Curious CPAP question for ya'll

[Sandy GlueStick 33]

If you have been required to use a cpap, I'm wondering...

*Does your insurance pay for it?

*How much is it if you have to pay out of pocket?

*Have you heard any cases where patients suffered from untreated sleep apnea?

*I know this is a pre-op forum, but do you know anyone who has had the sleeve surgery and didn't use their cpap in recovery after all?

*I can't think of anything else right now so I'm leaving this one blank for future questions! Ha.

Thanks!

(I'm asking for purely curious reasons, because I'm a crazy researching googling kind of person.)

Sent from my SM-G900V using the BariatricPal App

[josiek1988 70]

Hi, my name is Josie and I am preparing for band to sleeve revision. I work for a Pulmonary and sleep clinic and I use a cpap. Let me answer a few questions for you. Yes, your insurance should pay for it or at least a portion of it. It all depends on your policy. As for paying out of pocket, if you buy a new machine, they are very expensive and that doesn't include the mask and supplies. You an get them used on ebay and places like that. Sometimes the equipment company may even have used ones you can buy or rent. But honestly, after you loose weight the need for the cpap may resolve. I can tell you the left untreated, apnea can cause enlarged heart among other issues. In our office, we see lots of bariatric pre-op patients. If your sleep study determined that you need a cpap, your surgeon may not do surgery until you have a cpap and show your compliant. Let me know if you have any other questions. If I don't know the answer, I can ask one of our docs. I hope this helps.

Sent from my SM-T350 using the BariatricPal App

[kmorri 1,689]

@@Sandy GlueStick My mother had a mild stroke due to sleep apnea! That was actually when they discovered she had sleep apnea. So yes it can be quite serious. Luckily she recovered completely. My husband also has severe sleep apnea and uses a CPAP every night. During his sleep study he had 78 episodes within 1 hour! He is a very compliant patient sometimes I think he is afraid to fall asleep on the couch watching TV...

As far as your other questions.....if the machine is medically necessary it should be covered under your insurance. My husband's was a rental fee for several months...(sort of like rent to own).....so we had our 20% co-insurance to pay each month. I think that was for around 6 months to a year (sorry it's been a while)....I don't remember the amount but it was less than $20......Then there is also the cost of the supplies, (mask, hoses....).

Good luck!

[mmell 22]

Sandy GS...Mel from Green Bay here. sleep Apnea, must be treated with ABSOLUTE concern. I have had it since God no's when? I was diagnosed around the year 2000. I went through the sleep study, and had many, many sleep disturbances. (I don't remember the number). I was put on a sleep machine, which went unused. The mask didn't fit, and it just didn't work properly. I'm sure I could have tried a little more, and been more compliant. After years of crappy sleep, (sleep 4-5 hrs. get up for 4 hrs. and go back to sleep for 3 hrs.) I decided to get this straightened out. SHAZAM!!!!!! I received a new CPAP, and my life has changed. I sleep 7-9 hrs.straight through, (1 bathroom visit/night). The technology has changed so much, I can't believe it. As far as payment...I rent the machine, and eventually the ins.company will buy it for me. The company I deal with, can see through a computer chip, all my sleep info. (time usage, sleep disturbances, mask fit information etc.). So I do have pretty good insurance. They do cover mask, filter, hose replacement, with the usual co pay. As far as people not using their machines?, I'm sure there are people like the way I used to be, but with the new machines, it really shouldn't be a problem. Folks with apnea, need to use their machines every night, if possible. Strokes and heart attacks are caused by untreated apnea. Untreated apnea causes the heart to work overtime, and will raise your BP, while you sleep. And anyone who suffers from it, knows how damn tired you are the next day. EXHAUSTED!!! was the name of my game. Without getting too dramatic...my CPAP, has changed my life. Good Luck.

[Sandy GlueStick 33]

My paranoia has subsided since I first made this post. But here is my theory...

