Medicare question . . .
Medicare question . . .
My wife has used a S9 for (2) years and because of ResScan and a high insurance deductible we have always purchased supplies from cpap.com. She now has Medicare A, B and F. Is a new Letter of Medical Necessity and Rx from our GP enough to make Medicare happy and cover supplies now? She does fine and no way/no how does she want to have another sleep study.
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Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: AirFit™ N10 Nasal CPAP Mask with Headgear |
Additional Comments: S8 Autoset II for travel |
- chunkyfrog
- Posts: 34397
- Joined: Mon Jul 12, 2010 5:10 pm
- Location: Nebraska--I am sworn to keep the secret of this paradise.
Re: Medicare question . . .
Since Medicare changes their rules frequently, I would call them and ask.
My doctor needed to send the DME several pieces of documentation, no new sleep study. {{{a year ago}}}
--and that included a note from the doc that I was compliant and was helped by therapy. (Office visit)
The phone number is 1-800-633-4227. Plug in your phone. There may be a wait.
My doctor needed to send the DME several pieces of documentation, no new sleep study. {{{a year ago}}}
--and that included a note from the doc that I was compliant and was helped by therapy. (Office visit)
The phone number is 1-800-633-4227. Plug in your phone. There may be a wait.
_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Airsense 10 Autoset for Her |
Re: Medicare question . . .
_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion) |
Additional Comments: Back up is S9 Autoset...... |
Re: Medicare question . . .
A new sleep study isn't required as long as the original sleep study that was done meets certain criteria.
Special documentation does need to be sent in by the new DME that you will be using and I think they will know what is needed and all of it can usually be acquired from your sleep doctor or PCP if he has a copy of the sleep studies.
Medicare does have this question addressed in their rules and regulations for people who were diagnosed with sleep apnea prior to being eligible for Medicare.
Give me a little bit to see if I can find where I hid the link to that sections of the rules at the Medicare website.
Special documentation does need to be sent in by the new DME that you will be using and I think they will know what is needed and all of it can usually be acquired from your sleep doctor or PCP if he has a copy of the sleep studies.
Medicare does have this question addressed in their rules and regulations for people who were diagnosed with sleep apnea prior to being eligible for Medicare.
Give me a little bit to see if I can find where I hid the link to that sections of the rules at the Medicare website.
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/ |
I may have to RISE but I refuse to SHINE.
If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.
If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.
- ChicagoGranny
- Posts: 14471
- Joined: Sun Jan 29, 2012 1:43 pm
- Location: USA
Re: Medicare question . . .
See https://www.google.com/url?sa=t&rct=j&q ... k4ChAAaj0gFor patients who received a PAP device prior to enrollment in FFS Medicare and are seeking Medicare coverage of either rental of the device, a replacement PAP device, and/or accessories, both of the following coverage requirements must be met:
1.
The patient had a documented sleep test, prior to FFS Medicare enrollment, that meets the Medicare AHI/RDI coverage criteria in effect at the time that the patient seeks Medicare coverage of a replacement PAP device and/or accessories; and
2.
The patient had a face-to-face clinical evaluation, following FFS Medicare enrollment, by the treating physician who documented in the patient’s medical record that:
a.
The patient has a diagnosis of OSA; and
b.
The patient continues to use the PAP device.
https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... OSCAR_Help
http://www.apneaboard.com/wiki/index.ph ... ganization
For those not so good with technology: https://home.sleephq.com/
http://www.apneaboard.com/wiki/index.ph ... OSCAR_Help
http://www.apneaboard.com/wiki/index.ph ... ganization
For those not so good with technology: https://home.sleephq.com/
- chunkyfrog
- Posts: 34397
- Joined: Mon Jul 12, 2010 5:10 pm
- Location: Nebraska--I am sworn to keep the secret of this paradise.
Re: Medicare question . . .
I called them because the published data does not always get updated in a timely manner.
One DME in my area quit selling CPAP equipment several years ago, yet their name appeared on the site for YEARS.
One DME in my area quit selling CPAP equipment several years ago, yet their name appeared on the site for YEARS.
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Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Airsense 10 Autoset for Her |
Re: Medicare question . . .
Page 50 of your wife's Medicare and You 2016 book
Continuous Positive Airway Pressure (CPAP)
therapy
Medicare covers a 3-month trial of CPAP therapy if you’ve been
diagnosed with obstructive sleep apnea. Medicare may cover it
longer if you meet in person with your doctor, and your doctor
documents in your medical record that the CPAP therapy is
helping you.
You pay 20% of the Medicare-approved amount for rental of the
machine and purchase of related supplies (like masks and tubing),
and the Part B deductible applies. Medicare pays the supplier to
rent the machine for 13 months if you’ve been using it without
interruption. After you’ve rented the machine for 13 months, you
own it. Note: If you had a CPAP machine before you got Medicare,
Medicare may cover rental or a replacement CPAP machine and/or
CPAP accessories if you meet certain requirements.
If you live in certain areas of the country, you may have to use
specific suppliers for Medicare to pay for a CPAP machine and/or
accessories. See page 53 for more information.
Continuous Positive Airway Pressure (CPAP)
therapy
Medicare covers a 3-month trial of CPAP therapy if you’ve been
diagnosed with obstructive sleep apnea. Medicare may cover it
longer if you meet in person with your doctor, and your doctor
documents in your medical record that the CPAP therapy is
helping you.
You pay 20% of the Medicare-approved amount for rental of the
machine and purchase of related supplies (like masks and tubing),
and the Part B deductible applies. Medicare pays the supplier to
rent the machine for 13 months if you’ve been using it without
interruption. After you’ve rented the machine for 13 months, you
own it. Note: If you had a CPAP machine before you got Medicare,
Medicare may cover rental or a replacement CPAP machine and/or
CPAP accessories if you meet certain requirements.
If you live in certain areas of the country, you may have to use
specific suppliers for Medicare to pay for a CPAP machine and/or
accessories. See page 53 for more information.
_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
Additional Comments: Using a Buckwheat pillow its great |
For Medicare Assistance by State http://www.seniorsresourceguide.com/dir ... onal/SHIP/ or here http://www.medicareinteractive.org/