Baskadia

1.1:INTRODUCTION:

CPAP and APAP machines are widely used in US for Obstructive sleep apnea. Firstly, need to understand, what is basically sleep apnea?

Sleep apnea is a condition in which someone is not able to sleep at night. And in severe condition the nasal airways are blocked causing obstruction so is called Obstructive sleep apnea.

On average, 70% of the Americans are suffering from the sleep apnea starting from a childhood to young and old ages yet the disease severity may vary in the individuals.

Today, my focus is not on the disease itself but the treatment and most Importantly; understanding the process and workflow for the patients.

I have been in the field for a long time so I have closely been in the system understanding the standard procedure for Sleep apnea treatment so that patients may get benefitted, particularly; the NY residents.

1.2:How CPAP/APAP works?

CPAP stands for "Continuous positive airways pressure" and APAP stands for "Auto titrating positive airways pressure". Both are effective for sleep apnea treatment yet APAP are little advance since they automatically adjust pressure of the machine for patients with high blood pressure and cholesterol levels.

A CPAP/APAP equipment filters the room air pressurized to your mask through the tubing to keep your breadthways functioning normally without any sleep disturbance.

A lot of time we don't know the ways: how one can get the CPAP or APAP and it's supplies(facemask, filters, cushions, tubing: heated or slims line, chin strip and water chamber) every 3 months or 6 months covered under one’s insurance.

1.3:Treatment options for Obstructive Sleep Apnea:

Whenever a patient sets up an appointment with any of the doctors’ at sleep clinic then on initial consultation, doctor analysis the severity of sleep apnea considering his medical history normally suggests three treatment options.

(I)-CPAP/APAP EQUIPMENT:The Most commonly used method to treat sleep apnea.

(II)-INSPIRE SURGERY(It is a small device placed during outpatient treatment in the body)

(III)-ORAL DEVICE(It is a soft plastic placed around your tongue that keeps the tongue out of your mouth during sleep at night to keep your airways open, it is a little uncomfortable usually)

The treatment option that is workable comes out with mutual consent of the doctor and patient.

In this session, we will discuss only CPAP/APAP treatment option 1.

In NY, there are three are many sleep apnea clinics where the procedure is initiated by initial consultation or setting up a meeting with the doctors because untill and unless you don't have a prescription(Rx) in which CPAP or APAP is advised then the vendors will not proceed on CPAP/APAP or supplies as in case they are not covered by your insurance since they have to charge it back from your insurances(like Empire blue cross blue shield, Fidelis, United health, health first, Aetna, Oxford and many more) and in case you will have to bear the OUT OF POCKET cost which could raise your budget much . So why not to go with insurances that are bearing the cost 80% for you and in few cases they bear 100% of it and if your insurance covers it all ;you are lucky enough to get every supplies free for your sleep apnea.

Many people don’t know that whatever you pay either individual/family deductibles deductibles or out of pocket ,these are contributed to your insurance that adds it into your account and once anyone meets his individual/family deductibles or the out of pocket, you are fully covered. Still the figures for out of pocket are always kept higher.

Any of the patients that want to covered by his/her insurance must be active and in network on the date of service he/she received.

it is a must condition by most of the vendors that it should be your primary insurance and you must be active under that with member or policy number.

There are many high ranked and well reputed sleep study centers in NY, some of these are:

• Sleep disorder institute headquarters NY

• New York Sleep disorder center

• Sunset sleep diagnostics

• Sleep, TMS & Wellness Center

So all you have to do is just search online any of the sleep disorder institute who has high ranking and repute, get the number and call them for appointment for a sleep study in any one of these three clinics nearby your location. Still you may get appointment with any reputed doctor in any of the sleep institute in your ears. The sleep studies are covered under your insurance too so it will be with a nominal fee. Moreover,everytime you schedule a visit to your doctor, you will be charged only copays like $10, $20, $30 etc. depending upon your insurance.

On the result of these studies in which patient remains in hospital or clinic on a sleep bed for a night, your doctor will suggest you CPAP or APAP and the accessories or supplies. Then you SDI will automatically send your prescription to the vendors that are covered under your insurance. The vendors in next step, can may call you verifying your insurance details and then working with your respective insurance for eligibility and authorizations for DME(Durable medical equipment). The process is not too much time taking but it’s a usual practice for vendors since few patients change their insurance for instance or they are not authorized due to any reason then how the vendor is going to claim his payments for your supplies and machine from your insurance?. As discussed above, In few insurances, you are fully covered and pay almost nothing or only a nominal percentage of the cost of CPAP/APAP or it's supplies(facemask,filters,tubing and cushions, water chamber, chin strap).

