Back Again and no more fooling around

[lliann]

Hi Everyone. It amazes me to still see some of those familiar names. I had to break out the vpap and masks again because I flunked my stress test and methinks gasping at night did not help my cause at all. Cardiac cath time etc. I am going through my masks (I found a provider who told me what I had coming by my insurance policies and was ordering as allowed), but there have been some changes in machines since my s9. I may just buy it because well compliance sort of escapes me and plus at my age I really don't like having to report in all the time compliant or not. This group taught me what I needed to know and answered whatever questions I had and I remain grateful for that.

So which of the new machines do you like the best? BTW,I like the new Dreamwear mask(altho headgear slides around on my head because I toss and turn). I wish a full or mouth mask worked for me because I can't shut my mouth day or night (apparently<g.)((yes I have chin straps and paper tapes)but I move too much and I end up chasing squeaks which defeats the purpose of getting good sleep)

Barb/Lliann

[Pugsy]

I would suggest that you stick with the ResMed brand since you are used to it's algorithm and way of doing things.
The newest model with them is the AirSense/AirCurve 10 model line.
Your S9 model in your equipment isn't showing up since it has been discontinued so I don't know which one to tell you would match what you have.
Since you mention VPAP I assume some sort of bilevel.

Which model VPAP do you have? S...Auto...other???

The AirCurve 10 model line is ResMed's bilevel model line like the VPAP was with the S9 models.

http://www.resmed.com/us/en/consumer/pr ... vices.html
scroll down to see the AirCurve models.

Though I will be honest...if your S9 is working well they didn't change anything in terms of the working blowing air part of the algorithm and other than some new minor cosmetic changes and a few setting options and flagging of CSR looking events, I don't know that I would spend the money if it was all coming out of my pocket unless I had to.

You can go here and request the provider/clinical manual for the AirCurve equivalent to whatever you have in the S9 line and see what the minor differences are.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

[D.H.]

I was very annoyed last year when I was told that I needed to prove compliance for a replacement machine. Funny thing is, I spoke to someone who did not realize that it was a replacement machine, and he said he never saw such steadfast compliance before! I will "own" this machine next month. I had it outside the country twice (once in Europe once in Asia), but that doesn't seem to be problematic.

[lliann]

I was very annoyed last year when I was told that I needed to prove compliance for a replacement machine. Funny thing is, I spoke to someone who did not realize that it was a replacement machine, and he said he never saw such steadfast compliance before! I will "own" this machine next month. I had it outside the country twice (once in Europe once in Asia), but that doesn't seem to be problematic.

Do you think the compliance is different for a replacement machine (over 5 years) then for a first time machine?

[Pugsy]

Do you think the compliance is different for a replacement machine (over 5 years) then for a first time machine?

It might be different depending on the insurance but most insurance will want the same compliance proof as they would if you were brand new to this therapy.
You would need to check with your insurance directly. Heck, your insurance may not even require proof...it is all up to the insurance company.

The DME may or may not check directly with insurance...most likely they won't and will just apply the universal standard compliance restrictions that Medicare uses. Which is of course minimum of 4 hours a night for 70% of the nights in a 30 day consecutive window of use.

If you have Medicare...count on needing to prove compliance just like you were new to therapy.

[lliann]

I have Cigna primary and medicare secondary. I checked with a new DME local provider and the compliance was way more than that. More than 4 hours and at least 90 days. I really did not want to be confined like that. But I also did not say if it was new or replacement (just that I wanted to compare cash and insurance) I think I will do some more checking around since I am more committed than when I asked. At that time I did not know I had an enlarged heart and some blockages. Finally got my attention. Sigh. OTOH, my s9 is still working perfectly well.

[Pugsy]

Check with Cigna directly....never, never, ever take a DMEs word as the gospel on anything.
They have been know to tell blatant lies about compliance to put the fear of God in people.
Medicare doesn't do the 90 day thing...it's 30 days within a 90 day period from getting the machine but the 30 days have to be consecutive.
I am betting that Cigna's is the same.

