why are insurance companies replacing bi-pap machine only when broken

[springman946]

hello everyone i was wondering my DME tells me that my insurance company will ONLY replace my bi-pap machine if its broken. for example if I were to get a frowning face on the humidifier that would mean that the humidifier quit working I'm coming up on my 5 year anniversary this coming November of having my bi-pap machine. I was under the impression that they would replace it ever 5 years OR if it breaks. why did they change their rules? and also what are the spaces in my graph do they represent leaks in my mask.

[Dog Slobber]

Because they are (rightfully) tired of paying for new machines to replace perfectly good machines that still have years of working life in them.

[Pugsy]

why did they change their rules?

To save money.

what are the spaces in my graph do they represent leaks in my mask

Not leaks. The gaps are when the machine shut itself off or you turned it off and it wasn't blowing air.

[ChicagoGranny]

Because they are (rightfully) tired of paying for new machines to replace perfectly good machines that still have years of working life in them.

And, in the US, Medicare made this change for the same purpose. Most insurance companies match their benefits closely with Medicare.

[chunkyfrog]

Define "broken"---
It does not necessarily mean "will not power on at all".
Sometimes getting really noisy, or failing to record usage is enough.
Sometimes it is not.
Time to look for a backup machine--used, if that's what you can afford.
Murphy takes no holidays off--in fact, he works extra hard when the DME's are goofing off.
Reason enough to have a spare machine.

[JLROhio]

Similar question - maybe it deserves its own thread but...

Does anyone know if the VA is (or is not) replacing CPAP/BiPap machines on the 5 year timeline? BiPap's seem a LOT more expensive.

I recall my DME telling me, when they handed me my ResMed AirSense 10 (Autoset) CPAP 4 years ago, that it would need to be replaced in about 5 years.
She seemed to imply that 5 years was the useful life of CPAP's - although from what I've read here - some have machines well past 10 years and still working just fine.

Next year will be my 5 year window for my CPAP - I'm waiting to get into the VA's CPAP system so I can get supplies (ex. masks), etc... For some reason, I just figured that I'd probably be getting a new machine next year...but the question of this thread and reality seems to indicate that I probably won't be seeing a new machine, especially if my machine is working just fine....which it is. But I figured I'd ask the question, especially if there are fellow Vets reading this and getting their CPAP & supplies from the VA...and if the VA is practicing the same fiscal responsibility with CPAP replacements.

BTW, OP, if you don't mind could you share the basics of your insurance coverage - as others have noted, I could see every insurance company switching to a model like this from a fiscal standpoint.

[ChicagoGranny]

Next year will be my 5 year window for my CPAP - I'm waiting to get into the VA's CPAP system so I can get supplies (ex. masks), etc... For some reason, I just figured that I'd probably be getting a new machine next year...but the question of this thread and reality seems to indicate that I probably won't be seeing a new machine, especially if my machine is working just fine....which it is. But I figured I'd ask the question, especially if there are fellow Vets reading this and getting their CPAP & supplies from the VA...and if the VA is practicing the same fiscal responsibility with CPAP replacements.

If I were in your position, I would file for a new machine stating the age and number of hours on my current machine. Don't let a forum stop you from doing this.

If you get a new machine, set your old (but well-working) machine aside to be used as a backup in case of machine failure.

BTW, I'm not a vet, but I had no problem with my Medicare Advantage plan paying for a new machine when mine was five years old. This was in 2018 after Medicare changed their policy of automatically paying for a new machine every five years. The DME helped with this.

[Wulfman...]

hello everyone i was wondering my DME tells me that my insurance company will ONLY replace my bi-pap machine if its broken. for example if I were to get a frowning face on the humidifier that would mean that the humidifier quit working I'm coming up on my 5 year anniversary this coming November of having my bi-pap machine. I was under the impression that they would replace it ever 5 years OR if it breaks. why did they change their rules? and also what are the spaces in my graph do they represent leaks in my mask.

Doesn't look "broken" to me. Looks like you had a large leak and the "auto-off" feature did what it was supposed to......turn it off.......maybe a couple of times. Is the "auto-off" feature turned on? That's what I'd be checking first.
Bi-level machines are EXPENSIVE! Why do you think THEY should be obliged to replace them when YOU think they're "broken"?
Do you have spare/backup machines?

Personally, I would never enable the "auto-off" feature.


Den

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