The best insurances, I found were Emblem, GHI, HIP and Aetna. With first three of these, you just pay $100 to your vendor in mostly cases with exceptional of few plans and you are covered for complete calendar year and vendor will be shipping your supplies automatically to your mailing address every quarter. It is really great, isn't it? Nonetheless, if your secondary insurance is Medicaid or Medicare then you are 100% covered….Wow, it’s really great if it’s so.

Your doctor's prescription will be valid for 5 years for CPAP/APAP and 2 years for your supplies. But just to overcome the misuse the insurance makes sure the patient is using it's machine at least 4 hours every night. So a compliance report is generated and if patient is found not using the machine for the least hour, then insurances have right that they may call it back from patient anytime.

1.4:TYPES OF MASK:

The mask is suggested by the doctor since there are 3 major types;

1-Full face mask:Covere the full face nose and mouth. The most common types of full face mask are F10, F20,F30 and F30i.

● cover more of your face can sometimes offer a better seal against leaking

● if you have facial hair, you may find that you need a larger mask to get a better seal

2-Nasal mask: Covers the nasal openings only and lighter than a full face mask. The most common types of nasal mask are:N10,N20,N30 and N30i

3-Nasal pillow mask. Its almost the same as nasal mask but have a pillow so is the name. Light weight and minimal than a nasal mask.

● If you have claustrophobia, it’s likely that a smaller mask will feel more comfortable.

The most common types are P10,P20,P30 and P30i.

Commonly used masks brands in above all categories are;

AMARA, MIRAGE,DREAMWEAR, QUARTRO, AIRTOUCH.

The vendor(Suppliers of CPAP & accessories) to whom you are referred by Sleep disorder institute (SDI) will receive the doctor's prescription from SDI and will initiate your supply request may asking few question and will suggest you the best type and size of mask.

If it still making any issue then the vendor can set up a video call or telephonic assistance with their technician who can guide you virtually and even can suggest you the change of type or size.

Different types of CPAP masks are available for those diagnosed with sleep apnea

Minimalistic Masks (For patients who don't like to feel bulky)

Freedom Masks * Air Tubing connection on the top rather than the front/ nose

Ultra Soft for patients with sensitive skin

Universal Fit Masks* the most used/ rated.

AirFit Masks have silicone cushion

AirTouch masks have memory foam cushion

Full Face Mask: Have “F” in the name for full face. Example AirFit F20 // AirTouch F20

Nasal Masks contain an “N” - AirFit N20

Nasal Pillows Masks contain a “P” - AirFit P10

1.5:Quick Info for MASKS:

Sleep on Stomach: AirFitF20i

AirFit N30i

I have a beard: AirTouchF20

AirTouch N20

AirFit P10

Move a lot while sleeping: AirFit F30i

AirFit N30i

Sensitive Skin:

AirTouch F20

AirTouch N20

Allergies/ Stuffy nose/ Deviated Septum:

AirFit F20 AirTouch F20 AirFit F30

AirFit F30i

Mouth breather:

AirF20

AirTouch F20

AirFit F30i

AirFit F30

Wear Glass:

AirFit F30

AirFit P10

AirFit N30i

The vendor(Suppliers of CPAP & accessories) to whom you are referred by Sleep disorder institute (SDI) or any of the sleep institution, will receive the doctor's prescription and soon after, they will initiate your supply request may asking few question regarding confirmation of your subscriber policy number with your active insurance,current mailing address and best callback number and will suggest you the best type and size of mask.

If it still making any issue then the vendor can set up a video call or telephonic assistance with their technician who can guide you virtually and even can suggest you the change of type or size.

1.6:MANUFACTURERS: There are two renowned CPAP/APAP manufacturers are there; Resmed and Dreamstation by Phillips respironics.

Resmed has Airsense11 ,the latest one still Airsense10 is also working perfectly. While Phillips has only Dreamstation2(D2) in the market that is latest one since they recalled Dreamstation1(D1) and gave free units of upgraded D1 in few patients and D2 for the mostly patients who retuned back D1, although the process took some months in few cases.(In case, you can just sign up at their portal and you may proceed with series number for your CPAP or APAP).

Some other Chinese manufacturers are available but most trusted are still Resmed and Dreamstation by Phillips. I hope you will find these information useful for you.

Continued to Sleep Apnea Treatment NY-Edition 2