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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Re: Medicare & Machine Replacement?

Postby Guest on Sat Mar 18, 2017 8:52 am

OboeVet wrote:My machine and supplies are provided because I am rated as 20% "Service Connected" for orthopedic injuries.
Slight correction on this. You do NOT have to be service connected to get treated for OSA at the VA. You do have to be a veteran enrolled in the VA system who has been Dx'd with OSA and can provide a copy of the Dx and sleep study or you will have to take another sleep study at the VA. As mentioned supplies and equipment are provided at no cost to the veteran.

You may have to put up with some other things like proof you are using it and/or travel to the VA (for supplies, etc) in some areas but in others they will send a DME/RT to your home and mail you supplies which is very convenient.

Now if you have to have one of the service organization help you to get qualified for something with the VA that can and often does take time as in years but that is normally not the case with cpap but proving you have some other "service connected" disability the VA should cover. But those organizations will help and support you the whole way thru. Some may even have a cpap or a member have one that can be loaned out, I know they do for things like wheelchairs etc.

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Re: Medicare & Machine Replacement?

Postby dlby on Sat Mar 18, 2017 9:30 am

Cpap.com secondwind
Any where from 100 -2000 bucks for sale

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Re: Medicare & Machine Replacement?

Postby Physician on Sat Mar 18, 2017 6:20 pm

kalatraza wrote: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.




Have NOT read the posts here. Medicare will replace a PAP machine every FIVE years even if the machine is working well. It's quite a bit of paperwork for the DME. No repeat sleep study needed if there's been compliance and a recent Sleep Medicine visit with a prescription and documentation.

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Re: Medicare & Machine Replacement?

Postby chunkyfrog on Sat Mar 18, 2017 9:21 pm

Call Medicare and ask THEM.
Some rules change without warning, and current rules are known by Medicare personnel first.

_________________
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
Please ignore xxyzx's posts. He is often so wrong it could be harmful. He is also delusional and extremely abusive.

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Re: Medicare & Machine Replacement?

Postby Guest on Sat Mar 18, 2017 10:13 pm

chunkyfrog wrote:Call Medicare and ask THEM.
Some rules change without warning, and current rules are known by Medicare personnel first.
This obviously got lost...
kalatraza wrote:Thanks so much everyone.

Looked into it and dad does have a Medicare Advantage plan. It sounds like that makes a big difference on the replacement policy?
So those are the people the OP needs to contact to find out how this plan works then compare that to what the DME is telling them. May be time for another DME.

But then we haven't heard back from the OP who may just be too shocked to reply.

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chunkyfrog
 
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Re: Medicare & Machine Replacement?

Postby chunkyfrog on Sun Mar 19, 2017 7:22 pm

Yes, do not be embarrassed.
The system is confusing in order to baffle us.
Sometimes it works on even the smartest of us.

_________________
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
Please ignore xxyzx's posts. He is often so wrong it could be harmful. He is also delusional and extremely abusive.

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