Traditional medicare rules about prescriptions

[Sanjay1976]

I am writing this for my friend Sanjay (not confident in english language skills)

I have traditional medicare. Requested a refitting of my mask from the DME. They said I need a new prescription from my doctor. They said that it's a Medicare rule that I need a prescription that is less than 12 months old to purchase a filter. Really? I need to spend 75 dollars (for an office visit) to get a prescription for a filter that cost 2 dollars.
Is this true/
What a country.

[Pugsy]

They lied to you...big surprise there.

They do that all the time...make up stupid in house rules and blame Medicare or some other insurance for their idiotic rules.

[Janknitz]

Some STATES require a new prescription every year. But if your DME is claiming that you need a new prescription for Medicare coverage, then ask them to show you the regulation in black and white. AFAIK, it does not exist.

I suggest you get a copy of the prescription for supplies, and go elsewhere if you can. Ideally the prescription should read "mask of patient's choice" so you're not stuck with one mask, or one type of mask.

I have no coverage for supplies, so I buy my things from our hosts at cpap.com (I have a prescription on file with them, and the duration listed in the prescription is 99 years!), or eBay or Amazon. You can't buy a complete mask, but you can buy brand new "parts" like a frame and a cushion. It's often less than I was paying out of pocket for my share when I had coverage. No prescription needed.

As for filters: https://a.co/d/gAvmCyS How about a pack of 60 for about $7 (apply the 10% discount). No prescription, no hassle.

[ChicagoGranny]

I have traditional medicare. Requested a refitting of my mask from the DME. They said I need a new prescription from my doctor. They said that it's a Medicare rule that I need a prescription that is less than 12 months old to purchase a filter. Really? I need to spend 75 dollars (for an office visit) to get a prescription for a filter that cost 2 dollars.

Do you need a mask or a filter?

About the requirement for a current prescription, Noridian Medicare Services administers services for Medicare and is the largest trainer of DMEs. Noridian's training for DMEs includes instructions that current prescriptions must be on hand to prevent claim denials. See https://youtu.be/AFT--8YVafs?si=40eWkiaGUIGhHFDH&t=25

So, there is no use in fighting it. Since Medicare provides a free annual visit, I have my PCP update my prescription at every annual visit. The DME makes it easy by faxing the PCP a form to fill out and sign. Easy peasy. When I first asked my PCP if he would do this, he said he knew nothing about CPAP. I said that was OK because I would tell him everything he needed to know.

[babydinosnoreless]

Filter or mask ? You can buy a 3 year supply of filters off of amazon for under $15. No prescription needed. You can get masks parts as well. You can't buy the whole kit but you can get all the pieces separately and put it together yourself.

[SleepGeek]

I am writing this for my friend Sanjay (not confident in english language skills)

I have traditional medicare. Requested a refitting of my mask from the DME. They said I need a new prescription from my doctor. They said that it's a Medicare rule that I need a prescription that is less than 12 months old to purchase a filter. Really? I need to spend 75 dollars (for an office visit) to get a prescription for a filter that cost 2 dollars.
Is this true/
What a country.

Welcome to America (joke).

This doc and DME may be partners or the doc could own the whole thing.

Time to get a copy of your records, including your sleep study, and find another doc and another DME. Replace them both and start over.

IF you share your location someone here may have some recommendations.

Also get copies from the new doc at each visit - by law you (your friend) are entitled to them.