) -Canadian or USA, remember to think that the average used car salesman is an honourable and knowledgeable guy who has only your best interest at heart in comparison.
You want either a RESMED Elite or Autoset (NEVER an "Escape")

Or a PR system one 450 or higher model number - never anything with a "Plus" in the name

Both these systems have easy to use software - available here by our members.

Go to our host Cpap.com and research the prices. Also on ClinicalSleep.com (canadian site you will have to register and log in to see prices) Note that some manufacturers will not allow their products to be shipped to Canada. Have the printouts from those suppliers in hand when you go to the DME's

Masks are like shoes to be worn for a marathon, they must be comfortable and fit right and you need to try them on with the machine going full required pressure while laying down. Once you have one that works or you yuo can order them over the internet at 1/2 the price of the DME

Thanks. I contact the ministry directly and they told me it should definitely come with something basic. One thing I do find odd with the units, is that they increase in price if the gov't is chipping in

Since I do understand the importance of a mask, my main concern wasn't so much if I can get away with the basic, but put if off until I can afford something better. The place I contacted is literally across the street, and claims to do price matching, so hopefully they'll be able to provide something that fits my needs, it'll just have to wait a month or so until my wallet can take the hit.

I was looking at the ResMed units, as well as the Philips - I trust the Philips name, so I'm leaning towards that, but I'll have to do some more research on everything. Glad to see there's software available, I do a lot of coding myself, so it'll be nice to see what I can do with the data.

There seems to be an almost slavish worship of ResMed on the forums. I'm sure they are excellent machines but virtually any brand or model approved by insurance companies will work. Some may not have all the bells and whistles but will do the job which is to keep your airway from closing.Especially people who are going to have to foot a large portion of the cost themselves should try to strike a balance between features and costs. OK, now the ResMed clique can burn me.

You're right. The Resmed has become THE machine to have on this forum. That is a relatively recent development but nonetheless it certainly appears that way. I don't really see why. I have had the Philips Respironics and now the Devilibiss Intellipap. While I have never had a Resmed machine, both Philips and the Intellipap gave me good therapy but I do prefer the Intellipap of the two brands I have used.

The main thing is to get a machine that is auto (if you can) and have software so you can monitor your therapy, and, of course, use it every night AND every nap, If you can or need to take naps.

ResMed and Philips Respironics have always been the top two here, most probably due to
the availability of software.

The M-series generation of Respironics machines did not help the company image. The bright
blue lights bothered people. It was almost as if the designers didn't know that the
machines were used while sleeping. The humidifiers had problems, too. They were
noisier than the ResMed S8 machines. And while software was available, Encore Viewer lacked
some functionality, and Encore Pro was a pain due to its use of the SQL Server database.

When I got my first machine it had to be the S8 AutoSet II. Didn't want to think about an M Series.

Then, with the S9 series, ResMed beat Respironics to the market with an integrated heated hose to
reduce rainout.

But since then, with the new System One machines, things have leveled out. The blue lights are gone.
(If you don't believe what a pain they were search the forum for "blue lights".) The new System One
humidifier with its dry box design is a major improvement. The new machines are quieter. And
Encore Basic resolved the software issue. The creation of open-source SleepyHead didn't hurt, either.

With the introduction of the more-recent System One 60 Series machines Respironics added a heated
hose, too.

So, while there still are differences, the ResMed and Respironics machines are much closer competitors.
And when I wanted to try a used bipap, I picked up a System One BiPAP Auto (DS750).

I'm 5 weeks in as an Ontario hosehead. First off, I think you're making a good move doing your research up front. I didn't spend any time researching the options in terms of equipment or suppliers. I spend weeks agonizing over what TV to buy, but then I get prescribed CPAP therapy and go to the closest DME, which happened to be in the same building where I did my sleep test. I'm not complaining, just stating that if you have the time, look at these medical devices the same way as any other consumer product.

