Can I purchase and adjust my own CPAP machine?

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Susan48
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Can I purchase and adjust my own CPAP machine?

Post by Susan48 » Mon Nov 24, 2014 3:57 pm

Hello, I am an experienced user of a CPAP machine for about 14 years. I am presently using a Respironics model 1043237 which has a heated humidifier feature. My unit is getting old and I would like to know if I can acquire my own machine and be able to adjust the flow characteristics myself. I was under the impression that that you must be evaluated by a sleep lab and then have a prescription in order to obtain a CPAP device, (which was where I started). I have not researched the Internet for sources yet and thought that I would learn from other people's experiences. I have depended on Aeroflow as a source of supplies and support locally as was determined by my insurance coverage. Aeroflow has never been a reliable or dependable supplier in my opinion. I have since retired and now am on Medicare so I would appreciate any opinions or experiences from others.

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grayghost4
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Re: Can I purchase and adjust my own CPAP machine?

Post by grayghost4 » Mon Nov 24, 2014 4:01 pm

medicare will provide a cpap for you at no cost if you have a supplemental plan. You will have to have a Dr. script and probably have to have a new sleep test .
If you're not part of the solution you're just scumming up the bottom of the beaker!

Get the Clinicians manual here : http://apneaboard.com/adjust-cpap-press ... tup-manual

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grayghost4
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Re: Can I purchase and adjust my own CPAP machine?

Post by grayghost4 » Mon Nov 24, 2014 4:04 pm

Once you have the new machine .. you can get the clinicians manual and and a copy of sleepyhead software and monitor and adjust the machine yourself if you want to .
If you're not part of the solution you're just scumming up the bottom of the beaker!

Get the Clinicians manual here : http://apneaboard.com/adjust-cpap-press ... tup-manual

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Jay Aitchsee
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Re: Can I purchase and adjust my own CPAP machine?

Post by Jay Aitchsee » Mon Nov 24, 2014 4:08 pm

Hello, Susan,
No matter how you acquire a machine, if it is adjustable and you know how (like have the manual), you can adjust it yourself. All DME in the US, including internet, will require a prescription to sell you a machine. However, you may buy from a private seller without a prescription. From time to time, sellers offer new or low hour equipment on this forum. But, it's buyer beware and you probably won't have a warranty.
J

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Last edited by Jay Aitchsee on Mon Nov 24, 2014 4:10 pm, edited 1 time in total.

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TangledHose
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Re: Can I purchase and adjust my own CPAP machine?

Post by TangledHose » Mon Nov 24, 2014 4:09 pm

You always have the option to buy from a source like Craigslist and not have to deal with script and sleep study...........when you purchase from most reputable online cpap dealers such as our sponsors at cpap.com you will have to provide a dr's prescription. I simply clicked the box at cpap.com for them to obtain my Dr's script directly from the Doctor so that I didn't have to do it myself.........very convenient. If you use Craigslist be sure you do your research and remember....buyer beware.

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mike1953
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Re: Can I purchase and adjust my own CPAP machine?

Post by mike1953 » Mon Nov 24, 2014 4:13 pm

Initial Medicare Coverage
Medicare requires a clinical CPAP diagnosis done in a sleep lab or with an approved home device. If you meet the criteria, Medicare will cover CPAP for an initial 12-week period. If you need the therapy longer than that, you or your doctor must let your medical equipment provider know by the 61st day of CPAP therapy.

Medicare Replacement Schedule
Medicare has a set schedule for replacement of each part of a CPAP machine. For example, your full face mask, CPAP mask or oral interface can be replaced as often as every 90 days, but the cushion of your face mask can be replaced every 30 days. Nasal cushions, replacement pillows, tubing and disposable filters can also be replaced as often as every 30 days. Headgear, chinstraps and non-disposable filters can be replaced every six months. The CPAP machine and humidifier can be replaced every five years.

Ongoing Medicare Coverage
CPAP therapy falls under Medicare Part B. Medicare Part B has an annual deductible; after the deductible is met Medicare generally covers 80 percent of costs, with 20 percent being the patient's responsibility. The 20 percent remainder is often, but not always, covered by supplementary insurance.



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

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Pugsy
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Re: Can I purchase and adjust my own CPAP machine?

Post by Pugsy » Mon Nov 24, 2014 4:16 pm

Are you wanting for Medicare to pay for the new machine or do you just wish to get a machine and do your own thing?
There are ways to get a machine without a RX if you are willing to pay out of pocket.
Adjusting is the easy part. Not difficult at all.
Also..if you have a Primary Care Physician who will write a new RX then you can buy a machine from any online source but without a RX you would have to resort to the secondary market (not all that bad because that's where I have bought all my machines) but then insurance doesn't pay.

