New prescription vs. old prescription?

spc2005 · Post by **spc2005** » Thu Nov 10, 2005 2:48 pm

As I had mentioned in another thread a day or two ago, I had submitted my insurance info to billmyinsurance.com to see if I could be covered for a new equipment order through them ...

Background - I'm wanting a new, better machine than the one I currently have through a local DME. I currently have an Invacare Polaris machine.

The very same afternoon that I submitted my request, I got a call back from the folks at billmyinsurance.com. The lady I talked to was very helpful, but she informed me that if I already have a CPAP machine through a DME, and I used my insurance to rent it (I pay a co-pay on it), then I would have to wait five years before my insurance would cover a new machine. I was so disappointed when I heard this!

After mulling all of this over and over in my mind, I had a thought (takes a while with the OSA, ya know ...) I am getting ready to undergo another sleep study this Sunday the 13th to set my titration rate, etc ... It's been about two years since my initial study and I was never titrated then (long story).

Here's my thought ... If, after the sleep study on the 13th, I can get my doctor to write me a NEW prescription for an APAP machine (I'm wanting the Respironics with C-flex), would this possibly be a "work-around" for the insurance issue with having to wait five years for a new machine to be covered?

My thinking is that this is a different kind of machine and the one I have no longer suffices for what I need ...

Am I wishing here, or does this sound like it might work? I'm desperate ... I've been off CPAP for well over a year because I can't deal with that Invacare machine any longer.

Any advice or experience in this regard?

wading thru the muck! · Post by **wading thru the muck!** » Thu Nov 10, 2005 3:03 pm

Is this the same insurance company that bought the first one?? If so, they are unlikely to pay for the auto. If it was determined that you need to switch to a bi-level machine I'm sure this method would work. Unless you are contending that the straight cpap is not working for you and cannot be adjusted so that it will then they are unlikely to pay again.

spc2005 · Post by **spc2005** » Thu Nov 10, 2005 3:06 pm

This is what I was afraid of. Yes, it would be the same insurance company. Looks like I'm going to have to pay cash for the new machine for sure. I just wanted to explore all avenues before I did that. Oh well.

Thank you for the advice!

snork1 · Post by **snork1** » Thu Nov 10, 2005 3:26 pm

I got hit by that 5 year machine replacement policy too.

The only way I got around it was I was "lucky" enough to change jobs and get a new insurance company in the process. I also switched DME's which I am not sure if that helped. So for the new insurance it was my "first machine". That is one of the few upsides of losing insurance everytime you lose a job.

Guest · Post by **Guest** » Fri Nov 11, 2005 12:15 pm

Illinois RRT here,
It should not matter if you switch DME companies, prescriptions, etc (although like another poster said, if you need to switch to a BiPAP, that's another story). The five year mark is pretty standard. If you switch DME companies, they will still communicate with each other to find out billing dates, etc. How long have you had the Invacare machine? Is it still in active rental? If it's an old machine and has been moved to a capped rental item, you may not have five whole years to wait, if that makes sense. You might be better off to check with your insurance company yourself and see if they can help you out. Good luck!