Quantcast

Bookmark and Share
General Discussion on any topic relating to CPAP and/or Sleep Apnea.
kalatraza
 
Posts: 14
Joined: Wed Feb 02, 2011 12:19 pm
Gender: None specified

Medicare & Machine Replacement?

Postby kalatraza on Fri Mar 10, 2017 3:18 pm

Hi! Hoping you can help me figure out what I can do to help my dad out in Iowa. He has severe sleep apnea. His cpap machine is 7 years old. A month ago, the machine quit working in the middle of the night. It was frightening to both him and my mom because he started coughing with the full face mask on and had a lot of trouble getting his breath back. He took the machine into the DME and they gave him a loner. When he picked the machine up they said there wasn't anything wrong with it. Fast foreward to this week when it stopped working again. Now the DME is going to send the machine into the manufacturer because it is apparently repairable.

The machine is old. It does not automatically adjust and that would be better for dad. Any of dad's doctors would agree.

I asked the DME what needed to happen to get a new machine. We just don't trust this old one now! Too scary. :( They said as long as the cost of repairing the old one is less than the new machine, Medicare will not allow a new machine.

Do I have any options here?

--Dad has Medicare, BCBS Medigap, and Veterans "coverage"
--I can come up with some cash to cover what isn't paid by his plans but not enough to just buy the machine outright
--His doctors are wonderful and will help in any way needed, but they aren't good at negotiating DME world

Thanks for any assistance you can provide.

PS. I also would very much like to get a backup battery because they live in a rural area where the power goes out all the time.... no clue how to go about that process.

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Fri Mar 10, 2017 3:35 pm

kalatraza wrote:--I can come up with some cash to cover what isn't paid by his plans but not enough to just buy the machine outright
The quickest way out of this is to check on Craigslist under "health and beauty" for your area. Look for that same brand he uses now in the hopes that any supplies he has will fit this cpap. Hopefully the one he has now also will work on 12 Volts - most Respironics do.

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Fri Mar 10, 2017 3:51 pm

At some point it would be helpful to know the make & model of the cpap he has now.

kalatraza wrote:--Dad has Medicare, BCBS Medigap, and Veterans "coverage"
But the 2nd step I would take is to take him to his primary doc at the VA. Bring with you a copy of his sleep study and script for his cpap. If he doesn't have that see if his docs will help. Having the sleep study and script will save him having to take another sleep study at the VA and may save some time. But the reason to buy a cpap on Craigslist is these other options can take a month or more.

kalatraza wrote: They said as long as the cost of repairing the old one is less than the new machine, Medicare will not allow a new machine.
Stick with this but get him something else to use meanwhile. Don't let the DME know he has a backup or they may not put forth any effort but the bottom line is it will likely cost more to fix than a new cpap. I am honestly surprised the DME doesn't just certify it is beyond repair. Could they be in trouble with Medicare for something else? Sure sounds that way.

But there ya have it -
1st Craigslist (quickest)
2nd the VA
3rd pursue the repair option

And don't worry Medicare doesn't have to know about the VA and the VA doesn't have to know about his other cpap. So he can have two very good cpaps just try to make sure they are both from the same mfg and use the same filters and other supplies like the DC power cord for a battery.

For the battery option start another thread so it doesn't get more confusing.

Please, Do Thank Dad for his service for me.

User avatar
Hang Fire
 
Posts: 353
Joined: Mon Nov 04, 2013 8:03 pm
Location: Raleigh, NC
Gender: Male

Re: Medicare & Machine Replacement?

Postby Hang Fire on Fri Mar 10, 2017 4:35 pm

kalatraza wrote:Hoping you can help me figure out what I can do to help my dad out in Iowa.


You can get some good help here, but not from those two unregistered guests - their posts each contain some bad advice. Wait to act until some of the registered regulars reply. It may be Monday because sometimes they don't post on the weekend. Sorry, but I have to leave and can't help you now.

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Fri Mar 10, 2017 4:47 pm

Hang Fire wrote:
kalatraza wrote:Hoping you can help me figure out what I can do to help my dad out in Iowa.


