Why Your DME Requires an Annual Prescription

[ChicagoGranny]

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

[Movieman]

I am not on Medicare, but BC/BS requires the same annual prescription. I found this out last year when I got some CPAP supplies denied. I just had to have my doc send a new prescription to DME and then they filed the claim again and got paid. DME doesn't warn me either when prescription is going to run out. It was a pain, but at least I didn't get charged extra.

Don't most sites that sell CPAP supplies require a prescription on file yearly as well even if insurance doesn't pay? I seem to remember I need a prescription on file with cpap.com. It might only be for the mask. I can buy hoses and filters on Amazon with no prescription.

[Pugsy]

Don't most sites that sell CPAP supplies require a prescription on file yearly as well even if insurance doesn't pay? I

I don't know about other online suppliers because I have mainly used cpap.com over the years but my RX that they have on file covers machine and any mask of my choice and it is dated Aug 2009.
Cpap.com does NOT require a new RX unless for some reason the RX has an expiration date on it....mine doesn't...it's good for 99 years.

[Movieman]

I don't know about other online suppliers because I have mainly used cpap.com over the years but my RX that they have on file covers machine and any mask of my choice and it is dated Aug 2009.
Cpap.com does NOT require a new RX unless for some reason the RX has an expiration date on it....mine doesn't...it's good for 99 years.

Oh, so my prescription has an expiration date then. Thanks for the information. I also mainly use cpap.com. I will ask my doctor to not include an expiration date. I wonder if he will agree. I have a feeling he does it on purpose so I see him annually. LOL

[Pugsy]

I have a feeling he does it on purpose so I see him annually.

Some docs are like that. I just this month fired my PCP for being "like that".
I have only had her for about a year and never been happy with her anyway.
Didn't take much for me to give her the boot.
BTW....had nothing at all to do with cpap stuff.
I haven't see a sleep doc since August 2009.

[SleepGeek]

I will ask my doctor to not include an expiration date. I wonder if he will agree.

If he doesn't then its time to find another and get a copy.

[ILoveFlowers]

My state requires a yearly prescription. Fortunately, my PCP is willing to write it because she knows how important it is to my health. Unfortunately, my Medicare advantage plan said that wasn't good enough, they insisted I need a new sleep study before they will cover anything cpap related. I am not up for going through another sleep study (worse night of my life) so I just pay my own way, as I always have before. The online sources I buy from have not required updated prescriptions.

[SleepGeek]

Unfortunately, my Medicare advantage plan said that wasn't good enough

so I just pay my own way, as I always have before.

So your "Advantage" plan isn't really saving you anything.

Time to look elsewhere - viewtopic/t187337/Medicare-Open-Enrollment-is-Here.html

[Janknitz]

I have a feeling he does it on purpose so I see him annually. LOL

I always get the impression that sleep doctors don't really want to see patients at all. That's why they went into sleep medicine, so their patients, for the most part, are asleep and can't talk back.

SleepGeek said

Time to look elsewhere - viewtopic/t187337/Medicare-Open-Enrollment-is-Here.html

Be careful! https://insurify.com/health-insurance/k ... nrollment.

When you first enroll in Medicare, you get a signup period called “guaranteed issue rights.” This means you can enroll in a Medigap plan without medical underwriting.

Medical underwriting is the process of figuring out a person’s health insurance premium. It’s based on several factors, including their health. It also means that a healthcare insurer can deny coverage to people who don’t meet health standards.

Outside of your initial enrollment period, you’re not offered “guaranteed issue rights.” That means you’d be subject to medical underwriting. For people with pre-existing conditions, this means more expensive monthly premiums. Even denial of coverage.

See also https://www.aarp.org/health/medicare-qa ... itions.html

Everyone 65 and older on Medicare qualifies for these protections, known as guaranteed issue rights, for the six-month period after you enroll in Medicare Part B benefits. That means insurance companies cannot refuse to sell you a Medigap policy or charge you higher premiums based on your current health or medical conditions. Some people qualify beyond that time frame; see details below.

If you apply for a Medigap policy when you don’t have a guaranteed issue right, you’ll usually have to answer questions about your health. An insurer may reject you or charge more if you’ve had certain medical conditions, usually within the past two years. But the conditions, timeframe and effect on your coverage can vary a lot by insurer and state.

Contrary to popular belief, underwriting is still permitted for Medicare when switching plans after your initial enrollment period. https://www.aarp.org/health/health-insu ... akes.html Be sure to talk to your state's SHIP or HICAP about this before deciding to switch.

[ChicagoGranny]

Unfortunately, my Medicare advantage plan said that wasn't good enough, they insisted I need a new sleep study before they will cover anything cpap related.

That's strange. Did you get this information directly from the insurance company? Or the doctor's office? Or a lying DME?

[SleepGeek]

Unfortunately, my Medicare advantage plan said that wasn't good enough, they insisted I need a new sleep study before they will cover anything cpap related.

That's strange. Did you get this information directly from the insurance company? Or the doctor's office? Or a lying DME?

Very Strange which is why SleepGeek said

Unfortunately, my Medicare advantage plan said that wasn't good enough

so I just pay my own way, as I always have before.

First - Visit shiphelp.org to get the phone number for your state.
Then make sure the plan you choose will cover your cpap supplies and any meds you take today.

AND be sure any & all docs you see are on the plan you choose.

Can you use the plan if/when you travel? Some are only ER visits.

I know with many *Advantage* Plans if you move (even to another county) you will need to choose another plan all over again.

Get a notebook and write down your questions before you call.

What I have never recommended is any Advantage Plan because it can cause other problems mentioned above by Jan.

Explore your Medicare coverage options
https://www.medicare.gov/plan-compare/# ... &year=2024

[chunkyfrog]

UNDERWRITING will cost you if you want to change your supplement (not part D).
Apnea is only one of MANY conditions that trigger this requirement.
And the penalties are forever!

[ILoveFlowers]

That's strange. Did you get this information directly from the insurance company? Or the doctor's office? Or a lying DME?

Yes, that was from the insurance company. It's about time to choose the plan for this year, I'm going to see if there's a better one available.

[babydinosnoreless]

Just this weekend I was in Vegas at my daughter's house when my short hose developed a leak. It was the only replacement part I didn't have with me. Went to a local cpap store and they wanted $55 for the short hose. but they let me buy the full mask kit for $104. No prescription needed. ‍♀️ I thought prescriptions were required for a full mask. Apparently not in Nevada.

[SleepGeek]

Check out a Truck Stop or pharmacy next time for masks and other cpap supplies.