Original Medicare and Cpap

[chronic]

Well, my Cpap machine is starting to act up, 7 years old. Called my DME and they said, yes, medicare would pay, but first, I had to have a face to face with a doctor and tell them that I benefit from cpap and that I use it every night and that my cpap is not working properly. And then the dr needs to give me a script that says: replacement machine, old machine unrepairable. And then I give it to them or the dr. can fax to them and the ball will start rolling on giving me a new machine which would be a resperonics Dreamstation auto with humidifier. The tech stated for sure it had to be a face to face with a dr. Does this sound correct to you all. (Pugsy?)

[chunkyfrog]

Exactly my experience. But the DME is not who you should ask--talk to Medicare.
I have been on Medicare since August 2013, and they bought my Airsense.
I have the face to face every year, and my pneumo faxes it over to ACS. (My DME)
(((Unless Medicare bought the old machine, its condition does not matter.)))

[Grouch]

I just went through this last month. I see my sleep doc yearly to qualify for Medicare supply replacements: masks, hose, etc. He had me make a new appointment for just after the 5 year anniversary of my machine. Apparently that's the machine life period that Medicare uses. My machine was still working, but there have been advances since then and my sleep doc wanted me to take advantage of them.

He then took care of contacting my DME and ordering the machine via a new prescription. It was a simple process - one 15 minute visit. However, he did warn me that the DME could require a new sleep test. They didn't. I have no idea what criteria they use on this. I have been making regular visit to my sleep doc and I use my CPAP machine religiously. My doc has all the records on file of my use, as he pulls them off my SD card on every visit.

If you don't have this backup documentation, it could be the reason your DME wants you to see your doctor. It may be that a new machine requires a new prescription. I know my doc did write a new one for me and sent it to the DME. Another reason for a face to face.

[LSAT]

Well, my Cpap machine is starting to act up, 7 years old. Called my DME and they said, yes, medicare would pay, but first, I had to have a face to face with a doctor and tell them that I benefit from cpap and that I use it every night and that my cpap is not working properly. And then the dr needs to give me a script that says: replacement machine, old machine unrepairable. And then I give it to them or the dr. can fax to them and the ball will start rolling on giving me a new machine which would be a resperonics Dreamstation auto with humidifier. The tech stated for sure it had to be a face to face with a dr. Does this sound correct to you all. (Pugsy?)

Medicare Rules...........
https://www.cms.gov/Outreach-and-Educat ... 905064.pdf

[SewTired]

FWIW, Medicare will accept any sleep study that was done 10 years or less. For this reason, always make sure that you get a copy of both the raw data and the final report and keep for your records. The hospital lost my brother's records, but fortunately, I made him get a copy so we were clear on that.

Make sure that you decide in advance what machine you want and then have your doc write that machine on the script. So, check out stuff here FIRST.

[chunkyfrog]

Unless your DOCTOR or Medicare demands a sleep study, you do not need it.
The DME can not require more than Medicare or your doctor.
To do so may be against the LAW!

[Guest]

Well, my Cpap machine is starting to act up, 7 years old. Called my DME and they said, yes, medicare would pay, but first, I had to have a face to face with a doctor and tell them that I benefit from cpap and that I use it every night and that my cpap is not working properly. And then the dr needs to give me a script that says: replacement machine, old machine unrepairable. And then I give it to them or the dr. can fax to them and the ball will start rolling on giving me a new machine which would be a resperonics Dreamstation auto with humidifier. The tech stated for sure it had to be a face to face with a dr. Does this sound correct to you all.

Yes it does. Once you get things going you will be fine.

Just be sure to search this forum for DME's not to do business with and it should save you some aggravation.