You can get some good help here, but not from those two unregistered guests - their posts each contain some bad advice. Wait to act until some of the registered regulars reply. It may be Monday because sometimes they don't post on the weekend. Sorry, but I have to leave and can't help you now.

"Hang Fire" if you don't know why would you say something you know nothing about is bad?
Guest wrote:The quickest way out of this is to check on Craigslist under "health and beauty" for your area.

Talk about "Bad Advice" said another way it's called "Hang Fire".

User avatar
LSAT
 
Posts: 7958
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin
Gender: Male

Re: Medicare & Machine Replacement?

Postby LSAT on Fri Mar 10, 2017 4:59 pm

Medicare should replace the machine if it is 7 years old. Call Medicare and/of BCBS.....Don't believe what the DME tells you. He.will need a copy of his sleep study and a prescription from his doctor

I also would not take advise from an unknown guest. We don't even know if he/she or it is a CPAP user.

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 Autoset...APAP Settings 11-15


S9 Autoset with another as back up
Back up mask is another Quattro FF and an F20
Buckwheat Hull Pillow (CPAPfit) from http://www.pur-sleep.com/


User avatar
Midnight Strangler
 
Posts: 161
Joined: Tue Oct 07, 2014 5:39 am
Gender: None specified

Re: Medicare & Machine Replacement?

Postby Midnight Strangler on Fri Mar 10, 2017 5:18 pm

kalatraza wrote:Fast foreward to this week when it stopped working again.

Did he get another loaner to use until his machine comes back???? (I'm worried.)


Hang Fire wrote:You can get some good help here, but not from those two unregistered guests - their posts each contain some bad advice. Wait to act until some of the registered regulars reply.

Right!

LSAT wrote:I also would not take advise from an unknown guest.

Right.

Guests can get some things right. But, the best advice comes from experienced regulars who have a track record of helping people work through problems.

Any time I need help, I ignore the guests and wait for some of the trusted regulars.

D.H.
 
Posts: 847
Joined: Sun Sep 04, 2016 7:07 pm
Gender: Male

Re: Medicare & Machine Replacement?

Postby D.H. on Fri Mar 10, 2017 5:26 pm

He will probably need a new prescription. Hopefully, the doctor will write one without a sleep test. Since the DME is good enough to give him a loaner, this will keep him out of immediate danger. If the doctor prescribes an automatic and/or data capabilities, they might provide a new one for that reason.

If you can fix the old one, I recommend doing that so that he can have a spare on hand.

_________________
Machine Mask Humidifier 
Additional Comments: Min pressure 13.5 - Max pressure 20. No ramp. No exhalation relief. Max automatic humidification with heated hose.

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Fri Mar 10, 2017 5:56 pm

It appears that not one of the above negative posters can point to anything that is wrong in what is quoted below.
Guest wrote:At some point it would be helpful to know the make & model of the cpap he has now.

kalatraza wrote:--Dad has Medicare, BCBS Medigap, and Veterans "coverage"
But the 2nd step I would take is to take him to his primary doc at the VA. Bring with you a copy of his sleep study and script for his cpap. If he doesn't have that see if his docs will help. Having the sleep study and script will save him having to take another sleep study at the VA and may save some time. But the reason to buy a cpap on Craigslist is these other options can take a month or more.

kalatraza wrote: They said as long as the cost of repairing the old one is less than the new machine, Medicare will not allow a new machine.
Stick with this but get him something else to use meanwhile. Don't let the DME know he has a backup or they may not put forth any effort but the bottom line is it will likely cost more to fix than a new cpap. I am honestly surprised the DME doesn't just certify it is beyond repair. Could they be in trouble with Medicare for something else? Sure sounds that way.

But there ya have it -
1st Craigslist (quickest)
2nd the VA
3rd pursue the repair option

And don't worry Medicare doesn't have to know about the VA and the VA doesn't have to know about his other cpap. So he can have two very good cpaps just try to make sure they are both from the same mfg and use the same filters and other supplies like the DC power cord for a battery.

