Advice for those newly diagnosed with OSA

So you've just learned the results of your sleep test and the news is not good: You have Obstructive Sleep Apnea or OSA and you've been told you need a CPAP.  


What to do next?

Step 0.  The Titration Test.
Unless your diagnositic study was a so-called split study where the tech came in during the middle of the night to put a mask on your nose, you will be asked to come back for a so-called titration test in which the tech fits a CPAP mask on your nose and adjust the pressures during the night to determine a starting guesstimate for what level of pressure you need to use each night in order to keep your airway open. Many people are asked to sign a form authorizing the sleep center/doctor to immediately fax your prescription to a DME of their choice either when the titration study is scheduled or at the beginning of the titration study. Do NOT sign such a paper.  Politely tell the tech (or doctor) that you need to contact your insurance company and locate a DME of your choice once you know what equipment will be prescribed for you.   And then be sure to follow through and let the doc's office know where to send your prescription when you've located a DME you want to work with.


Step 1: Read and RE-read  What you need to know before you meet your DME.
Janknitz, the author of What you need to know before you meet your DME, is a long time poster over at cpaptalk.com.   In this essay, she's got plenty of tips on how to get the machine you WANT instead of the machine the DME wants to give you.  Read her essay.  And then read it again.  And follow her advice.


Step 2: Call your insurance company.
It is imperative that you find out about your coverage for CPAP equipment and supplies NOW. You want to find out both how much they pay and HOW they pay for your CPAP equipment. It's particularly important to find out if your insurance company pays for CPAP machines by something called the HCPC codes. These are billing codes, and the HCPC code for any CPAP/APAP machine is E0601. Also note that your copays for durable medical equipment such as the CPAP machine, its humidifier, and the necessary "consumable" supplies (hoses, masks, replacement filters, replacement mask cushions, and other replacement parts) may be very different from the copays you are used to for prescription drugs.

If you still have to meet a very high annual deductible for durable medical equipment, you may also want to consider the cost of simply paying for the CPAP equipment out of pocket from an on-line CPAP supplier such as cpap.com because their prices may be comparable to what you might wind up paying out of pocket before the insurance coverage kicks in.

If (as most folks do) you decide to go through your insurance to purchase the CPAP equipment,  get a list of DMEs from your insurance company that are considered to be in-network so that you can comparison shop the DMEs instead of just blindly going to a DME that the doctor just happened to fax your prescription to and  finding yourself "stuck" with the machine the unknown DME chose to "give" to you.  Keep this in mind: the DME doesn't "give" you the machine at all; they sell (or rent) the machine to you and your insurance company.  And if your insurance company does pay by billing code E0601, the DME will recieve the same amount of money for the most basic, compliance-data only CPAP as they will for a full featured, top-of-the-line APAP with full efficacy data.


Step 3: Start researching CPAP machines.
Figure out exactly which brands and models of CPAP/APAP machines you are willing to accept from your DME. While all CPAP/APAPs provide the pressurized air you need to keep your throat open, they are NOT all the same in terms of important features that improve your comfort and improve your odds of fully adjusting to therapy and thus benefiting from CPAP for a long time to come. My advice about what kind of a machine to get? Get yourself a CPAP that records full efficacy data to start with. Without a full data machine, you can't trouble shoot if (when) something doesn't go as smoothly as you and your doc hope things will go. User software should also be a consideration if you hope to monitor your therapy yourself on a daily basis. But don't bother asking the insurance company, the DMEs, or the doc about software choices: They all seem to think us folks with OSA are babbling idiots who are incapable of understanding the data these machines record and are inherently incapable of making intelligent decisions about our therapy based on that data.  

Step 4: Find a DME you want to work with.
Once you know what KIND of machine you want, start calling the DMEs that are in-network for your insurance company.  Interview each DME and make them earn your business: Start the conversation by saying something like:  

I've been recently diagnosed with OSA and I am looking for a DME. If I were to use you for my DME, would you provide me with a (your choice of CPAP machines)? 

If the answer is No, politely hang up and keep on making phone calls.  When you locate a DME that will set you up with your choice of machine, then ask them about their mask return policy:

How many times can I swap a mask that's not working out for me while I'm getting used to the machine? What kind of restrictions do you have on returning a mask that is not working? 

Ideally, you want to find a DME that has a reasonably generous mask return policy since some new CPAPers literally go through 5--10 masks (or more) before finding one that is right for their nose.

Step 5: Do NOT feel as though you must accept a machine that records only compliance data from a DME that you've never heard just to get your therapy started immediately.
You will be sleeping with this machine for the next five years (or more) and you will have a five year (or longer) relationship with the DME. If you are NOT comfortable with the hard sell to get you to accept an Resmed S9 Escape or a Philips Resprionics System One Plus with C-Flex when you talk to the DME after talking to the docor, then WALK. Do NOT sign any papers saying you refuse treatment. Simply tell the DME that you intend to purchase your equipment from a different DME that will provide you with the equipment you need. Remember: You are under no obligation to use a particular DME unless your insurance company specifies the DME. And even then, you've got the (possibly expensive) choice to buy everything out of pocket if need be.

And while you are looking for a DME to supply your equipment, learn more about your medical condition.
Start by asking your sleep doctor's office for the full sleep study reports. Make sure you get the full report---both the dictated interpretation AND the full summary data with the graphs. And start learning what that report means. (Some help for interpreting all those numbers can be found in Understanding the data in your sleep test report). And if you have questions about what stuff means, join an online support group such as the one at cpaptalk.com. Be sure to register and start posting your questions.