Being Forced to use a Reconditioned Machine

[Uncle_Bob]

Yikes, There is no way i would accept a used machine from a DME.

[akcpapguy]

Leave that DME...(do not pass go....do not collect $200) . Medicare pays the DME for a new machine. If the DME gives you a reconditioned unit they are in violation of Medicare rules. They should be reported to Medicare.

I agree he should run from this place as fast as he can, if indeed he can. However your statement about new machines and the violation of Medicare rules are absolutely false. Medicare does not stipulate that a DME gives NEW equipment to a patient, only new supplies. I do not advocate giving patients used or refurbished equipment.

[archangle]

You're still renting the machine, and can return it for a while and only pay the rent for the months you've used it. Do you expect the DME to eat the cost of rental return machines?

There's also believed to be no health risk from using a used blower unit. A used mask or hose would be a different question.

Yes, I'd rather have a brand new machine, but I wouldn't expect it.

[StuUnderPressure]

I do not advocate giving patients used or refurbished equipment.

Yet, you defend doing so.

[DreamStalker]

I do not advocate giving patients used or refurbished equipment.

Yet, you defend doing so.

No he didn't. He clarified Medicare policy and then said he does "not advocate giving patients used or refurbished equipment".

[ProfessorEd]

I work for a DME so you can believe SOME things we say
We DO NOT practice this (giving a used machine for MDCR pts) but I can see where some companies may. What hapens (and this is from the DME point of view) is that MDCR will only pay for the first 3 months and then the DME has to provide a download showing that the patient is using the machine (at least 4 hours per night 70% of the time in a 30 day period) AND the pt has to be seen by a physician and they have to submit a form to MDCR saying that the pt is using the cpap, its beneficial etc..
Well as you can imagine, we have many MCR pts that we setup that are not compliant (they did not use 4 hours) or they do not see their doctor again within the time frame req by MDCR. When this happens we have to pick up the machine. That's easier said than done. SOmetimes you cant find the pt, they wont pick up the phone, they are not home, they dont open the door etc..
Now from DME point of view thats a $300-$500 or more piece of equipment plus a mask and tubing and filters that someone did not pay for. The DME lost money.
Becuase this happens quite often the thought has been suggested, well what if we set these pts up with a refurbished machine and then after the 3 months if they are compliant we switch them to a new machine.
You can see why a DME would want to do this.
So as usual there is always two sides to the story its not as easy as one side is bad and evil and the other side is purely innocent.

I could understand this strategy. However, this was not what was suggested, although it would be acceptable.

You do point out another "cost" to getting the new machine. Apparently I will need to see the doctor again in three months (I saw him when getting the new machine), even though it is not medically necessary. I am a long term user of a BIPap machine, and all that is happening is a machine upgrade, and replacement of a possibly defective machine.

This may be yet another case of Medicare rules that my make no sense. As stated, the second visit to a doctor may be wise for new CPAP type patients, but not for ones who are long term patients, and compliant. A related unwise rules apparently requires to receive "supplies" a statement from a doctor that the patient is compliant based on an exam within a short period of starting Medicare. For a long term patient, the docotr should be able to make such a statement without seeing the patient. As I remember it, I could meet this condition by using my GP, who had seen me at the required time and believed me when I said I used the machine.

Putting on my bean counter hat, one thing that is needed is a way for Medicare to pay for the examination, testing, and repair of older machines. I may be wrong, but this is apparently not easily done. This is probably why Sleepmed would not check my old machine, but used the opportunity to "sell" me a new one (I was an easy sell since I knew it would cost me little, and was thinking of a new one anyhow.) While it may make sense for a "service" contract to come with new machines, the insurance industry seems to have created a situation where the only way to get service is to have a service cotract arising from having bought a machine from the DME currently being used.

[ProfessorEd]

One other issue is what supplies, if any, should I expect with a new machine.

I noticed this DME checked to see if I could use the old filter (and when I could not) put a new one in. What about tubing, she told me I could use my old tubing?

Is there more than one model of a BiPap auto from Respironics? I notice the manual shows a dial with numbers, but my machine lacks such numbers.

Would I end up with better supplies if I talk them into a new machine?

[cflame1]

One other issue is what supplies, if any, should I expect with a new machine.

I noticed this DME checked to see if I could use the old filter (and when I could not) put a new one in. What about tubing, she told me I could use my old tubing.

