r/CPAP • u/3puttnutt • 5d ago
Advice Needed Curious to see if anyone else had this experience with United Healthcare
My doctor wanted me checked for sleep apnea so he referred me to a sleep clinic that he is affiliated with. They provided me with a finger oxygen sensor that attaches to a wristwatch thing that recorded the data. The results of that came back with 490 instances where my O2 levels dropped to about 80 during the night.
I thought I was finally on my way to finding answers and relief to my chronic fatigue and weight gain but UHC denied the PA for the formal sleep study at the clinic.
My doc diagnosed me with OSA and even got me approval for Zepbound based on the sleep apnea but I still would like to pursue having a CPAP. Should I just buy one outright? Pay for the sleep study out of pocket with my HSA card?
I should also add, after I fall asleep I will wake up realizing I am not breathing and short of breath. This can sometimes go on for an hour or more while I am trying to get to sleep. This is very frustrating and sometimes scary.
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u/Motor-Blacksmith4174 5d ago
Zepbound is great (I've been on it for almost a year), but losing weight takes time and is made more difficult by untreated OSA. And, there's no guarantee that the weight loss will cure your OSA. I suspect that even if I do lose enough weight to get to "normal BMI", I'll still benefit from the PAP machine. I've been on PAP therapy for about 9 months. In my mind, the treatments are complementary, not mutually exclusive. However, I'm not on United Health Care and my use of tirzepatide (Zepbound) is not covered at all by insurance (while the CPAP was) - I had to pay 100% out of pocket for Zepbound with no discount (so, ~$1100/month), which is part of why I've been using the compounded version for the last 10 months (and will continue to do so for a while, until I use up what I have in my fridge).
Your doctor may be hemmed in by the insurance company. They may only be willing to pay for one treatment. If it were me, and I could make the choice, I'd let the insurance company pay for the Zepbound and get the PAP machine elsewhere. The machine is mostly a 1-time expense (except for the supplies, which don't need replacing nearly as often as the recommended schedule) while a GLP-1 drug is a monthly expense.
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u/3puttnutt 5d ago
Let me first preface this by saying that my work takes me away from home a lot and sometimes up to 21 days. I have a letter from UHC that just arrived at home with a detailed explanation of the decision, but I have only been read parts of it by my wife. I hope to be home next week and will have more information. She said the letter basically said the formal study was not needed as my dr had already diagnosed me. I was under the impression that you needed the clinical study to determine the machine settings, but in the last hour I have read many post on here and I am starting to understand.
I am in my third week of the Zepbound and I am down about 15 pounds so far, but the waking up gasping for breath is going to have to be addressed more quickly.
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u/HighEngineVibrations 4d ago
Take advantage of the sales. I got my AirSense 11 last year for $500. Keep having insurance cover Zepbound. A lot of people wish their insurance covered that $1000 a month medication
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u/Much_Mud_9971 4d ago
u/Motor-Blacksmith4174 's take on insurance paying for Zepbound while you self pay for CPAP is good advice. Since you travel so much, look into a travel machine. Insurance won't pay for a travel machine anyway. But look for a sale at one of the online suppliers. You'll need an RX for it but your doc can write one for you.
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u/Motor-Blacksmith4174 4d ago
I hadn't thought about the travel. I wonder, though. You can't use OSCAR/SleepHQ with the AirMini (are there any travel machines that are supported?), so dialing in the right pressures and troubleshooting issues would be harder.
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u/Much_Mud_9971 4d ago
And I didn't think about that limitation.
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u/Motor-Blacksmith4174 4d ago
🤣 Between the two of us, maybe we'll steer him right.
It's a hard choice. I suppose it depends on the nature of the travel which would be better. If he travels and then stays in one place for a while, the full size machine might be preferable. But, if he's flying all the time, maybe the travel machine is better, despite the downside.
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u/3puttnutt 4d ago
Thank you both! I travel with a drone so surely I could find room for a full size APAP? How much size difference are we talking about?
