Went on Medicare Jan. 1st

[Rickv]

I turned 65 on January 4th and started Medicare on January 1st. I was due for my 3 month supplies near the end of December my DME suggested I wait until I was on Medicare to avoid a potential bill issue. So I did and now have been getting run around in circles trying to get supplies. The DME first said I would need a compliance letter and a prescription from my sleep doctor so, I figured that would not be an issue since I had just seen him on December 19th. I wait about a week and check back with the DME and they tell me that the got the info from my sleep doctor and now they were waiting on the results of my last sleep study (which was in May of 2013). I have been busy and didn't have a chance to check with the DME. Today I got something from them in the mail that wasn't directly related to the Medicare stuff but, it reminded me to check with them. So now it appears that they got the info from the sleep doctor at facility that I had the May 2013 sleep study done but, they it didn't state that it was done to Medicare guidelines or some crap like that they also said something about 4% which lost me too. So I called the Sleep Lab where the 2013 study was done and the person I talked to said she would send it back to the medical assistant or the respiratory therapist and that they would contact the DME and then let me know.
I have a feeling another sleep study is in my future. Does Medicare pay for sleep studies or am I about to part with a large amount of cash? BTW I have been on sleep therapy since 2007 and can probably count on my hands and toes how many nights I have not used my machine.

[palerider]

There's no reason to get "3 month supplies" the rip off 'schedule' exists purely to pad the DMEs pockets.

Replace things when they wear out, not before, and have spares of everything. Get more when you have to use a spare.

[Pugsy]

Medicare pays for sleep studies....so no worries there.

The 4 % thing is part of the criteria...4 % desat in oxygen levels associated with some sort of apnea event.
Some sleep studies use the 3 % desat criteria but Medicare wants 4 % or more. Chances are your sleep study in 2013 probably used the 4% criteria so you should be good there.

I doubt that you will need another sleep study but if you do...Medicare will pay for it.

[ChicagoGranny]

I have a feeling another sleep study is in my future.

I would switch DMEs.

[Rickv]

Medicare pays for sleep studies....so no worries there.

The 4 % thing is part of the criteria...4 % desat in oxygen levels associated with some sort of apnea event.
Some sleep studies use the 3 % desat criteria but Medicare wants 4 % or more. Chances are your sleep study in 2013 probably used the 4% criteria so you should be good there.

I doubt that you will need another sleep study but if you do...Medicare will pay for it.

I hope so, if I remember correctly I was borderline back in 2013, the tech said he would be able to pick enough points to get me recertified. I average about 0.2 ahi nowadays and have many 0.0 nights but, if I don't use my machine I feel like crap. Will post back when i find out one way or another.

Palerider I agree on the 3 month thing but, you missed the whole point of my post. I am trying to get approved to get supplies under Medicare if and when I need em.

[Rickv]

I have a feeling another sleep study is in my future.

I would switch DMEs.

I don't think it is them per say it is getting all the info to make Medicare happy.

[Goofproof]

The facts are DME's lie, didn't you see their lips move. You should have taken care of business when it was due. You should have got ahead on supplies, it's called spares. At worst you can buy online out of pocket, only getting what you truly need. Having a used low hour is a good idea. Jim

[chunkyfrog]

It is good you found about these monkeys before you needed something.
GO TO A DIFFERENT DME.
Even though Medicare sometimes looks like the 3 stooges, DME's are 1000% WORSE.

[Sheriff Buford]

Oh man... Medicare is a little over a year for me away... dang...

Sheriff

PS: I thought of a worser word than dang, but I didn't post it....

[Okie bipap]

My wife and I have both been on Medicare the entire time we have been using bi-level machines. My first sleep doctor scheduled me for a sleep study without documenting the required face to face meeting. I had to repeat the sleep studies before Medicare would approve the machine. The only other problem we have encountered was when my DME lost their Medicare contract, but I was able to find an on line supplier that accepted Medicare. We got my wife's machine through them without any problems. Our local DME has regained their Medicare contract, so all is well, once again.

[bombayone]

Medicare and the Social Security Administration are two government systems that work well. Most problems are the result of the unrealistic expectations and the lack of user knowledge of beneficiaries. Thumbs up to these organizations and their staffs.

[Rickv]

Update: Just heard from my Sleep Doctor's Office, the scoring used in the 2013 sleep study do not meet Medicare's supposedly new guidelines. So now I have to do a home sleep study at least I don't have to go to a sleep lab. I watched a video on the home sleep study is there anything I need to know about it? Is it accurate?

[Pugsy]

There are several different home studies available (different brands) and within the brands there are various levels of data gathering.

You can read about the different levels of data gathering here.
http://freecpapadvice.com/home-sleep-tests

Accuracy depends on brand and which level of data gathering it does.
Medicare does have some specific rules about home studies for Medicare to be satisfied that the appropriate data has been gathered.
I don't remember exactly which type is Medicare approved but it's available on the medicare website.
Hopefully your doctor knows this and will order a home study that Medicare is happy with the way it is done and it gathers the data that Medicare wants.

[greatunclebill]

Oh man... Medicare is a little over a year for me away... dang...

Sheriff

PS: I thought of a worser word than dang, but I didn't post it....

don't worry about it, sheriff. i've been on medicare 5 yrs and have had no problems. just understand you're going into a new system with new requirements. to you medicare will be a new provider so they will require a copy of your last sleep study. dme gets it from the doc. they need a new preccription, no sweat. then they need the fsace to face meeting note from your doc dated AFTER you turn 65. if it's done before that date it won't count. easy peasy. I was really apprehensive about going to medicare. when the day came it went seamless, no problems with anything medical for 5 years. same with my wife for 2 years.

[Rickv]

Thought I'd update this since I finally received my cpap supplies today. My sleep doctor's office found a study from 2009 that met Medicare's guidelines. They haggled back and forth with The DME but it got approved with me not having to do a home sleep study.