Is there more than one model of a BiPap auto from Respironics? I notice the manual shows a dial with numbers, but my machine lacks such numbers.

Would I end up with better supplies if I talk them into a new machine?

Yes there are 2 models... one is setup to handle a heated hose (newer) and one is not (older).

[Pugsy]

Is there more than one model of a BiPap auto from Respironics?

There are 2 PR System One BiPap Autos that are considered current models.
The model 750 and the 760..with the 760 being the newest (this past August release). The 760 has the heated hose option.
Yes, you can use your old hose but they should have included a new hose.
A new out of the box machine includes a new hose and a white Performance hose (lighter and more flexible) unless someone is getting the 60 series heated hose option and then they get a heated hose which is special.
The heated hose can only be used on a 60 series machine with the special power supply and lid on the humidifier but any hose can be used on the 60 series as well as the 750 model.

New machines include the blower unit, the humidifier, the travel case, the power supply, the SD card, the hose and a gray foam filter and a white fine filter (I think on the white filter).
The 60 series heated hose thing is an option. There are 760 models that don't have the heated hose optional power supply and lid.

Sounds to me like your DME is really el cheapo....I would be finding a different DME if it were me.
It's not so much that new machines have "better" supplies...it's just that a new hose should be included as well as filters and such...even with a reconditioned or used machine. It should be complete without missing parts or be forced to use your old parts.

[ProfessorEd]

Is there more than one model of a BiPap auto from Respironics?

There are 2 PR System One BiPap Autos that are considered current models.
The model 750 and the 760..with the 760 being the newest (this past August release). The 760 has the heated hose option.
Yes, you can use your old hose but they should have included a new hose.
A new out of the box machine includes a new hose and a white Performance hose (lighter and more flexible) unless someone is getting the 60 series heated hose option and then they get a heated hose which is special.
The heated hose can only be used on a 60 series machine with the special power supply and lid on the humidifier but any hose can be used on the 60 series as well as the 750 model.

New machines include the blower unit, the humidifier, the travel case, the power supply, the SD card, the hose and a gray foam filter and a white fine filter (I think on the white filter).
The 60 series heated hose thing is an option. There are 760 models that don't have the heated hose optional power supply and lid.

Sounds to me like your DME is really el cheapo....I would be finding a different DME if it were me.
It's not so much that new machines have "better" supplies...it's just that a new hose should be included as well as filters and such...even with a reconditioned or used machine. It should be complete without missing parts or be forced to use your old parts.

The doctor and I discussed a heated hose, with he speaking favorably of one as solving certain problems, and I thought he was going to write a prescription that included one.
I remember asking if insurance would likely cover one. What is the best way to learn the pro's and cons of a Heated Tube Humidifier? Is Medicare (and Cigna) insurance likely to pay for one if the prescription is properly worded, and how should it be worded?

From what you say, if you get the right model you get a heated hose included. I sounds like with the right model, the power supply for the hose is a lot simpler than with others, when a heated hose would require its own power supply, cord, etc. and finding a place to plug it in among a tangle of extension cords.

Any advice as to just what model I should be asking for (and/or asking the doctor to specify), and why?

Possibly a PR System One 60 Series BiPAP Auto with Heated Tube?Humidifier

[Pugsy]

What is the best way to learn the pro's and cons of a Heated Tube Humidifier? Is Medicare (and Cigna) insurance likely to pay for one if the prescription is properly worded, and how should it be worded?

Medicare will pay for a heated hose. There is a billing code for heated tube.

There are 60 series machines that come with the heated hose option stuff and there are 60 series machines that don't come with the heated hose stuff. Those 60 series machines that don't come with the special hose or power supply can be retrofitted for a heated hose though. Just need that upgrade kit.
So a 60 series machine doesn't necessarily automatically come with the heated hose stuff....

There is no way to learn the pros and cons of a heated tube other than by your own experience. I have used a machine without a heated hose...I have used a stand alone heated hose (that one does require an additional electric plug in) but the 60 series machines heated hose is built in to the machine so same number of plug ins...and I have used the ResMed ClimateLine heated hose....the ClimateLine is the superior of the hoses I have used. I have never tried a 60 series heated hose but I would assume it is the same quality as the Climateline and I would want one if it were me.
It's better to have it an not need it than need it and not have it. Not many people are unhappy with heated hoses but a good many people would love to have one and can't get one.
Especially since insurance pays for it and the out of pocket cost to the patient is unchanged.