For the battery option start another thread so it doesn't get more confusing.

Please, Do Thank Dad for his service for me.

So in summary -
What is wrong with buying a cpap from Craigslist?
Apparently not one of these posters is a veteran or knows anything about the VA
And now I question whether they even know how a DME or getting a cpap repaired works.

Maybe none of these negative posters (can't call them people) even uses a cpap - they are just here to cause trouble.

This place gets creepier everyday.

SewTired
 
Posts: 1145
Joined: Thu Apr 16, 2015 8:33 am
Location: Minneapolis area
Gender: Female

Re: Medicare & Machine Replacement?

Postby SewTired on Fri Mar 10, 2017 6:05 pm

Even us regulars don't quite know how DMEs are going to respond to the new Medicare rules. Local Lincare said if the machine run hours say 15,000, then they will certify it worn and you can get a new one. They have no intention of waiting for your machine to break down before replacing it - sheesh, it can take weeks to get the paperwork done! Lincare in other parts of the country may review this differently. However, you still need a doc prescription with notes that include mention of continuing medical need. I'm just using Lincare as an example.

http://www.resmed.com/us/dam/documents/ ... achine.pdf

My bro's DME (Mpls-St Paul only) simply requires that the physician write a new prescription and notes that indicate continued medical necessity and records (yours or the DMEs) showing the machine was delivered to you 5 or more years ago. They don't actually care about the run hours or whether it works or not.

Can't help you on the VA one though. My BIL is scheduled for a sleep study, but it got pushed off again. However, OP already HAS a machine and is seeking a replacement, so that info wouldn't be of any help. My BIL's son (retired Navy - 2015) hasn't had his machine long enough to replace it yet.

If you want used, there are a number of RECENT threads that discuss current pricing and stuff for cpap machines. Check the stickies for Apap machines with full efficacy data and that work with Sleepyhead. The S9 Autoset, the S9 Autoset for Her, the Airsense Autoset and the Airsense Autoset For Her all meet this in the Resmed line. Avoid the Airstart which only has compliance info.
Diabetes 2, RLS & bradycardia
Settings: range 8-12

User avatar
chunkyfrog
 
Posts: 21426
Joined: Mon Jul 12, 2010 5:10 pm
Location: Lincoln Nebraska (Go Huskers)
Gender: Female

Re: Medicare & Machine Replacement?

Postby chunkyfrog on Fri Mar 10, 2017 10:18 pm

I wonder if the OP has Medicare DISadvantage, which, IMO, is worthless at best, and more likely to be dangerously insufficient.

_________________
Machine: AirSense™ 10 AutoSet For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Backup: Devillbiss Intellipap Autoadjust
Link to medicare suppliers, by zip code: https://www.medicare.gov/supplierdirectory/search.html

Woody
 
Posts: 434
Joined: Sat Mar 10, 2007 7:59 pm
Gender: None specified

Re: Medicare & Machine Replacement?

Postby Woody on Sat Mar 11, 2017 5:52 am

I called Lincare 2 months ago and inquired about a new machine because mine was
coming up on it's 10th birthday. ( I had actually bought another machine years earlier )
Well they contacted my Dr. and verified I had had regular contact with him all these years
and got a new copy of my prescription. My prescription just called for a cpap and I was
worried they were going to try to just give me another brick but they let me have a
DreamStation Auto. And in my case they never asked how many hrs my old brick had
on it or if it still worked. Anybody want a slightly used Remstar M with a sticky on off
switch only a little over 17,000 hrs ! I can make you such a deal !

_________________
Machine: DreamStation Auto CPAP Machine
Mask: Ultra Mirage™ Full Face CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: SleapyHead software

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Sat Mar 11, 2017 6:37 am

chunkyfrog wrote:I wonder if the OP has Medicare DISadvantage, which, IMO, is worthless at best, and more likely to be dangerously insufficient.

Could very well be. Life is so much more flexible w/o an advantage plan which not only narrows the docs and places that will accept it but now has to be approved by them FIRST before you can do anything including surgery. So it just slows things down incredibly.
I am certainly thankful I don't have one.