I agree about the dangers of sleep apnea, but I have this suspicion about all the CPAP makers. They are seeing a great decline in sales, due to the miracle of WLS causing patients or future patients not needing them anymore. So they (big pharma?) have made a deal with Doctors to keep mandating their use, testing, etc, for as long as possible, so as not to jeopardize their industry.

I'm not usually a tin hat foil wearer kind of gal, but for 6 months I've been looking into this! Off and on, not like a full time job or anything. Lol.

Our Kaiser folks mandate it, but the actual surgeon, contracted through Scripps said No, we don't need any kind of sleep study. No, you won't need to bring in your CPAP machine for surgery date.

I'm probably not coming across as eloquently as I'd like to believe I am. Phone typing isn't as nice to me as keyboard typing usually is!

Sent from my SM-G900V using the BariatricPal App

[2goldengirl 2,076]

My paranoia has subsided since I first made this post. But here is my theory...

I agree about the dangers of sleep apnea, but I have this suspicion about all the CPAP makers. They are seeing a great decline in sales, due to the miracle of WLS causing patients or future patients not needing them anymore. So they (big pharma?) have made a deal with Doctors to keep mandating their use, testing, etc, for as long as possible, so as not to jeopardize their industry.

Sent from my SM-G900V using the BariatricPal App

I hate to tell you this, but CPAP makers aren't seeing a "great decline in sales". The use of CPAP is on the rise, because sleep apnea affects upwards of 20% of the population, many, many of whom are of normal weight (my pulmonologist, for example) and many, many of whom have not yet been diagnosed.

Case in point. I do not snore. Other than headaches and my weight, I did not meet the profile for sleep apnea. I scoffed at my need for a sleep study but my surgeon wanted one anyway. Imagine my surprise when I was diagnosed with sleep apnea? My problem is hypopnea, which doesn't cause snoring, any may very well stay with my after I reach goal weight.

DME manufacturers don't drive the increased incidence of sleep studies, pulmonologists do. And in a lot of cases, that's a good thing.

[Inner Surfer Girl 12,015]

Or, alternatively, sleep apnea is deadly and under diagnosed and under treated and insurance companies want to make sure that if they are paying for WLS surgery they want to make sure you have the biggest chance of successfully coming through the surgery alive.

Just a thought.

[MomOf4OhMy 47]

My insurance will pay for my CPAP month to month but I must take my sim card from it in to the pulmonologist once a month to demonstrate compliance or else they will no longer pay for it. My surgeon will also not do the surgery unless I've been demonstrating compliance. I'm still pre-op, but my aunt who had lap band about a year ago has lost 85 pounds and no longer needs her CPAP. She said while she got great sleep with it, she was not sad to see it go.

[josiek1988 70]

I can tell you that there are very stringent guidelines for cpap equipment just like there is for WLS. Insurance companies don't want to pay for anything they don't need to. So there must be a medically necessary diagnosis. And a doctor can't just say that you have apnea. There are parameters that must be met.

Sent from my SM-T350 using the BariatricPal App

[Rainy Days 73]

I was just recently diagnosed with mild sleep apnea. The paperwork they gave me says the CPAP machine cost about $1100 (not sure if that included the mask that they said cost $190). My portion will be about $300. I am a little frustrated to spend so much money on this when my pulmonologist said she felt I wouldn't need it once I lose some significant weight. However my surgeon won't proceed with surgery unless my sleep apnea is treated, so I'm stuck.

On the bright side, it's not as bad as I thought. The mask fits really well and isn't that horrible. I don't notice a difference in my sleep (yet) but I do appreciate that it's probably protecting me from negative effects from the apneas.

[josiek1988 70]

I was just recently diagnosed with mild sleep apnea. The paperwork they gave me says the CPAP machine cost about $1100 (not sure if that included the mask that they said cost $190). My portion will be about $300. I am a little frustrated to spend so much money on this when my pulmonologist said she felt I wouldn't need it once I lose some significant weight. However my surgeon won't proceed with surgery unless my sleep apnea is treated, so I'm stuck.