I am not sure what documentation Medicare will need after 14 years but there is a provision in Medicare where they would/could possibly accept your old documentation (if it was available and met their requirements) where they step in and will pay for equipment and supplies. Certain requirements have to be met though and I don't have those handy.
Those requirements are deep within Medicare's cpap coverage and especially addresses those people who were diagnosed with OSA prior to Medicare age and who then get older and Medicare kicks in.

So it depends...are you wanting to bypass the hassle and are willing to foot the bill yourself or are you wanting Medicare to do it's share?
Is your existing supplier still in business? They would/should have the documentation needed to at least start with Medicare to see if your old documents met the requirements.
A new sleep study isn't always needed.

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DreamDiver
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Re: Can I purchase and adjust my own CPAP machine?

Post by DreamDiver » Mon Nov 24, 2014 4:35 pm

I think most states require you to get another sleep lab every so many years to make sure you still need CPAP in order for insurance to pay for the new device. If you are willing to pay for it yourself, you could probably get your general health care provider to write you a script. Cpaptalk is run by the folks at cpap.com. They have decent prices. You will probably get your best price over the phone from them. You can ask them to send a script request to your preferred doctor, and they'll also help with mostly-filled-out forms for your insurance.

That said, if your needs have changed, it might not hurt to get a new sleep study. And there are some really great new machines out there, and some of them may be even more comfortable than the one you've been using. The two most popular seem to be Respironics and ResMed, but Intellipap seems to be gaining popularity.

I ditched Apria after my first machine, but other people have had positive interactions with some of the national DME's. Like many here, I just buy my supplies and machine online.

If you have data showing you actually use your CPAP, it's probably cheaper simply to buy the new machine rather than "rent-to-own". You can get your insurance to apply whatever the cost is against your deductible in one lump sum. When I compared the cost of my first machine (rented) against the one I just bought outright, the overall cost difference was pretty amazing.

There are a lot of good resources here. Check the CPAP wiki (yellow lightbulb).

Welcome and good luck.

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LSAT
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Re: Can I purchase and adjust my own CPAP machine?

Post by LSAT » Mon Nov 24, 2014 5:27 pm

I have a Medicare Complete Plan from AARP. When I needed a new machine last summer I took a prescription into my local DME and walked out with an S9 Autoset. No hassle, no new sleep study, and no compliance checks.

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Pugsy
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Re: Can I purchase and adjust my own CPAP machine?

Post by Pugsy » Mon Nov 24, 2014 5:55 pm

LSAT wrote:I have a Medicare Complete Plan from AARP. When I needed a new machine last summer I took a prescription into my local DME and walked out with an S9 Autoset. No hassle, no new sleep study, and no compliance checks.
Medicare bought your old machine from 5 years ago though...didn't they?
It's a bit different when Medicare didn't buy the first machine.

To OP in this thread.
from this link
http://www.medicare.gov/coverage/sleep- ... erapy.html
"
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 qualifications."


I am still trying to find those "certain qualifications"..my old link to them is dead but it has to do with AHI, type of sleep study done and where it was done, and co morbid conditions (if any when someone has a low AHI less than 15).

Edit... Please note that it does NOT mention a new sleep study absolutely having to be done...now it might need to be done if the old sleep study doesn't meet their requirements but it isn't always a given that a new study just HAS to be done.

I found this
http://www.cms.gov/Outreach-and-Educati ... 905064.pdf
See pages 3 and 4 especially.
"For 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.
If either criterion 1 or 2 above is not met, the claim will be denied as not
medically necessary.
In these situations, there is no requirement for a clinical re-evaluation or
for objective documentation of adherence to use of the device."

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chunkyfrog
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Re: Can I purchase and adjust my own CPAP machine?

Post by chunkyfrog » Mon Nov 24, 2014 6:20 pm

You may use the link in my sig. to find a local DME which will work with Medicare.
A green " M" indicates the ones contracted with Medicare.

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Re: Can I purchase and adjust my own CPAP machine?

Post by zoocrewphoto » Tue Nov 25, 2014 2:23 am

My mom got a new machine in 2012 with medicare. The previous machine was before medicare. She asked for a new sleep study and was denied as her last sleep study was only 2 years old. She wet to a new sleep doctor with a copy of the old sleep study and two printed reports from partial nights with *my* machine. The new doctor prescribed a new machine, and medicare did the rent to own deal with one compliance check at about 2 months.

So, in her case, she had a history of sleep apnea, did not need a new sleep study, but did have to do compliance. I suppose it varies based on that criteria and who is doing the reviewing. But she had no problems getting the machine after being denied for a sleep study. Seemed odd, but it worked out.

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Who would have thought it would be this challenging to sleep and breathe at the same time?