Medicare and New Machine

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
SMenasco
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Medicare and New Machine

Post by SMenasco » Thu Oct 06, 2011 2:15 pm

I was under the impression that Medicare would pay for a new cpap machine every five years. I was going to go in and possibly go back through a sleep study and request a prescription for a new S9 Auto set. I called the DME to find out if they carried and/or supplied bipaps and was told that Medicare has stopped replacement of machines every five years unless there is an unrepairable problem with the existing unit. Anyone know anything about this? Thanks

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GumbyCT
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Re: Medicare and New Machine

Post by GumbyCT » Thu Oct 06, 2011 2:21 pm

SMenasco wrote:I was under the impression that Medicare would pay for a new cpap machine every five years. I was going to go in and possibly go back through a sleep study and request a prescription for a new S9 Auto set. I called the DME to find out if they carried and/or supplied bipaps and was told that Medicare has stopped replacement of machines every five years unless there is an unrepairable problem with the existing unit. Anyone know anything about this? Thanks
Maybe this DME is not happy with the rate that Medicare will pay. Contact Medicare directly or try another DME. I think you might get a clearer answer from Medicare directly.

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Emilia
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Re: Medicare and New Machine

Post by Emilia » Thu Oct 06, 2011 2:36 pm

This article was published in July 2011 so I presume it is up-to-date information. Janknitz is our Medicare expert so I am sure she will along soon to let us all know!

http://www.ehow.com/facts_7319281_medic ... ement.html

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Janknitz
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Re: Medicare and New Machine

Post by Janknitz » Thu Oct 06, 2011 6:35 pm

I'm not sure why you asked the DME about biPaps. You do know that an Auto is NOT a biPAP machine, right???

What I recommend is that you call around to other DME's and find one that really wants your business. Ask if they are willing to supply you with a new ResMed S9 Autoset as a Medicare replacement machine after 5 years.

If multiple DME's tell you the same thing, then it will be worth our time to look it up and find this change in policy (IF it exists). But I strongly suspect it does not exist, this DME just doesn't want to supply you with a more expensive machine. The DME's profit margin isn't the greatest on an S9 Auto and beware that if you find a DME purportely willing to provide one that they don't pull a bait and switch and supply you with a cheaper S9 Auto ESCAPE instead.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
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SMenasco
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Re: Medicare and New Machine

Post by SMenasco » Thu Oct 06, 2011 9:07 pm

No, I don't know the difference between a bipap and an Autoset. I just wanted to try a new machine that has different pressures depending on the need. What is the difference? I asked the DME because they are the ones that supply the machine. Who else would I ask?

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chunkyfrog
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Re: Medicare and New Machine

Post by chunkyfrog » Thu Oct 06, 2011 9:26 pm

Just my ignorant opinion, but DME's, as a rule, don't know or share anything that might cut into their profit.
Insurance or Medicare pay the same for great machines or lousy machines.
Read the information under CPAP Wiki at the top of the page.
There is more there than you are likely to find anywhere else.
I wish I had done it earlier.

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ems
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Re: Medicare and New Machine

Post by ems » Thu Oct 06, 2011 10:18 pm

I was under the impression that Medicare will give you a new machine every 5 years. I haven't heard that changed.
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SMenasco
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Re: Medicare and New Machine

Post by SMenasco » Fri Oct 07, 2011 9:01 am

I called Medicare and here's what they said. If the current machine is less than five years old, broken and/or not functioning well, they will pay to have it repaired. If the repair cost is more than what they feel is appropriate, they will pay for a new machine. If it is more than five years old, they will pay for a new machine.

nanwilson
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Re: Medicare and New Machine

Post by nanwilson » Fri Oct 07, 2011 10:03 am

Woot Woot!! You get a new machine..........and stick to your guns with the DME and get what YOU want.
Started cpap in 2010.. still at it with great results.

Janknitz
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Re: Medicare and New Machine

Post by Janknitz » Fri Oct 07, 2011 12:19 pm

No, I don't know the difference between a bipap and an Autoset. I just wanted to try a new machine that has different pressures depending on the need. What is the difference? I asked the DME because they are the ones that supply the machine. Who else would I ask?
An Autopap will automatically adjust the pressures depending on need. That's what you want. A Bipap may be fixed or auto, but it allows a broader range of pressure difference between exhalation and inhalation. You must have a documented reason to need a biPAP rather than a regular XPAP machine. BiPAP's are VERY expensive, and Medicare does not cover them without proof of medical necessity. THAT may be why your DME gave you a song and dance about needing new documentation, etc--they thought you wanted an entirely different machine.