On the bright side, it's not as bad as I thought. The mask fits really well and isn't that horrible. I don't notice a difference in my sleep (yet) but I do appreciate that it's probably protecting me from negative effects from the apneas.

Did the DME company put you on a rental program? Most of the time you rent the machine per insurance for 13 months and then you own the Cpap. But if in that time you loose a significant amount of weight and feel like the Cpap is not necessary, you can have another sleep study. If you had mild apnea it shouldn't be a problem once you drop some weight to get off of the cpap.

It does completely suck that even with mild apnea that your surgeon is requiring a cpap for you. At this point, I am willing to do just anything to get this WLS over and done. Just when you think you have jumped through the last hoop, another is tossed in front of you!!

[theantichick 2,204]

I don't like sleeping with my CPAP, but my goodness it makes such a difference in how I feel. I am hoping the weight loss after surgery will eliminate my need.

My insurance paid for it, with a co-pay. I had an FSA for all of my out of pocket needs, so I honestly don't remember how much I had to pay, I'm wanting to say it was $100 - $200. My insurance pays for my supplies with I think a $45 copay for 3 month's of supplies (which last me almost a year).

There are places you can get CPAPs for little or no money, the National sleep Foundation has a program. As a nurse, I will tell you it's best to get it treated, even if it is short term. It has so many health implications, from high blood pressure to stroke to weight gain... it's nothing to be messed with. And in the hospital, they'll have you on a pulse ox during your recovery, and if your oxygen keeps dropping, they'll keep waking you up. And it's hard enough to sleep in a hospital without that!!!

[Rainy Days 73]

I was just recently diagnosed with mild sleep apnea. The paperwork they gave me says the CPAP machine cost about $1100 (not sure if that included the mask that they said cost $190). My portion will be about $300. I am a little frustrated to spend so much money on this when my pulmonologist said she felt I wouldn't need it once I lose some significant weight. However my surgeon won't proceed with surgery unless my sleep apnea is treated, so I'm stuck.

On the bright side, it's not as bad as I thought. The mask fits really well and isn't that horrible. I don't notice a difference in my sleep (yet) but I do appreciate that it's probably protecting me from negative effects from the apneas.

Did the DME company put you on a rental program? Most of the time you rent the machine per insurance for 13 months and then you own the Cpap. But if in that time you loose a significant amount of weight and feel like the Cpap is not necessary, you can have another sleep study. If you had mild apnea it shouldn't be a problem once you drop some weight to get off of the cpap.

It does completely suck that even with mild apnea that your surgeon is requiring a cpap for you. At this point, I am willing to do just anything to get this WLS over and done. Just when you think you have jumped through the last hoop, another is tossed in front of you!!

No, mine is not a rental. It's not even an option. They said that I have to use it for 3 months and after that they will bill my insurance, of which about $300 is my portion. If I am not compliant with the machine, then I will be responsible for the entire amount. My machine has it's own modem and is connected to the cloud so the respiratory therapy dept knows if I am compliant or not. Compliant means using it at least 21 days a month for at least 4 hours a night.

[josiek1988 70]

@@Rainy Days, I work for Pulmonology/Sleep Doctors and the one thing they nor the DME company will never tell you is that you don't have to be asleep to record compliance!!!! I mean ideally this is when you have apneas and that is what the machine is for. But, you can wear it anytime and it will record. When I got mine, and even sometimes now, I will put it on while watching TV/Movie. And yes, most new machines are wireless, so they can time. One thing to keep in mind, if there comes a point in the future that you no longer need your cpap, you can sell it for a pretty penny!!! Because they are so expensive with insurance people are always looking for a good deal on a nice machine. Or, people who travel that want a second cpap to travel with. Just a thought!!!

[Rainy Days 73]

after I feel I don't need it, I'm hoping my husband will wear it. I'm pretty sure he has sleep apnea but he has rotten insurance, so he isn't getting tested for it. And my machine is an automatic adjusting machine. I found that Amazon has cpap masks for much less than elsewhere, so we'd just get him a mask from there.

or if he won't wear it, then sell it! great idea!