Comfortably Numb wrote:"My experience was a little different. My prescription was for a Cpap set to 14 cm."
If you are a Medicare patient and if your doctor is required by Medicare to be very specific concerning equipment (see above comment), then how could this happen?
Woody was given the DreamStation Auto CPAP machine....in short terms an APAP.
This happens is because an "APAP" machine is a cpap machine with auto adjusting pressure mode capabilities.
Medicare pays by HCPCS billing codes.. E0601 for cpap or single pressure machine.
Woody's DreamStation Auto IS A CPAP machine but just has 2 modes of operation...cpap or single fixed pressure or auto (apap) with single auto adjusting pressure.
The other HCPCS billing codes for xpap machine are for bilevel machines with and without back up rates.
Medicare doesn't care if you get a machine that will do auto adjusting..they just care if you meet the criteria for the E0601 machine.
Woody's DME gave him the "APAP" and just set it to cpap mode and thus fulfilled the RX requirements stated on the order.
Legally that is all they had to do. Some DMEs routinely dispense APAP machines in this situation because that's just what they have elected to do. Yeah, it may cost them a bit in terms of profit margin but it's just their choice. They did nothing wrong.
The DMEs who say "you can't have apap capable because your Medicare won't pay" are flat out telling a whopper. Medicare doesn't care....they just care about E0601.
Guest (edited...it was AirPump) gave you some information that isn't true for all areas of the country. It might have been true for the DMEs in his area but it's not necessarily true for other areas. I think most likely his DME told him a story and blamed it on Medicare...wouldn't be the first time.
Medicare doesn't care about brand or model...all they care about is if your diagnosis supports the criteria for whatever billing code machine you get....single vs bilevel pressure.
Assuming your OSA is plain jane vanilla OSA and your pressure needs don't support the need for a bilevel...you will get an E0601 billing code machine.
Lincare.......avoid them at all costs. While some local offices are good folks...Lincare and Apria are notoriously difficult to work with. My first DME office was a Lincare affiliate. I lost count of the number of lies they told me and that was before I even got a machine from them. They were fired before I ever got a machine. When I told them I wouldn't accept the crap machine they were trying to pawn off on me I told them to "keep it and a couple of not so nice words"...
They said "you refusing treatment"....I said "No, I am going to get the machine ...just not from you"...and that was that.
Most docs do just write generic RX unless they happen to have a specific preference and some do.
DMEs can dispense and apap machine with a cpap RX because an apap machine is a cpap machine. All apap machines have the 2 modes of operation available...cpap mode or fixed pressure and apap mode or auto adjusting pressure.
To fulfill the RX all they have to do is set the machine to cpap mode at whatever pressure is stated. Easy and quite legal.
Woody's DME did nothing wrong and Guest's DME may have fed him a line of BS. What guest told you is not what Medicare typically does....but does fit what DMEs typically feed as BS to patients.
Getting the doc to write the RX stating brand and model...gives you more ammunition if yoru fun across a DME who is more interested in profit margin than in anything else. Some doctors will do that because they don't care and they think a happy patient is more apt to be a successful patient. Some doctors are just hard assed with preconceived notions against anything but cpap and think that if there was a titration study there is no way the titration study got it wrong.
My doc was the later...hard assed. Part of the reason I haven't seen him since Aug 2009.
If I were in your shoes I would call each of the DMEs that you have available locally to you...and just say
"I have been recently diagnosed with sleep apnea and I have Medicare and I will be getting a cpap machine soon"
"What brand and model E0601 machine do you typically dispense"
See what they say...they may typically dispense the machine you want...if they don't then you just say
"thank you but that is not what I have decided I want and I will go elsewhere".
If they tell you they don't know because they haven't seen the RX...just state E0601 machine which tells them you have already done your homework and they won't likely be as able to feed you a line of BS. It's amazing how quickly a DME will come into line when faced with a hard assed patient who knows what they want and won't accept anything less.
Or...they might be like my local Lincare office was...hard ass and a bunch of bitches in the office and they were as glad to get rid of me as I was to get rid of them.