My insurance gives me a hard time to give me a proper answer what they cover in which time frame. Basically, they only tell me what I know to ask, but wouldn't tell me the important things I don't know. So far I know they would cover the machine to a certain amount only every 5 years. However, I expect there are some components that need to be replaced more often.
Therefore, I would like to ask the users of APAP machines of their initial cost and ongoing cost.
For the AutoSet machine the initial cost on line for the machine, carrying case, slimline hose, mask, and heated hose is about $875. That is all you need to get started. A replacement mask insert is about $35 and is needed perhaps every year or so based on my wife's experience. Filters for the machine are about $3 each and probably need to be replaced every 6 months or so. My wife's machine is 4 years old and seems to be operating fine. Perhaps for budget purposes count on a replacement once every 5 years based on wear. No indication that hose life is an issue. The only real problem is that it seems ResMed thinks it needs to change the hose fittings with each new machine, so a new machine probably means new hoses too. And if you camp and want to run on 12V DC power supplies are about $130. They also seem to be specific to the current machine with ResMed,
You can buy parts wherever you want. You need a prescription for a machine but not parts. There are lots of CPAP machine and components on line stores in Canada. The good news is that prices in Canadian dollars are virtually the same as what the US folk pay in $US. Perhaps Trump has a 25% tariff on Australian imports?
I suspect the more practical issue is that you may want a new machine just to get the latest bells and whistles technology, not because it is worn out. The iPhone effect!
The wildcard cost is that of a mask that works for you. If you can get the mask type and model sorted out on somebody else's nickel, that is a big win. After that all you have to do is replace the insert once a year or so.
Almost all insurance companies lease a machine from a DME for a year and make the payments on the machine. After the year, the machine basically is yours. Kind of a "rent to own" thing. Most insurance plans cover perishable supplies like masks, cushions, hoses, water reservoirs and filters. Most send stuff every 3 months. Most send a mask and a couple cushions for that mask. Most will send filters every 3 months. As far as hoses and water reservoirs, they don't send these as often; perhaps every other 3 month cycle. I am not positive if a DME will automatically send a reservoir; mine leaked and I asked for one and received it. Most insurance plans allow a DME to automatically send this stuff as the DME loves getting the money regularly. After five years, most insurance companies will replace the machine as that is what they must consider its life cycle. Most machines actually still work great at the 5 year mark. If you decide to switch up mask types, you will likely have to spring for the mask you want to try on your own dime and then you can tell the DME that you have a new mask type and they will send supplies for it rather than the one they handed you on day one.
I believe SirRobin is located in British Columbia, Canada. To my knowledge we do not have the DME system here, although Ontario may have something similar. Health care in Canada is administered provincially although the Federal government supplies the money. For that reason each province is different. Where I am the provincial health care system pays for the sleep studies but not the machine or accessories. Many, and especially those who are working for a larger company may have a supplementary private insurance plan. But there are various levels of coverage and different companies that provide it (ManuLife, SunLife, etc). But in most cases they pick up the costs not covered by the provincial health care system up to a specific limit. How you spend up to that limit can be negotiable if you talk directly with the insurance company. It depends on the company and the coverage. The CPAP/Study provider of course likes to put themselves in the middle and will say they will bill the insurance company direct. And they do that often while charging very high prices. For example $2400 for a machine and mask, instead of the on line price of $875. It is not a very efficient system but it is what it is. I'm retired and no longer have a Cadillac insurance plan so everything I get is on my nickel. While this sounds bad, it is not really that bad. I can buy what I want, when I want, and do not have to dance to the tune of a government health cares system, or an insurance company. In the scheme of things the costs of a CPAP are not all that high when you are paying it all yourself, and shop around for the best prices.
Sierra described very well how it works up in the North. Although my lung doctor told me to shop around and not to go to only one sleep clinic for the machine.
I did a quick check of CPAP supply places located in BC. There are several, but none have any pricing. It appears they are all likely to be on the inflated insurance company pricing system.
If insurance is paying it may not make sense for you to buy on line. Here is a link to the machine I would recommend packaged along with a heated ClimateLine hose for $825. I have bought from them and they provide good service. This page also has the prices for replacement parts and consumables, except for the mask inserts. You will be able to find it under mask parts though.
While I am fortunate to have 100% coverage (Kaiser) I find the schedule for re-supply incredible. One nasal pillow per month-swift fx One headgear-swift fx One tubing per 6 months One humidifier per six months Two and a half years in, with every day use, I am on the original tubing, headgear and humidifier. I do find the nasal pillows need replacing about every 40-45 days. Selling this stuff is a money maker for someone. I did order on schedule one time, and will not reorder until these backups are put into use.
Yes, the government and private insurance systems are certainly not the most efficient when it comes to costs, and we know at the end of the day we are paying for it all. Seems to me that if the government just made necessary medical equipment 100% tax deductible, it would be a much more efficient system. When people are paying expenses out of their pocket they tend to be much more frugal about it.
