If get dental device will Medicare take away CPAP

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Sebastian3

If get dental device will Medicare take away CPAP

Post by Sebastian3 » Tue Sep 09, 2014 10:23 pm

Having trouble sleeping with CPAP. Trying different masks, mouth straps. Dr. said a dental device might work for me. Not sure if my Medicare will pay for it? Can others give me their experience, please. Also, if so, will the CPAP have to be returned? What is your experience? Does how soon you do this matter? Have APRIA. I would like to try a good dental device from a doctor specializing in these, but haven't given up on the CPAP.

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Wulfman...
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Re: If get dental device will Medicare take away CPAP

Post by Wulfman... » Tue Sep 09, 2014 10:33 pm

Sebastian3 wrote:Having trouble sleeping with CPAP. Trying different masks, mouth straps. Dr. said a dental device might work for me. Not sure if my Medicare will pay for it? Can others give me their experience, please. Also, if so, will the CPAP have to be returned? What is your experience? Does how soon you do this matter? Have APRIA. I would like to try a good dental device from a doctor specializing in these, but haven't given up on the CPAP.
Well, DON'T give up on the CPAP therapy. If you'll tell us more, fill in your profile (I see you've got a registered name) along with your machine settings, we'll try to help you. But, you're going to need to give it some time and effort.


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Re: If get dental device will Medicare take away CPAP

Post by Wulfman... » Tue Sep 09, 2014 10:38 pm

I see you've already been posting for about a month under your registered name.

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Den

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Re: If get dental device will Medicare take away CPAP

Post by Wulfman... » Tue Sep 09, 2014 10:47 pm

As far as your original question goes, I really don't know. Some people use a combination of a dental device AND the CPAP machine. It all depends on what you're considering. I would imagine that if you're still under an insurance payment plan with the DME and you would then opt for not using the CPAP but switch to the dental device, then, I imagine Medicare MAY decide to take it back. If you doctor might prescribe the dental device to be used either with the CPAP or as a substitute in case you were in an environment where you couldn't power a CPAP, then you may be able to keep both.

That's a question for your doctors, I think.


Den

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49er
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Re: If get dental device will Medicare take away CPAP

Post by 49er » Wed Sep 10, 2014 2:09 am

Agree with Den on everything he said. But if you want to find out about coverage issues, I would contact Medicare.

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Re: If get dental device will Medicare take away CPAP

Post by Guest » Wed Sep 10, 2014 4:12 am

That I know Medicare does not cover dental devices but you could call a dentist to ask.
afaik - cost avg. about $2500

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Re: If get dental device will Medicare take away CPAP

Post by Cereal Killer » Wed Sep 10, 2014 6:16 am

Sebastian3 wrote:Having trouble sleeping with CPAP. Trying different masks, mouth straps. Dr. said a dental device might work for me. Not sure if my Medicare will pay for it? Can others give me their experience, please. Also, if so, will the CPAP have to be returned? What is your experience? Does how soon you do this matter? Have APRIA. I would like to try a good dental device from a doctor specializing in these, but haven't given up on the CPAP.
As soon as I turned 65, the first month I got a new CPAP machine and the second month my first dental appliance (TAP). Medicare payed for both.

To keep the machine, you need a doctor to read your data card and certify that you are using the machine. That is if Medicare is renting the machine.

If Medicare has already paid for your machine and you quit using it, they are not going to come get it.

Best to check with your insurance carrier or Medicare.

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Re: If get dental device will Medicare take away CPAP

Post by moz » Wed Sep 10, 2014 8:05 am

When you say "trouble sleeping" on CPAP - how so ? Fragmented sleep.unable to sleep,etc.

Feb 2014,I had a dental appliance fitted ( $3,000 out of my pocket ). I have mild OSA - AHI around 2.5.

My experience was that it certainly helped ..but.. after about 3 months, I started to feel my jaw muscles "very tired" - as if I'd been chewing for 12 hours. As a result, was finding myself mumbling and slurring words ( not constantly but enough to be aware of ) . That and the shifting of your teeth/bite -- could not see myself using the appliance for a very extended period of years. At that point I switched to APAP -- now on the newest ResMed Airsense 10 .

I feel better than when I used the appliance.

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Re: If get dental device will Medicare take away CPAP

Post by StuUnderPressure » Wed Sep 10, 2014 10:09 am

Cereal Killer wrote: As soon as I turned 65, the first month I got a new CPAP machine and the second month my first dental appliance (TAP). Medicare payed for both.
Do you now use ONLY the TAP?
Or, do you also use your CPAP at the same time as the TAP?

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Re: If get dental device will Medicare take away CPAP

Post by Cereal Killer » Wed Sep 10, 2014 1:17 pm

StuUnderPressure wrote:
Cereal Killer wrote: As soon as I turned 65, the first month I got a new CPAP machine and the second month my first dental appliance (TAP). Medicare payed for both.
Do you now use ONLY the TAP?
Or, do you also use your CPAP at the same time as the TAP?
I use CPAP every night and get excellent results.