Best way to get what you might want....have the doctor write exactly what is wanted and mark "dispense as written" on the RX.
In the case of the PR system One 60 series Bipap this wording.
"Respironics PR System One 60 series BiPap Auto with BiFlex along with the heated tube equipment."
This would also insure that you get a relatively new machine because this particular model wasn't released for sale until this past August.
DMEs will want to get rid of old stock first...that's how you got a reconditioned/used machine in the first place.

[VikingGnome]

What part of the machine was reconditioned? Did they put in a new blower? How many hours does the machine say it has been used? (Of course, if opened the machine to replace motor, then then could reset to zero hours).

I would be VERY CAUTIOUS about accepting a reconditioned machine. You have NO WARRANTY. Medicare allows a new one and it will have two-year warranty from the manufacturer. Don't mess with reconditioned machines unless you are paying cash yourself and you get a deep discount for it.

[ProfessorEd]

What part of the machine was reconditioned? Did they put in a new blower? How many hours does the machine say it has been used? (Of course, if opened the machine to replace motor, then then could reset to zero hours).

I would be VERY CAUTIOUS about accepting a reconditioned machine. You have NO WARRANTY. Medicare allows a new one and it will have two-year warranty from the manufacturer. Don't mess with reconditioned machines unless you are paying cash yourself and you get a deep discount for it.

I was told nothing abut the history of the machine. I would be very much surprised if there was a new blower.

I do notice a pleasant odor, sort of woodsy, which I assume was from cleaning or disinfecting the machine. I wonder if there is any way to get such a fragrance (which I do like) by adding someting to the water.

[Pugsy]

I do notice a pleasant odor, sort of woodsy, which I assume was from cleaning or disinfecting the machine. I wonder if there is any way to get such a fragrance (which I do like) by adding someting to the water.

I wouldn't add anything to the water but you can use aroma therapy at the air intake on the back of the machine.
I use some essential oils on a little disc from PurSleep but you can also just use a cotton ball.
The oils would make the tank yucky and harder to clean but you can put whatever scent you might like near the air intake and the air that gets suck in will smell nice.
Lots of us use some sort of aroma therapy.

[ProfessorEd]

Pugsy, Your advice is most useful. Thanks.

From what you know (Medicare and Cigna insurance, current Respionics Bipap auto user) is the Respironics PR System One 60 series BiPap Auto with BiFlex along with the heated tube equipment probably the best to ask the doctor to prescribe? I think this is their latest and best model, but I may have missed something. I do not not travel much and appearance and quietness are secondary to good treatment, and access to data to improve.

What is the best way to learn the pro's and cons of a Heated Tube Humidifier? Is Medicare (and Cigna) insurance likely to pay for one if the prescription is properly worded, and how should it be worded?

Medicare will pay for a heated hose. There is a billing code for heated tube.

There are 60 series machines that come with the heated hose option stuff and there are 60 series machines that don't come with the heated hose stuff. Those 60 series machines that don't come with the special hose or power supply can be retrofitted for a heated hose though. Just need that upgrade kit.
So a 60 series machine doesn't necessarily automatically come with the heated hose stuff....

There is no way to learn the pros and cons of a heated tube other than by your own experience. I have used a machine without a heated hose...I have used a stand alone heated hose (that one does require an additional electric plug in) but the 60 series machines heated hose is built in to the machine so same number of plug ins...and I have used the ResMed ClimateLine heated hose....the ClimateLine is the superior of the hoses I have used. I have never tried a 60 series heated hose but I would assume it is the same quality as the Climateline and I would want one if it were me.
It's better to have it an not need it than need it and not have it. Not many people are unhappy with heated hoses but a good many people would love to have one and can't get one.
Especially since insurance pays for it and the out of pocket cost to the patient is unchanged.

Best way to get what you might want....have the doctor write exactly what is wanted and mark "dispense as written" on the RX.
In the case of the PR system One 60 series Bipap this wording.
"Respironics PR System One 60 series BiPap Auto with BiFlex along with the heated tube equipment."
This would also insure that you get a relatively new machine because this particular model wasn't released for sale until this past August.
DMEs will want to get rid of old stock first...that's how you got a reconditioned/used machine in the first place.