Interesting Journey

[BMAC1206]

New to the Forum, but not to CPAPS. First diagnosed in 2005 and fitted with a Resperonics REMstar. Had that machine until July 2015 when one of my doctors asked me about no reports from my sleep doctor. I replied, I don't have a sleep doctor. I got the machine after doing a sleep study at our local hospital.

So, he recommends a local doctor, I have a examination that included a sitting stress test. He recommends the continuation of CPAP use and a visit is scheduled for a company that curiously works out of the lower level of the doctors office.

I get a home visit and I am given a Philips Respironics System One with Resmed Airfit P10 mask. Fits terribly, but later find out that I was left incorrect nasal pillows and strap. Once they are exchanged for mens sizes, all is ok.

This is 5 months before I enter the "age of medicare." That is where my problems begin.

Medicare makes me rent the machine for months, eventhough it was processed through BC/BS 5 months earlier. Then I started having terrible service from the replacement supply company and wanted to change to my old one only to find that Medicare wouldn't allow that without a new sleep study.

Finally, the sleep supply company was purchased by a bigger company. Before they were totally gone, they sent me a box with 10 paper filters, 10 sponge filters, 8 nasal pillows, a water chamber and 4 straps.

So, I get a form letter last week from my supplier stating I haven't responded to their monthly "it's time to order supplies" phone message. Curiously, this message is blocked about 50% of the time by NOMOROBO as it comes in without a valid ID line. The other times that it makes it through, I've called back and left a "none needed" message as instructed.So I call in and I am told that Medicare will discontinue support (payment) if I don't order supplies. Even if I don't need them? So I order a new chamber and a new mask strap. I also comment about the mark the strap makes. The young lady states that the manufacturer knows about this, it is their #1 complaint and that they offer a free product that takes the straps away from the face. She will include those in the order.

Today the order comes, no special product. Call them and the CSR tells me he has never ever heard of that and it is not on the list of products they offer.

Is this typical for this industry? I live in Carroll County Md. It just feels so slimy to deal with them.

[Janknitz]

You are being lied to. Medicare does not cut you off of CPAP if you don't order supplies. Instead, if you DO order supplies, they want to know why. DME's are no longer permitted to provide automatic replacements, you have to ask for them.

Medicare does not require a new sleep study just to change durable medical equipment companies, but you do need a current sleep study to get Medicare to pay for equipment and supplies. The one you had in 2015 should be current. More likely the issue was that your old DME is not a certified Medicare vendor in an area that has competitive bidding so they can't bill Medicare for you.

Did you and/or your insurance company purchase the CPAP outright before you became eligible for Medicare or was it still on some sort of rent to own basis? If they are double charging you, that's fraud. But if you were in the middle of an existing rent to own contract, then you have to follow Medicare's rent to own for 13 months procedure (this is called a "capped rental"), but they should have supplied a brand new machine. I think it's Medicare fraud to bill Medicare for a brand new machine when you had a used machine (even if you are the only user).

As for the mask issue, some masks ship now with wraps to go around silicone parts. Some vendors take them out of the packages and resell them. If you let us know what mask you are using, we can tell you. We also recommend padacheek.com. She makes all sorts of wraps and padding to increase the comfort of the mask (but not paid for or supplied by Medicare or insurance).

[Okie bipap]

Once you switched to Medicare and dropped your previous insurance, you started a new 13 month rent to own contract between the DME and Medicare. You are liable for 20% of the Medicare rental on the machine. Medicare will not drop you if you do not order supplies. I am using Medicare, and I only order supplies about once every six or seven months. If you want to change DME, go to this web site and search for approved supplies in your area: https://www.medicare.gov/supplierdirectory/search.html You can use a different supplier for your mask and other supplies but leave your current machine contract with your current DME. I went to the bottom of the list for my area and found a mail order DME located in Florida even though I live in Oklahoma. I have had no problem with my new supplier. When we ordered my wife's new machine, the brought it to the house on a Saturday afternoon.