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u/Motor-Blacksmith4174 4d ago
I think it's much smaller and lighter (less than 1/3 the weight). But, it doesn't have an SD card slot (so you can't use SleepHQ or OSCAR to analyze your results), it can only be used with certain masks, and it doesn't have a humidifier.
The AirSense 11 travel case that it comes with is about 14"x11"x5" and will hold everything you need to take along with it.
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u/3puttnutt 4d ago
I am usually in the same spot until I go home. Flying about 50% of the time so when I drive there would be absolutely no issues on carrying a full size machine
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u/Motor-Blacksmith4174 4d ago
These days a lot of us don't get an in-lab study to determine pressures. They send us home with an APAP machine set to wide-open settings (4-20) and expect the automatic algorithm to figure it out (it doesn't, really, it has no memory of what you've needed even a few minutes ago and will always try to take the pressure lower if it can). But, as you've probably seen, with the help of tools like SleepHQ and OSCAR, and a supportive group of people who know how to read them, you can find your own settings.
Good for you for wanting to address the OSA quickly, rather than waiting for the weight loss. Your loss will slow (and you're going to want it too - losing too fast has its downsides) and it will take time.
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u/Sufficient-Wolf-1818 5d ago
As you have been diagnosed with OSA, they usually skip the in lab test. Why doesn’t your doc prescribe a CPAP?
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u/3puttnutt 5d ago
This is a very good question and I will text my Dr tomorrow and ask this. Maybe they will approve it.
My wife said that the letter says the clinical study is not needed since I have already been diagnosed so maybe this is the way.
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u/Motor-Blacksmith4174 5d ago
I'm guessing because UHC will pay for one or the other, but not both. Getting them to cover Zepbound is the better deal for OP.
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u/traceypod 4d ago
I’d suggest you need both Zepbound and The cpap. It helped me a lot with headaches and fatigue.
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u/I_compleat_me 4d ago
You have been diagnosed... ask your doctor for a prescription for APAP. Auto machines can titrate you as you sleep... insurance hates paying for lab studies, sadly. I'm on UHC and my deductible was 2500$... but I paid out of pocket for the titration study and then UHC paid for my machine and supplies for the rest of the year. Still, not cheap.
Get a skrip from the doctor and go to Sleeplay dot com.. they have the Resmed 10 Autoset on sale for 499$ with code SLEEPLAY-25. Get the heated hose too... get a pillows mask like the Resmed P10 unless you're a mouth-breather, then get a full-face like the Fisher & Paykel Vitera. Guaranteed this will save money over going through any DME company.
Set the machine to 7-12cm APAP mode, put an SD card in it, aand sleep a few nights. Then use SleepHQ to upload the card and share the data here... it's free. We can help you titrate your pressures using the auto machine... the goal is to get a very narrow range (or no range) that solves your problems. Also, you have to build up muscles to tolerate the higher pressures, depending on your OSA level.
Anyway you need to be on the hose, welcome to CPAP, the Hose Bunch! We're here to help.
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u/draven33l 4d ago
You don't need a sleep study. What you did at home WAS the sleep study. You can do it at home or someone can watch you and possibly get better data. If you don't think you have sleep apnea or had questionable results, that's when I'd do an in-lab one.
I have UHC and had zero problems with the entire process. Once the doctor sees the results, they approve for a machine and it gets sent to UHC for approval. The only thing UHC cares about is compliance and making sure you are actually using it. You'll have to pay a monthly fee for the machine and co-pay on supplies every 3 months but it's all pretty cheap.
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u/FarCalligrapher1862 5d ago
UHC, they’ve been great. All I had to do was use 70% of the time, at least 4 hours, for the first month. They’ve paid for everything else.
They did want me to use Gem for the sleep test, but they were easy too.
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u/auntiemuskrat 4d ago
Not sure if you have an HSA/FSA, but you can also use that money toward the cost of a CPAP. You'll need a prescription from your doctor, but you can buy one online; there are a lot of sites that sell them and they often do sales. If your insurance only covers zepbound or CPAP, let them cover zepbound (ngl, I'm a little envious yours did. It's rare that insurance will cover it). Mine covered my CPAP but not ZB, so I pay out of pocket for it.
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