Call them back and tell them you want the ResMed S9 Autoset or the Philips Respironics System One Auto and ask them to order it for you. If they give you the same song and dance, call around to other DME's who may be happy to have your business.

Beware that if you get the S9 Auto make doubly sure it's an Autoset, NOT an Escape--Escapes are not fully data capable. Escapes cost the DME less, so they will try to foist one on you if they can.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
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GumbyCT
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Re: Medicare and New Machine

Post by GumbyCT » Fri Oct 07, 2011 12:35 pm

SMenasco wrote:I called Medicare and here's what they said. If the current machine is less than five years old, broken and/or not functioning well, they will pay to have it repaired. If the repair cost is more than what they feel is appropriate, they will pay for a new machine. If it is more than five years old, they will pay for a new machine.
Well now that is much clearer even if it is unchanged.

It may have been in another thread where someone said that insurance and medicare pay at the same rate. This makes me think they don't. I think that because medicare caps the payments many feel this cuts their profits and don't want to deal with medicare.

You prob should report this to Medicare and the Insurance Commissioner of your state. IF the people before you had taken the time to report it - you likely would not have had this problem.

NOW you have to decide what to do. IF it were me, I would not continue giving people like this my money. When they lie about little things how can you believe anything else they tell you?

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Humidifier: HC150 Heated Humidifier With Hose, 2 Chambers and Stand
Additional Comments: New users can't remember they can't remember YET!
BeganCPAP31Jan2007;AHI<0.5
I have no doubt, how I sleep affects every waking moment.
I am making progress-NOW I remember that I can't remember
;)
If this isn’t rocket science why are there so many spaceshots?
Be your own healthcare advocate!

SMenasco
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Location: Oklahoma

Re: Medicare and New Machine

Post by SMenasco » Fri Oct 07, 2011 5:28 pm

Number 1; Thanks for all your advice. I called the DME (a branch of a large health care hospital system) back and asked if they provided S9 Autoset machines with humidifiers when the prescription called for them and they said yes and they carry them in stock. I think I might have earlier talked with some doofus that had a higher opinion of her knowledge than was actually the case and was shot in the ass with importance.

Number 2, I love Canadians and what the heck is a Woot! Woot!?

Number 3, I have an appointment to consult with my sleep specialist MD and ask for a prescription for the machine I want. He probably will want me to go back throught the sleep lab. I went through it about 8 months ago and the whole thing was inconclusive, since at that time I had started recirculating and did not tape up. I also learned that Medicare will only pay for one study every five years unless there is a specific problem. We'll see what happens. If he won't give me a script, my family doctor will.

Number 4; Thnaks for the advice to turn in the DME. However, I choose not to involve state or local government in any of my business unless it is absolutely necessary. I'm not convinced that in the long run, it's in my best interest to get on anybody's list. This comes from 50 years of dealing with politicians, large and small goverment bureaucrats, corporate officers and managers, (having been one) and some members of the general public.

Thanks again.

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BlackSpinner
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Re: Medicare and New Machine

Post by BlackSpinner » Fri Oct 07, 2011 6:42 pm

Number 4; Thnaks for the advice to turn in the DME. However, I choose not to involve state or local government in any of my business unless it is absolutely necessary. I'm not convinced that in the long run, it's in my best interest to get on anybody's list. This comes from 50 years of dealing with politicians, large and small goverment bureaucrats, corporate officers and managers, (having been one) and some members of the general public.
We are not so much interested in YOUR best interest but the dozens of people who will also get ripped off by them because they have not the same support that you just got.

If you meet a friend and hear about how they got treated after you kept your mouth shut how will you feel? How will they feel about you?

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SMenasco
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Re: Medicare and New Machine

Post by SMenasco » Sat Oct 08, 2011 8:22 am

So I'm supposed to do everything for the benefit of you and the masses? What's going on with your attack? It is my opinion and remains so. You're entitled to yours, as well. Whining guilt trips don't register with me, so don't waste your breath or time.

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Re: Medicare and New Machine

Post by Guest » Wed Jan 25, 2012 5:01 pm

I work for a DME company and you can get a new machine every 5 years. you do not have to have a new sleep study unless you have been using and CPAP and now need a BIPAP and would have to have a titration with the CPAP and then with a BIPAP. The difference between a CPAP and BIPAP is a CPAP has one pressure with inhale and exhale and a BIPAP lets you exhale at a lower pressure. with an auto you can have a range of pressures set by the doctor and the machine will adjust due to the breathing. let the dr office send the new order to a DME company and they have to provide this to you.