I recall you were asking questions about using the AirMini for travel, and possibly full time. One thing you may want to consider is asking your insurance company if they would consider covering both the AirSense 10 and an AirMini for travel, if purchased on line for less cost than just the AirSense 10 at a bricks and mortar sleep clinic. That is what my son did with I believe Sun Life insurance. The sleep clinic wanted $2400 for an AirSense 10, and he talked them into giving him a AirSense 10 and Z-1 portable which cost about $1900 in total from an on line company. The insurance company saved $500 and he got two machines instead of one. I believe the AirMini costs about $1000 on line so the A10 plus AirMini would be about $1900 at current prices.
Thank you everyone for your feedback!
EDIT: Nevermind, a simple google/youtube research helped me out. @Sierra: Based on your posts I assume you setup your machine by yourself, correct? If so how would I get into the provider setup options in the Resmed 10 or dreamstation? With my trial dreamstation, I don't see an option to set max or min pressures. When I read the manual of the Resmed 10, they only say "Your AirSense 10 device has been set up for your needs by your care provider, but you may find you want to make small adjustments to make your therapy more comfortable."
Those of you buying the machine online probably don't go to a therapist, therefore you must have access to those settings. Or are the machines purchased at sleep clinics locked (like smart phones from a carrier) and as patient you cannot make important changes?
It sounds like you have sorted it out with the Google search but just in case here is the info on how to change the machine settings. Yes, I set my wife's machine up and also my own. Not nearly as difficult as trying to set up a "smartphone"! To my knowledge they cannot lock you out of your own machine, but they can pull a bit of a dirty trick and pull the SD card out. But, you can buy one for a few bucks and put it back in.
What is hard to find on the internet is the link to an actual clinician guide for the machine that goes into detail on the setup. This is a technical manual, not the user manual. These are pdf's that are a good idea to save as the links seem to come and go. And you have to be careful with the Dreamstation one as it covers multiple models and not all options will be on the machine you have. And if you do go into the clinical or provider manual be careful and be sure you understand what you are changing. You do not want to mess things up!
So I got the price tag from the sleep clinic due to a posting in my web profile of my insurance's website. CAD $2480. Despite insurance coverage, I would still have to pay almost as much out of my pocket as if I would buy it straight from a website! Isn't that crazy?
Let's be honest, do I need the ongoing service (and only annual review) of a cpap therapist? Right now, I don't see the value they provide with the inflated prices. In fact, they didn't even mention anything to met yet, all I know is either from the web or asking another sleep clinic chain.
Besides that, can't I just read out the settings with sleepy head which they made on the trial machine? If I know the pressure from the DreamStation, then I should be able to easily apply that to the Resmed 10 Autoset, correct?
Or is there any danger/health risk by treating myself without a therapist?
Do you not have an option of just buying the machine at a good price on line and getting all or most of that cost covered by your insurance company? That is what my son did in Alberta with Sun Life. That cost of $2480 from as sleep clinic is pretty consistent with my experience in Alberta. I was quoted $2400 and they would only supply a poor F&P SleepStyle. They would not supply a ResMed.
My suggestion is that if you are committed to monitoring your own results using SleepyHead there is no benefit in using a therapist. My experience in Alberta is that they provide next to zero support and ongoing monitoring, and your will be much better off if you take personal interest in your results.
Yes you can easily transfer your settings from the DreamStation to the ResMed.
How have you been doing for treatment with the DreamStation? If you have been doing well, there is no reason not to believe you will be able to seamlessly switch to a ResMed. The only current issue I can see is that with the ongoing Postal Services strike issues you may have to pay something extra to get the machine shipped with a courier company to avoid delivery delay.
On risk over the long term, I would expect like Alberta you always have the option of going back to your GP to get another referral if you are not able to maintain good results on your own with SleepyHead. I am currently maintaining under an AHI of 5 with my machine despite some central apnea issues. However, if I get to the point I can't then that is what I will do. I would ask to be referred to a different clinic than my last one, as I was not happy with the service they provided.
I am in the process to get from my insurance the purchase from an online retailer approved whereas I buy the mask from a sleep clinic since I would receive free service just by buying the mask from them.
Mentioning to them that I currently trial the DreamStation in APAP mode and my wish to switch to Resmed 10 Autoset, they told me to trial first the Resmed due to the different algorithm in the APAP mode. Honestly, I don't quite get that argument. The auto mode can't be that different, can it? In addition many people here pointed out the preference of the settings and modes of the Resmed 10 over the DreamStation. I don't follow why I would need to trial the Resmed 10 first.
They are correct in saying that the auto adjustment algorithm is different in the ResMed compared to the DreamStation. However, they are not that different, and the machine will self adjust for any difference. And, if you get the AirSense 10 AutoSet For Her version of the ResMed, you will have two choices of algorithms in that machine. You can try both and see which works best for you.
So, no I think it would not make sense to trial the ResMed first. When I did my sleep trial I was given a Fisher and Paykel SleepStyle machine. I went straight from it to the ResMed AirSense that I purchased on line. No problem at all.
There are a few difference in the options though and I can help you get started with the ResMed. If you post 3-4 SleepyHead reports of your recent typical nights, I can give you my suggestions for the starting settings with the ResMed.