There must be some reason the DME for this OP is not acting but that is the reason it was listed last in the things to do for dad.

Using the VA would give dad access to a brand spanking new backup and another place for supplies esp. nice if he got an identical cpap.

User avatar
CowFish
 
Posts: 217
Joined: Fri Nov 02, 2012 5:51 am
Gender: Female

Re: Medicare & Machine Replacement?

Postby CowFish on Sat Mar 11, 2017 7:43 am

Guest wrote:Life is so much more flexible w/o an advantage plan which not only narrows the docs and places that will accept it but now has to be approved by them FIRST before you can do anything including surgery. So it just slows things down incredibly.
I am certainly thankful I don't have one.


How do you know these things if you don't have a Medicare Advantage Plan?

I switched my mother to an Advantage Plan. It's saving her a lot of money. Of course, I had enough sense to check that all of her doctors were in the network. She has many health problems.

Maybe you have been talking to people who are too dumb to do this before signing up?

User avatar
Pugsy
 
Posts: 37693
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA
Gender: Female

Re: Medicare & Machine Replacement?

Postby Pugsy on Sat Mar 11, 2017 8:20 am

CowFish wrote:How do you know these things if you don't have a Medicare Advantage Plan?

I switched my mother to an Advantage Plan. It's saving her a lot of money. Of course, I had enough sense to check that all of her doctors were in the network. She has many health problems.

Maybe you have been talking to people who are too dumb to do this before signing up?


I have a Medicare Advantage plan...and glad to have it. Switched my mom to one 3 or 4 years ago. She hasn't given up a thing.
All her doctors and her preferred hospital accept the plan and the savings on her part D coverage for medications alone made it a good business deal. Her primary doctor visits have a copay of either nothing or $10..it bounces around each year.
Now specialist co pay is a bit higher but she rarely is in need of a specialist.

When I broke my wrist a few years back and required surgery to fix it...my total out of pocket was just a little over $700 for everything from the ER visit to the last post op following up. At the time my Advantage plan didn't cost me a dime and now it is $29 a month (and this covers medications too).
Yeah, if I go to the hospital and end up admitted I have some daily co pays that could bite me in the butt but I am generally healthy without any problems that might cause me to end up in the hospital. The money saved by using the Medicare Advantage plan over the years will more than cover any out of pocket I have had that I wouldn't have had if I had traditional Medicare and a Part B supplement.

I haven't had to settle for sub par medical coverage or had anything disallowed except for one blood test and I got billed a grand total of $19 for it. I could have fought it because it was billed out under the wrong code but it wasn't worth fighting about. That was a billing error and not related to my coverage anyway.

People should look closely at the various Medicare Advantage plans out there so they know exactly what is or isn't covered and what their copay might be in various situations so that there aren't any ugly surprises but it's not hard to do.
Then they make a choice...either pay now for sure with a Part B supplement or maybe pay later. I opt to maybe pay later.

For the most part Medicare Advantage plans are tied to what Medicare would allow and pay for. If traditional Medicare would disallow it then the Advantage plan is likely to disallow it.

In terms of cpap stuff...I pay 20% of the Medicare allowed amount (and I have checked with regular Medicare for what the allowed amounts are for my mask and it matches to the penny) so twice a year I get a new mask and pay out of pocket in the neighborhood of $29. I am a happy camper.
For me to get a traditional Medicare supplement for Part B stuff...the cost would be enormous since I have Medicare due to a early disability and only turn 65 this year. People like me....if we can find a traditional supplement that will cover you us the monthly premium is pushing 300 a month. I can pay a lot of little co pays for $3600 a year.
Heck I saved money just with the broken wrist out of pocket.

Medicare Advantage plans aren't crap. They are different though and people need to fully understand how they work and why the lower (or free) monthly premiums.
ChunkyFrog's comments....simply not true and I don't know where she gets these ideas.

Next

Return to CPAP and Sleep Apnea (CLICK HERE TO READ POSTS)

Who is online

Users browsing this forum: supertiredperson and 22 guests