CPAP and Medicare.....

[rfsmith84]

Folks,

I have been using CPAP for about 16 years. It’s a life saver.

I am on Medicare. My current Puritan-Bennett machine is not supported by the Manufacturer. I am using a humidifier.

I have had some dificulty staying asleep.

My Primary care doctor referred me to the local sleep clinic.

I have visited the clinic 3 times: Interview, test equpment fitting,and follow-up.

I was diagnosed with severe sleep apnea. I am not sure what the exact diagnosis was 16 years ago.

Medicare has paid for the 3 visits. The second visit was titled “Study of sleep patterns...”.

I have a follow-up appointment to test/select a new CPAP machine. The clinic has a business relationship with
Resmed, and one other supplier.

My questions to the Forum:

Does Medicare cover the new machine?
Does Medicare have an approved list of machines?
Which Resmed machine should I select, given a choice?
Any other pitfalls to avoid during this process?

All comments are appreciated.

Rog

[Okie bipap]

Medicare does not care what machine you get, as long as it matches what your script calls for. Medicare uses a 13 month rent to own plan. After 13 months, the machine is yours. You will need to prove compliance within 90 days (4 hours a night for 21 nights in a 30 day period). You will be required to have a follow up visit with the doctor between 30 and 90 days after starting treatment.

[Guest]

The clinic has a business relationship with
Resmed, and one other supplier.

whois the other supplier?
others may not worry about business relationships but I worry the DME doesn't care about the patient just how much money they will make on what model they sell, that includes masks and supplies.

good advice from okie.

[LSAT]

If you are on Medicare you must use a Medicare Approved Supplier. Sleep Center relationship doesn't mean anything. Fill in your Zip Code to find a supplier near you.
https://www.medicare.gov/supplierdirectory/search.html

[chunkyfrog]

Unless you are under a Medicare Advantage plan, you can go to any providers in the list.
The green "M" identifies those who are contracted to accept Medicare allowable as full payment,
---of which you (or your supplement) will pay 20%.
If nearby suppliers are too few, (and you are not adverse to a road trip) you can increase the search radius.

[JimW159]

If you are on Medicare you must use a Medicare Approved Supplier. Sleep Center relationship doesn't mean anything. Fill in your Zip Code to find a supplier near you.
https://www.medicare.gov/supplierdirectory/search.html

Please note: The lists you find through this method are in two parts.
1) Under the "competitive bid" category "Continuous Positive Airway Pressure Devices (CPAP) is noted - don't stop there
2) Further down the page in the "Non-competitive bid" category you will find CPAP, RADs, & Related Supplies & Accessories
Check both boxes and do your search.
The results in the second category will expand your options dramatically if in the column to the right, headed "Modify your results" you select a distance from your ZIP code that you are comfortable with. Keep in mind the distance noted is from your ZIP code to the headquarters of the location of the supplier; many suppliers have service areas that extend much further out than just their physical location. You might well never have to actually go there. Always call the supplier to find out what brands they push and how open they are to your specific needs. Within the "Non-competitive bid" category you may well find a supplier connected to a major hospital's sleep center; you might find them more knowledgeable and cooperative in getting you what you want if the doc who writes you is willing to cooperate in writing the script to suit your needs/wishes. Always try to get what you want, not what they want to give you. You have 16 years invested in this therapy, don't let someone with no investment in your health push you where you don't want to go.

[rfsmith84]

Thanks to all!

There is a lot of info here, and I need to do some homework.

Rog

[rfsmith48]

Folks,

So I just spoke with one of the Techs at the Sleep Clinic:
The machine they routinely prescribe is the Resmed Airsense10 with Humidifier and data logging. Worst case the machine is returnable.
This clinic does a 2 week followup and the Medicare mandated 9 week followup.
I will pickup a copy of the Rx.

These folks seem to be more thorough that the last 2 vendors that I have dealt with.

Comments?

Thanks to all.

Rog

[SewTired]

The machine they routinely prescribe is the Resmed Airsense10 with Humidifier and data logging. Worst case the machine is returnable.

You have to be suspicious of 'data logging'. To many doctors, this is just the compliance information which gives no detailed data. You want one of the machines that works with Sleepyhead as you can help yourself then. These are true data machines.

[LSAT]

Folks,

So I just spoke with one of the Techs at the Sleep Clinic:
The machine they routinely prescribe is the Resmed Airsense10 with Humidifier and data logging. Worst case the machine is returnable.
This clinic does a 2 week followup and the Medicare mandated 9 week followup.
I will pickup a copy of the Rx.

These folks seem to be more thorough that the last 2 vendors that I have dealt with.

Comments?

Thanks to all.

Rog

The ResMed Airsense 10 CPAP is a "Brick". It supplies no useful data except for compliance. You need to specify Airsense 10 Autoset. They are not more thorough if they will not give you the autoset.

[Guest]

Sleep Center relationship doesn't mean anything.

Apparently it does...

The ResMed Airsense 10 is a "Brick". It supplies no useful data except for compliance.

The clinic has a business relationship with
Resmed, and one other supplier.

whois the other supplier?
others may not worry about business relationships but I worry the DME doesn't care about the patient just how much money they will make on what model they sell, that includes masks and supplies.

good advice from okie.

[Janknitz]

I sense danger. The sleep center doctor has a vested interest in the sleep center's profits. They want to give you a cheap brick machine to pocket as much of the Medicare profit as they can. The doctor will tell you that you do not need an auto machine, and you do not need to see EFFICACY data. Therefore they make a little more money by giving you a cheap brick of a machine. They make it very easy and smooth for you to get a cheap brick of a machine.

You may be OK with that. It's convenient, and pretty much what you've had these last 10 years.

But if you want to be able to check EFFICACY data and know how the therapy is working for you, if you have a change and you want to know how to best adapt your therapy for the change, the EFFICACY data is crucial. Up to you.

[rfsmith48]

Does the "Autoset" function provide the efficacy data?

[Wulfman...]

Does the "Autoset" function provide the efficacy data?

Yes it does. Just make sure it's an AutoSET.


Den

.

[palerider]

Does the "Autoset" function provide the efficacy data?

it's not a function, it's a model, it needs to say 'autoset' on the front of the unit.