In other words...you have 90 days to meet the 30 day thing.
Has to be consecutive though...can't be spread out over 90 days...bummer.

If it were me...I would just keep using the S9. There's no urgent need for a new machine and if you were non compliant very much (and it sounds like you were) then it won't have all that many hours on it anyway. There's really nothing to be gained with a newer model that is of that much of a critical need or likely to make that much of a difference in your compliance.
Sounds like you need to have a little talking to that little devil on your shoulder telling you it's okay to take the mask off and sleep without it...or "for tonight ditch the mask"...

Now if you are having some comfort issues giving you and excuse for the little devil to speak up...we can maybe help with those.
But if it is just that you simply weren't committed and found any excuse to ditch the machine a good one...talk to that little devil on your shoulder.

[Goofproof]

Check with Cigna directly....never, never, ever take a DMEs word as the gospel on anything.
They have been know to tell blatant lies about compliance to put the fear of God in people.
Medicare doesn't do the 90 day thing...it's 30 days within a 90 day period from getting the machine but the 30 days have to be consecutive.
I am betting that Cigna's is the same.

In other words...you have 90 days to meet the 30 day thing.
Has to be consecutive though...can't be spread out over 90 days...bummer.

If it were me...I would just keep using the S9. There's no urgent need for a new machine and if you were non compliant very much (and it sounds like your were) then it won't have all that many hours on it anyway. There's really nothing to be gained with a newer model that is of that much of a critical need or likely to make that much of a difference in your compliance.
Sounds like you need to have a little talking to that little devil on your shoulder telling you it's okay to take the mask off and sleep without it...or "for tonight ditch the mask"...

Now if you are having some comfort issues giving you and excuse for the little devil to speak up...we can maybe help with those.
But if it is just that you simply weren't committed and found any excuse to ditch the machine a good one...talk to that little devil on your shoulder.

Maybe find a fireproof 2 by 4, give that devil a attitude adjustment. Jim

[LSAT]

I have Cigna primary and medicare secondary. I checked with a new DME local provider and the compliance was way more than that. More than 4 hours and at least 90 days. I really did not want to be confined like that. But I also did not say if it was new or replacement (just that I wanted to compare cash and insurance) I think I will do some more checking around since I am more committed than when I asked. At that time I did not know I had an enlarged heart and some blockages. Finally got my attention. Sigh. OTOH, my s9 is still working perfectly well.

I'm not doubting you, but, I was always told that if you were on Medicare, it was always primary and any other insurance was secondary. When I left my job years ago, I questioned it and that is what I was told. About 2 years ago a friend was in the same situation and was told the same thing.

[Pugsy]

I'm not doubting you, but, I was always told that if you were on Medicare, it was always primary and any other insurance was secondary. When I left my job years ago, I questioned it and that is what I was told. About 2 years ago a friend was in the same situation and was told the same thing.

It depends on the employer. When a person retires it depends on how the employer handles the insurance of the retirees. Might also depend on what capacity the employee worked.
My own step father worked in management for a large company and when he retired he kept his BCBS and it was primary and his Medicare was secondary.
It was part of his retirement package.

[Okie bipap]

When my brother retired from his job, he kept his BCBS for several years as his primary insurance until I finally convinced him he was wasting a lot of money every month. As retired naval reserve, he qualified for Tricare for life. That and Medicare was all he needed to cover all of his medical bills. Once he swapped over, he kept all of the doctors he already had, and had no problems with coverage.

[Pap-Daddy]

You must sign up for Medicare by 65 or you loose your Tricare. But yea, it is simple after that IF Medicare covers it then Tricare pays the rest. Life is Good.

[lliann]

I have Cigna primary and medicare secondary. I checked with a new DME local provider and the compliance was way more than that. More than 4 hours and at least 90 days. I really did not want to be confined like that. But I also did not say if it was new or replacement (just that I wanted to compare cash and insurance) I think I will do some more checking around since I am more committed than when I asked. At that time I did not know I had an enlarged heart and some blockages. Finally got my attention. Sigh. OTOH, my s9 is still working perfectly well.

