Question about Replacement CPAP with Medicare

[Setj]

I had heard there were some changes, and a replacement after five years was no longer possible. Today I asked the PA at my sleep doc, and she said Medicare now requires a letter from the doctor saying the machine no longer works properly. Of course, she would not issue such a letter unless the machine was actually malfunctioning.

So, my question is what she is telling me correct? If it is, I want to go ahead and buy another S9 Autoset at this time instead of waiting until my current machine is 5 years old. (I already have a backup machine, but it is not as good as the S9).

Thank you.

[Okie bipap]

Medicare requires your machine to be beyond economical repair before they will replace it. If your machine quits, you must have it repaired at an approved facility in order for Medicare to pay for it. If the cost to repair is too high, them Medicare will replace the machine. If I were you, I would pick up another S9 if that is what you are used to. I recently picked up a new AirCurve 10 vauto for what I considered to be a reasonable price, even though my machine is only a year old and is still under warranty.

[SewTired]

I had heard there were some changes, and a replacement after five years was no longer possible. Today I asked the PA at my sleep doc, and she said Medicare now requires a letter from the doctor saying the machine no longer works properly. Of course, she would not issue such a letter unless the machine was actually malfunctioning.

So, my question is what she is telling me correct? If it is, I want to go ahead and buy another S9 Autoset at this time instead of waiting until my current machine is 5 years old. (I already have a backup machine, but it is not as good as the S9).

Thank you.

Ask the PA if she has an in-house manometer to check the pressure of your machine. How would she know if the machine wasn't working if she had no way to check this basic function? I'm willing to bet that she doesn't have one. Does anybody have an actual link to this new Medicare requirement? Just wondering (my machine is only a year old and I have an S9 backup already).

[Setj]

How would she know if the machine wasn't working if she had no way to check this basic function?

Because I talked about how great I feel, how well I sleep and gave her a ResScan report showing AHI 0.8 for the last 60 days?

[Pugsy]

I have heard that Medicare has gone to the "not replacing unless its broken" thing even if the machine is over 5 years old. Haven't seen it in print though.
I have also heard that Medicare isn't the only one saving money by requiring the machine to be broken and not just old.

I wouldn't be surprised to see this become the norm instead of the exception....insurance companies want to save money when they can.

[Baja]

I just went through this with my father's 5 year old machine. It's easy. All the doctor and supplier need is a justification to put in their files in the unlikely event that Medicare audits their records.

Common reasons (take your pick):

1) Machine has gotten louder over the years and makes it harder to fall or stay asleep.

2) There is a chemical or burning smell.

3) Machine randomly powers off for no reason.

Most, if not all, suppliers will replace a machine at 5+ years instead of trying to repair it. That is especially true if you have a vague issue like a smell or noise.

[Setj]

take your pick

That's called Medicare fraud. I won't participate in it, and neither will the doctors at the sleep practice I use. If they did, I would switch to an honest practice.

I want honest doctors. Doctors who will lie to Medicare might lie to me about my treatment.

Thank you, but I will buy my own machine with my own money that I earned honestly.

[LSAT]

take your pick

That's called Medicare fraud. I won't participate in it, and neither will the doctors at the sleep practice I use. If they did, I would switch to an honest practice.

I want honest doctors. Doctors who will lie to Medicare might lie to me about my treatment.

Thank you, but I will buy my own machine with my own money that I earned honestly.

Easy to say when you are not on Medicare

[Susie Kay]

Easy to say when you are not on Medicare

His post is entirely about Medicare, so I think it is safe to assume he uses Medicare.

That's called Medicare fraud. I won't participate in it

I'm with you. I got this far in life without lying or cheating, and I won't start now. Glad to see others who are honest.

[chunkyfrog]

My previous machine was pre-Medicare, and under 4 years old,
but it was making more noise and not always saving data.
Medicare covered my new machine in November 2014.
I was told that the condition of the non-Medicare machine had no bearing on a Medicare claim.
I only needed to get the "face to face" letter from my doc, stating I used Cpap and benefited from it.