About the TAP, I only infrequently use it for day naps on the sofa. I curl up so I am sleeping on my side being very careful not to sleep on my back. As recommend by a forum member, I also wear a soft spinal collar. I feel that I am still having hypopneas sleeping like this but not the long apneas I am prone to. If I rolled onto my back or left off the spinal collar, I am sure there would be long apneas.

I don't believe I could tolerate wearing the TAP for a full night. I think it was fitted and fabricated properly, but it is just fundamentally a very uncomfortable way to treat sleep apnea. And, at least in my case, it is not nearly so effective as CPAP.

I am glad I have the TAP for a few reasons,

1. Occasional short day naps when unusually sleepy/fatigued.
2. In an emergency such as loss of power or CPAP machine failure when traveling.
3. It cured me of wondering if a MAD is a good solution for me. I now know it is not.

BTW, thanks to cpaptalk members for the idea of the spinal collar. I also wear it with CPAP and it reduces my pressure needs significantly.

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Re: If get dental device will Medicare take away CPAP

Post by StuUnderPressure » Wed Sep 10, 2014 1:56 pm

Cereal Killer wrote: About the TAP, I only infrequently use it for day naps on the sofa.
I don't believe I could tolerate wearing the TAP for a full night. I think it was fitted and fabricated properly, but it is just fundamentally a very uncomfortable way to treat sleep apnea. And, at least in my case, it is not nearly so effective as CPAP.
So, what made you even try TAP?

And, what justification did you have to provide to Medicare for them to pay for it?

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Re: If get dental device will Medicare take away CPAP

Post by Cereal Killer » Wed Sep 10, 2014 4:11 pm

So, what made you even try TAP?
Does this matter to anyone??? I listed three benefits for me of MAD.
And, what justification did you have to provide to Medicare for them to pay for it?
None. Although there was a lot of explaining that I had to do to the siloed clerks at my PPO. What it is, why it is not dental benefits, why a dentist makes them, why the dentist made me pay for the whole thing in advance, why there was no provider in my network. They do reimburse per the provider schedule if there is not one in their network.

I paid $1600 up front and the reimbursement was $1280. There is a story in itself about mishandling the reimbursement badly after giving a pre-approval. Insurance clerk incompetence.

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Re: If get dental device will Medicare take away CPAP

Post by snorebeard » Sun Dec 21, 2014 8:44 pm

Any further experience with Medicare and getting Dental Device at the same time, particular before the CPAP is paid for (first 13 months, I understand)? Dental device can help during difficult time with CPAP and when traveling, but hard on the jaw full time.

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Re: If get dental device will Medicare take away CPAP

Post by mike1953 » Sun Dec 21, 2014 9:58 pm

If your dentist does not accept Medicare you will be paying out of pocket for that. There are dentists that do not accept Medicare as Medicare does not have dental coverage. As far as taking your machine if you are within your first 90 days and have not achieved compliance and had your sleep doctor report to Medicare they will not continue paying for your machine. If you are in full compliance and still within your first 13 months when Medicare is still paying for the rental Medicare could stop the monthly payment and again you would be stuck making the payments or giving up the machine. Again let me say that COULD happen.
Dental services
How often is it covered?
Medicare doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you're in a hospital. Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though the dental care isn't covered.

From a TAP web page more information.
http://tapintosleep.com/faqs/

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Re: If get dental device will Medicare take away CPAP

Post by Too tall » Sun Dec 21, 2014 10:52 pm

I agree with Mike1953. The key is whether the dentist is a Medicare provider, this is critical. If he/ she isn't and can't file the paper work, you'll be out of pocket for the appliance. Call them and ask them if the device is medicare covered and also your supplement. Supplements usually pay if medicare pays.

Additional information; Once you get the dental device, you will need to go back to the sleep doctor and set up a sleep test with the device. Medicare will pay for that test. If the sleep test shows your AHI is under 5, you will not need the CPAP anymore but if you are finished with your compliance period which for me was 30 days, you can probably keep it and medicare will continue to pay for it if the sleep doctor will still prescribe the Cpap. Also call your sleep doctor to verify what I'm telling you.

My family dentist also has sleep apnea and he kind of discouraged me from the appliance. He said they are uncomfortable and pull your jaw in an unusual position that could possible cause TMJ issues. He was speculating and didn't have any experience with people that had issues. He did give me the name of a dentist in our town that makes these things.

Personally, if the device works, I'd do it in a heartbeat and am still considering it. I've been on this cpap for over for a year and I hate it as much today as I did the first night I used it. It did nothing for me other than lower my ahi. I sleep worst and can't tolerate more than about 6 hours max. I'm more tired in the day time now because I'm not sleeping well with the cpap. Everybody is different. There are some folks on this forum who have had good luck with the cpap and will encourage everyone to get on it. But, it doesn't work for everyone like that. If medicare will pay for it, I would encourage you to give it a try. You can always go back to the cpap. There's also the chance an operation could fix your apnea. My sister in law had it done and it was very successful.

So there are alternatives.
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