I'm not doubting you, but, I was always told that if you were on Medicare, it was always primary and any other insurance was secondary. When I left my job years ago, I questioned it and that is what I was told. About 2 years ago a friend was in the same situation and was told the same thing.

*****
My last job before retiring was as a hospital biller. So I spent many years duking it out with insurance companies because their goal is to deny claims- not pay them. I was very careful what I had in place when I retired. So my medicare is 2nd because my partner(officially on record) is still working for a large company of 20 or more employees. One of the benefits of having a group ins 1st and Medicare 2nd is that no matter what the deductible is on the first one, I only have to pay up to the Medicare deductible. Anything after that Medicare will not pay and does not pass on the charge. So usually after ded. I just pay a medicare copay (or co ins depending on the service)


*edit addition: Where it would not occur is if a company offers ins on the HSA plan. In that case, if a person is old enough for Medicare, they have to have Medicare primary (and its usually not worth the premium for a group ins to be 2nd)

When is Medicare the primary payer and when is it the secondary payer?

65+ with insurance based on current employment1 Less than 20 employees Medicare2 employer
20 or more Employees Employer Medicare

Disabled with insurance based on current employment3 Less than 100 employees Medicare Employer
100 or more employees Employer Medicare

End-Stage Renal Disease (ESRD or permanent kidney failure), with GHP or employer retiree plan During 30-month coordination period4 Employer/ Retiree5 Medicare
After the 30-month coordination period Medicare Employer/ Retiree

Personal Injury Insurance If available Personal injury insurance6 Medicare

Employer retiree plan7 Not eligible for Medicare Retiree N/A
Eligible for Medicare8 Medicare Retiree

COBRA Had COBRA before being enrolled in Medicare (Medicare eligible because of age, disability) or ESRD)9 Medicare COBRA terminates
Had Medicare before eligible for COBRA (Medicare eligible because of age or disability Medicare COBRA
Are under 65 and eligible for Medicare because of ESRD 10 COBRA (during 30-month coordination period) Medicare

[StuUnderPressure]

I'm not doubting you, but, I was always told that if you were on Medicare, it was always primary and any other insurance was secondary. When I left my job years ago, I questioned it and that is what I was told. About 2 years ago a friend was in the same situation and was told the same thing.

The Employer is the one that decides if you must go on Medicare when you retire & to make Medicare your primary insurer.

Of course, it is to the benefit of the employer to get someone older off of their group insurance & let someone else pay the "usually" higher health costs of that retired employee.

The advantage of having Medicare "my" primary insurer is that Medicare pays 80% & my Secondary (BC/BS) pays the remaining 20%.
I never have any copays, deductibles, or any other out-of-pocket costs.
"My" Secondary even pays the Medicare deductible in full.

The big disadvantage to having Medicare your primary is whether the current Doctors, etc. you use will accept Medicare.
If they do not, you may have to switch Doctors, etc.

All but 1 of mine were not accepting any new Medicare patients - but they were keeping their current patients who merely switched from a private insurer to Medicare.

[Guest]

As ridiculous as it sounds the VA is THE ONLY hospital in the US (afaik) that does NOT take Medicare. What they told me was the govt doesn't bill the govt. Anyone who has ever worked for the govt knows that is not true. Plus Medicare is insurance and the VA does bill insurance.

The VA has several classifications for veterans - you just have to be Honorably Discharged to be eligible. Of course if you have injuries related to military service there is no charge you are classed as "Service Connected" but only those injuries are treated in most cases.

IF you are just an eligible "veteran" you are eligible but may have a co-pay depending on your income - Typically $50 to see a "specialist" but you must be referred by your primary doc.

However, IF you are a retired veteran (>20yrs service) and have Tricare For Life and try to use it at the VA that same $50 copay becomes something in the order of $67. Keep in mind you must have Medicare after retirement in order to use TFL.
Thank You for you service.

Thankfully the VA has not billed for any cpap equipment. It seems to depend on your location but they do not have the best service either. Good equipment no doubt it is just the people (mostly draft dodgers at that) that work there, govt employees who know they can't be fired are hard to motivate.