Anyway, I ended up with the Resmed S9 Elite, I had no idea what an autoset was, just knew I wanted to see the data, so I chose a machine with that option. All I knew was that Resmed was one of the top brands and their machine seemed less plasticky than the others.

Bottom line in my case was $1700 as follows:
Resmed S9 with H5i Humidifier and basic hose $1080 (no mask)
Resmed Climateline $275 (a whole lot less on-line like $50-60)
Swift FX Nasal pillow mask $295
Machine set-up $75
3 pack of spare filters $15

The $780 paid by OHIP came off the top and the DME deals with that, so my out of pocket was $920. I have additional insurance through work and did get the money back, but I also wonder if that influenced the pricing.

In my case I did the initial sleep test, received the diagnosis (severe, AHI=40), my initial prescription (8cmH20) and booked a titration study. At that point I committed to a machine and mask (I needed my own mask for the titration study). I had a couple of weeks before the second study to get use to being a hosehead. I thought I was doing really good - AHI<1 and almost zero mask leaks.

Then I get the titration study result and my new prescription is 16cmH20. At this pressure my mouth is getting blown open and now the leaks are way above the recommended level. I'm going to try a chin strap tonight (another $40, yeah we're getting hosed in Canada ) and if that doesn't work, I may have to think about another type of mask.

So continue to ask questions. Find out what happens if your prescription changes and your initial mask doesn't work as well. This stuff is not cheap and when I see the online prices, I kind of wish it was one size fits all. But it's not and at least in this newbie phase of CPAP therapy it's hard to know what is going to work. Overall I believe the therapy works, but it is a process and the whole BS of the DME's role does make it feel a bit like a con job.

Welcome to the land of hoseheads

If you take a look further down the list of topics you will see a post by 123shawnT.W.. Shawn has a brand new Phillips machine for sale for $475. He is an honest guy here on the forum that just ended up with a machine he did not need. The machine is the latest Phillips model and he is selling it at a very good price...... if I had the $$$$ I would buy it myself. If you think you are going to have to get further "hosed" with the OHIP deal, then perhaps this would be the way to go. Just a suggestion on my part, I got "hosed" by a Alberta DME when I bought my first set up, so I do know how bad it can be for us Canadians. Good luck with your testing and again WELCOME to the best sleep apnea forum on the planet.
Cheers
Nan

btw62 wrote:Resmed S9 with H5i Humidifier and basic hose $1080 (no mask)

The $780 paid by OHIP came off the top and the DME deals with that, so my out of pocket was $920.

That right there is what worries me. I called up the OHIP devices program line yesterday, and they said that the $1080 package would need to come with at least a basic mask - if someone needs the device, they need the whole package, not just the main unit, it almost makes me wonder if some of these DME's are removing, or not drawing attention to the basic mask that should be coming with the package. I mean, I know the basic mask is likely horrible, but there's no way I could drop $500+ in a single shot. Seems like the main unit won't be a big issue for me to handle, I'm relieved to hear the S9 is covered - is it auto?

I know what you mean about research, I do the same with most of my purchases. When I go to pick it up, I want to be in and out in 5 mins so I can go home and sleep(properly for a change)

So it looks like the biggest issue for me, will be the mask. That really irritates me, they should definitely be providing some sort of basic option in the OHIP kit.

I've seen nothing but praise for the ResMed S9 series, and not just on this board, seems to be popular on YouTube as well, most likely going with that, glad about the humidifier, I didn't want to have to buy a separate external one.

Just going to have to do some more reading on the features.

Wait, 75$ to set it up? Why can't I do that myself? I do IT/software programming, pretty sure I could handle it... $75 is my 2 week food budget

edit - http://www.health.gov.on.ca/en/public/p ... /cpap.aspx just found that now... so they can charge an additional setup fee, but they must provide a basic mask. That's a relief.

You shouldn't need to pay for setup. We can help you here.

I don't see why a mask would not be included.

