Had to do a sleep test for a new CPAP even after 17 years!

[D.H.]

So a good doctor is one who counts on a 17 yr old result in someone ageing to go on prescribing for the future? Glad that's not my MD!

The good doctor can look at the results from the patient's machine. Unless the guy is having new problems, does he really need to be rediagnosed over and over again? No. My neighbor already knows he lost his leg. It isn't going to grow back. Should he consent to a new Xray to confirm that he lost his leg? Yes, he was actually asked to do that. DH has not said he had new problems, so his machine is already able to supply the information required.

Just for the record, the old machine was a brick and did not have stats. However, I was not lighter than I was at the time of diagnosis, and have not had any surgery (except for hand surgery) during the interim. Sleep Apnea does not need to be re-diagnosed; it does not go away on its own! I really didn't especially mind spending the night in the sleep lab; I minded sleeping without CPAP for the few hours that they required.

Just for the record expanded, most machines didn't have full data 17 years ago. Surprise! Jim

The machine at the time was CPAP #3, dating back to 2009.

[SewTired]

Just for the record expanded, most machines didn't have full data 17 years ago. Surprise! Jim

I totally agree, but if you look at his equipment profile, he is using a Dreamstation Auto, so that has all the data needed. It would be a different story if he was still using a 17 year old machine (or even a 10 year old one - not sure if they had data before that).

[codinqueen]

Medicare and Medicare Medicare Advantage Plans REQUIRE a new test to meet criteria to supply a new machine is what my sleep Dr told me. I was diagnosed in 2011, wanted to get a new machine, but Doc said I need another sleep test. I can't afford the co-pay so not doing it right now. Just hoping my machine keeps on keepin' on.

[Pugsy]

Medicare and Medicare Medicare Advantage Plans REQUIRE a new test to meet criteria to supply a new machine is what my sleep Dr told me. I was diagnosed in 2011, wanted to get a new machine, but Doc said I need another sleep test. I can't afford the co-pay so not doing it right now. Just hoping my machine keeps on keepin' on.

What you were told is not true.

What insurance paid for the machine in 2011? If Medicare...they don't require a new machine because they already have the sleep study results from 2011.
If not Medicare and you are now turning medicare age....it depends on the sleep study back in 2011. It depends on what criteria for diagnosis was used in that old sleep study.

[Lucyhere]

Medicare and Medicare Medicare Advantage Plans REQUIRE a new test to meet criteria to supply a new machine is what my sleep Dr told me. I was diagnosed in 2011, wanted to get a new machine, but Doc said I need another sleep test. I can't afford the co-pay so not doing it right now. Just hoping my machine keeps on keepin' on.

What you were told is not true.

Hmmm... my doctor said the same as codinq's, but she said a at home sleep study would suffice. I think I'll call Medicare tomorrow.

[Baja]

Medicare and Medicare Medicare Advantage Plans REQUIRE a new test to meet criteria to supply a new machine is what my sleep Dr told me. I was diagnosed in 2011, wanted to get a new machine, but Doc said I need another sleep test. I can't afford the co-pay so not doing it right now. Just hoping my machine keeps on keepin' on.

This is partially true. They need a copy of a Medicare compliant sleep study on file. It does NOT mean you need a new study for every machine. You also do NOT have to get a new study if you were diagnosed before enrolling in Medicare. Just call up the original lab and get a copy. That's what I did for my father when they tried to force him to get a new test.

That said, the OP's study was done 17 years ago. I could easily see a report that old with some flaw that could cause it to be rejected during a Medicare audit. If a doctor made a mistake, would he really want to volunteer that info to the patient? He would likely just gloss over the details and cajole the patient into getting a new test.

Documentation Fact Sheet for Medicare providers:

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

[Lucyhere]

Medicare and Medicare Medicare Advantage Plans REQUIRE a new test to meet criteria to supply a new machine is what my sleep Dr told me. I was diagnosed in 2011, wanted to get a new machine, but Doc said I need another sleep test. I can't afford the co-pay so not doing it right now. Just hoping my machine keeps on keepin' on.

Documentation Fact Sheet for Medicare providers:

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

Just talked to the assistant in my sleep doc's office. Baja is correct. My primary care doctor was apparently wrong.