Thought I'd let y'all know what's happened with our case. Those of you who said that a repeat sleep study is not necessary per Medicare guidelines are of course correct. What happened is that the pulmonologist switched us to a different DME without really thinking it through. The new DME naturally s...

Karen, I couldn't resist -- remember this?

Hi Jan -- No longer with Kaiser, we both have Medicare and Tricare for Life Ah, good to know. I understand that Tricare for life is more than "just" a Medicare supplement, so you may try to see if they will cover the CPAP even if it doesn't meet the requirements under Medicare. You might ask for an...

Kaisgram, do I remember correctly that you have Kaiser? Does your husband? If so you are facing an uphill battle because Kaiser Senior Advantage is both his healthcare provider and his Medicare intermediary. No incentive to go beyond the guidelines because their Medicare reimbursement is capitated ...

greatunclebill wrote: ↑

Sat Sep 29, 2018 5:20 pm

have you doc send a prescription to the dme. the dme will tell him what they need from him to 'git 'er done.

That was the first thing we did...

He did provide the sleep doc with his 2011 sleep study report as well as the data from his SD card showing compliance. We believed that was sufficient and the doc thought so too at first. Your doc's first thoughts seem to have been correct. My doc, who seems to know what she is doing, said a machin...

Does anyone know of a case where a Medicare denial of CPAP was successfully appealed? I don't know, but... alternatively.. what kind of machine does he need, and could LSAT or grayghost4 supply it, and just tell doctor and medicare to go 'eff themselves? He uses an APAP. For the time being he's fin...

I just thought of something else? He's been using CPAP since 2011 when he was diagnosed and we know he needs it. Why was a new sleep test (HST) ordered? Medicare doesn't require another test when you are 65 as long as you submit a copy of the original test and evidence that you have been using CPAP...

palerider wrote: ↑

Sat Sep 29, 2018 2:10 pm

Sheriff Buford wrote: ↑

Sat Sep 29, 2018 6:22 am

Just a question...… : why do you think he needs a cpap machine with a 4 AHI?

Sheriff

Because an AHI of 4 is bad.

Yes, that too!

I don't know the answer for sure, just thinking the doctor can specify things beyond the AHI that make it a medical necessity. Go over the details of the study. If there's any lacking of deep and REM sleep, or a lack of supine sleep in REM, the test would be termed by my doctor as "technically subo...

I'm confused........ What happened to his previous equipment? http://www.cpaptalk.com/viewtopic.php?f=1&t=114733&p=1112255&hilit=married#p1112255 http://www.cpaptalk.com/viewtopic.php?f=1&t=89986&p=827021#p827021 Any knowledgeable "sleep doctor" would require that a person who is using CPAP refrain...

Sheriff Buford wrote: ↑

Sat Sep 29, 2018 6:22 am

Just a question...… : why do you think he needs a cpap machine with a 4 AHI?

Sheriff

As I explained in my OP he was diagnosed in 2011 and has been on CPAP ever since. We don't just "think" he needs CPAP.

It isn't clear to me why he needs a NEW machine. Why can't he continue to use the machin he has been using? Did Medicare take his old one? My goodness, this gang loves to throw out challenges! He needs a new machine because the one he'd been using since his diagnosis in 2011 finally expired. As I e...

Pulmonologist assures us that Medicare will deny the new CPAP machine because his AHI was below 5 (we understand this to be accurate), so she doesn't want to go any further with trying to submit a prescription for him. ... (Good grief, the pulmonologist even suggested he refrain from using his CPAP...

Hubby is 3 weeks post heart attack and we just found out that the sleep test he completed last month for Medicare showed an AHI of 4.3. He's been using CPAP since 2011 when he was diagnosed and we know he needs it. Pulmonologist assures us that Medicare will deny the new CPAP machine because his AHI...