New machine after 7 years, or when it's broken?

DeeCPAP · Post by **DeeCPAP** » Sat Feb 25, 2017 3:25 pm

I got mixed messages. Are we allowed (by insurance companies) to get new machine after 7 years or only
when they break after 7 years? Thanks

ChicagoGranny · Post by **ChicagoGranny** » Sat Feb 25, 2017 3:33 pm

Insurance policies vary. Even within one company, the policies vary. You have to check with your own insurance company about your policy.

DeeCPAP · Post by **DeeCPAP** » Sat Feb 25, 2017 7:24 pm

ChicagoGranny wrote:Insurance policies vary. Even within one company, the policies vary. You have to check with your own insurance company about your policy.

How about Medicare? A lot of people here probably use Medicare.

Guest · Post by **Guest** » Sat Feb 25, 2017 9:13 pm

DeeCPAP wrote:How about Medicare? A lot of people here probably use Medicare.

Your DME will have to say that your cpap is not working. Contact them.

Goofproof · Post by **Goofproof** » Sat Feb 25, 2017 10:07 pm

DeeCPAP wrote:
ChicagoGranny wrote:Insurance policies vary. Even within one company, the policies vary. You have to check with your own insurance company about your policy.
How about Medicare? A lot of people here probably use Medicare.

If you use medicare, you would need to check with them. Jim

chunkyfrog · Post by **chunkyfrog** » Sat Feb 25, 2017 10:52 pm

My previous machine was not paid for by Medicare, so Medicare covered my new machine when I wanted it.
All I needed was the F2F visit with the doctor, and all the relevant paperwork.

ChicagoGranny · Post by **ChicagoGranny** » Sun Feb 26, 2017 7:50 am

DeeCPAP wrote:
ChicagoGranny wrote:Insurance policies vary. Even within one company, the policies vary. You have to check with your own insurance company about your policy.
How about Medicare? A lot of people here probably use Medicare.

ResMed explains Medicare replacement in this document - https://www.google.com/url?sa=t&rct=j&q ... -ZRFg83ztQ

"More than five years
The replacement of an item past the five-year lifetime will
be considered in cases of irreparable wear if the item has
been in continuous use by the patient, on either a rental
or purchase basis, for the equipment’s useful lifetime.
• Irreparable wear:
– I rreparable wear refers to deterioration sustained
from day-to-day usage over time and a specific
event cannot be identified.
– In cases involving irreparable wear, the Reasonable
Useful Lifetime (RUL) of the equipment is taken into
consideration, and in no case can it be less than
five years old.
– Computation of the useful lifetime is based on when
the equipment is delivered to the patient, not the
age of the equipment.
– A physician’s written order is needed to reaffirm
the medical necessity of the item.
• If a PAP machine is replaced following the five-year RUL,
there must be a face-to-face evaluation by the treating
physician documenting that the patient continues to
use and benefit from the PAP machine. There is no
requirement for a new sleep test or trial period. Note:
If a DME item reaches its five-year life expectancy, is
in good working order and meets the patient’s medical
needs, it should not automatically be replaced."

Sheriff Buford · Post by **Sheriff Buford** » Sun Feb 26, 2017 7:59 am

Looks like time to get you a new one? Be sure to get a data-machine.

Sheriff

D.H. · Post by **D.H.** » Sun Feb 26, 2017 12:02 pm

Also, keep the old one on hand as a spare. If the new one breaks, you would not want to go without, even for one night.

Guest · Post by **Guest** » Sun Feb 26, 2017 1:28 pm

Hopefully after 7 yrs Dee has a backup. She may need it when this one acts up while she is waiting for the DME to check it to confirm there is a problem. It can take some weeks to come out then they say they will have to order, pretty soon you are without for a month easily. Regardless, be sure to ask for a loaner - it is like driving a rental car - a good time to try something else to see if you will like it,

SewTired · Post by **SewTired** » Sun Feb 26, 2017 9:37 pm

Just start the process. You have to see your doc/sleep doc first. Don't worry about the 'new' Medicare rules. If you have over 15,000 hours, that's worn out. I think the goal of the change is to make people use their machine for 15,000 hours before they replace them (some people barely use their machines and then get new ones...strange).

DeeCPAP · Post by **DeeCPAP** » Mon Feb 27, 2017 1:33 am

Thanks everyone for your replies.

My machine is 7 years old and I'd really like one with data (other than a happy face for mask fit which is ghastly, but simplified
for the masses), AHI reading and hours used daily.

My DME said I can only get a new one if mine is broken so I wanted to confirm it with others. It's working okay,
but it indicates I've used it less than actual use, maybe an hour, about 4-5 hours, but I'm sure I sleep more than
that (and ALWAYS wear it when I sleep, so accuracy may be a problem. (Now that my sleep tech said he saw
leaking and I have to use a headband, I'm starting to hate using the CPAP again).

So, does it sound like I can order one?

Thanks

kteague · Post by **kteague** » Mon Feb 27, 2017 2:54 am

I thought replacement guidelines were for when that insurer paid for the prior machine. Is it any of their business otherwise?

Redonthehead · Post by **Redonthehead** » Mon Feb 27, 2017 7:52 am

My company insurance changed from Cigna to Anthem this year. Of course Anthem has no idea I am using CPAP. I called to see if they had a SA/CPAP dept and the rep said as long as I have a prescription to go for it. I have the funny feeling she was not up on Anthem's policies.

Guest · Post by **Guest** » Mon Feb 27, 2017 8:29 am

DeeCPAP wrote:My DME said I can only get a new one if mine is broken so I wanted to confirm it with others. It's working okay,
but it indicates I've used it less than actual use, maybe an hour, about 4-5 hours, but I'm sure I sleep more than
that (and ALWAYS wear it when I sleep, so accuracy may be a problem.

Is that from when it fell off the nite stand?

If you don't yet have a back up then be sure to buy one off Craigslist before this one falls again spilling water into the electronics. It that happens it will stop working for sure.

New machine after 7 years, or when it's broken?

New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Re: New machine after 7 years, or when it's broken?

Machine	Mask

Additional Comments: Auto PAP; 13.5 cmH2O min - 20 cmH2O max