You will have a lot of trouble getting an auto in Ontario unless the sleep specialist actually prescribes one. I bought one, years after diagnosis, online out of my own pocket.

BE SURE TO GET YOUR PRESCRIPTION IN YOUR HANDS! With it you can get equipment online. The cpap.com site ( providers of this forum) will honour an old prescription. Mine is 2002 and I have bought lots from cpap.com with it.

ironhands wrote:

btw62 wrote:Resmed S9 with H5i Humidifier and basic hose $1080 (no mask)

The $780 paid by OHIP came off the top and the DME deals with that, so my out of pocket was $920.

That right there is what worries me. I called up the OHIP devices program line yesterday, and they said that the $1080 package would need to come with at least a basic mask - if someone needs the device, they need the whole package, not just the main unit, it almost makes me wonder if some of these DME's are removing, or not drawing attention to the basic mask that should be coming with the package. I mean, I know the basic mask is likely horrible, but there's no way I could drop $500+ in a single shot. Seems like the main unit won't be a big issue for me to handle, I'm relieved to hear the S9 is covered - is it auto?

I know what you mean about research, I do the same with most of my purchases. When I go to pick it up, I want to be in and out in 5 mins so I can go home and sleep(properly for a change)

So it looks like the biggest issue for me, will be the mask. That really irritates me, they should definitely be providing some sort of basic option in the OHIP kit.

I've seen nothing but praise for the ResMed S9 series, and not just on this board, seems to be popular on YouTube as well, most likely going with that, glad about the humidifier, I didn't want to have to buy a separate external one.

Just going to have to do some more reading on the features.

Wait, 75$ to set it up? Why can't I do that myself? I do IT/software programming, pretty sure I could handle it... $75 is my 2 week food budget

edit - http://www.health.gov.on.ca/en/public/p ... /cpap.aspx just found that now... so they can charge an additional setup fee, but they must provide a basic mask. That's a relief.

The price quoted of $1700 sounds about what i paid in Quebec (no coverage) about 4 years ago.
There is no such thing as a basic mask. The mask fit is crucial to success of this therapy.

Set up is dead easy for anyone with the skills to operate a smart phone or can write code.
For $950 you could buy on line much cheaper. I also bought here a "second hand" system for a lot less and i am very happy with it.

BlackSpinner wrote:The price quoted of $1700 sounds about what i paid in Quebec (no coverage) about 4 years ago.
There is no such thing as a basic mask. The mask fit is crucial to success of this therapy.

Yes, there's no debating that, but, the government footing the bill says it has to come with something, even if it is of poor quality

btw62 wrote:I'm 5 weeks in as an Ontario hosehead. First off, I think you're making a good move doing your research up front. I didn't spend any time researching the options in terms of equipment or suppliers. I spend weeks agonizing over what TV to buy, but then I get prescribed CPAP therapy and go to the closest DME, which happened to be in the same building where I did my sleep test. I'm not complaining, just stating that if you have the time, look at these medical devices the same way as any other consumer product.

Anyway, I ended up with the Resmed S9 Elite, I had no idea what an autoset was, just knew I wanted to see the data, so I chose a machine with that option. All I knew was that Resmed was one of the top brands and their machine seemed less plasticky than the others.

Bottom line in my case was $1700 as follows:
Resmed S9 with H5i Humidifier and basic hose $1080 (no mask)
Resmed Climateline $275 (a whole lot less on-line like $50-60)
Swift FX Nasal pillow mask $295
Machine set-up $75
3 pack of spare filters $15

The $780 paid by OHIP came off the top and the DME deals with that, so my out of pocket was $920. I have additional insurance through work and did get the money back, but I also wonder if that influenced the pricing.

I just got quoted $1500 on the ResMed S9 Elite alone! %30 price difference, only weeks apart, I'm really wary of these suppliers now. I'd definitely rather buy online, but I can't get the ADP unless I go to a physical location