New to Medicare

[kwikwater]

Hi all. I just hit Medicare yesterday. Is it a given that you'll have to have a new full sleep study before moving forward with new mask or supplies? Does years of SleepyHead data help any? Thanks!

[SewTired]

Nope. If your previous sleep study is 10 years or less, then you don't need the study again.

[chunkyfrog]

If you are currently using cpap, Medicare requires a face to face doctor visit
within a month or so to establish you are a cpap patient.
Medicare covers it, so git er done, kid!

[Okie bipap]

If you do not have a spare machine, now would be a good time to get one. Medicare requires a thirteen month of a rent to own contract. Your part would be 20% of what Medicare pays, not what the DME tries to charge them. My wife got her machine in July (ResMed Air Curve 10 VAUTO), and the DME bills Medicare over $300 a month for the machine rental. Medicare actually pays about $76 dollars a month for the machine. Our share would be 20% of the $76. or around $16 a month if we didn't have a second insurance which covers our portion.

[AMESS]

Follow Ms. Frog's suggestion. If you do it right--it works.

[StuUnderPressure]

Hi all. I just hit Medicare yesterday. Is it a given that you'll have to have a new full sleep study before moving forward with new mask or supplies? Does years of SleepyHead data help any? Thanks!

It is not a given that Medicare will require a new Sleep Study.

Medicare accepts your previous Sleep Study "if" it meets "their" requirements - which most probably do.
However, there are some that do not meet the Medicare requirements - so I suggest you follow up on that.

They accepted mine & it was done 18 years +/- before I entered Medicare.

SleepyHead data means nothing to Medicare.

[Janknitz]

If you do not have a spare machine, now would be a good time to get one. Medicare requires a thirteen month of a rent to own contract. Your part would be 20% of what Medicare pays, not what the DME tries to charge them. My wife got her machine in July (ResMed Air Curve 10 VAUTO), and the DME bills Medicare over $300 a month for the machine rental. Medicare actually pays about $76 dollars a month for the machine. Our share would be 20% of the $76. or around $16 a month if we didn't have a second insurance which covers our portion.

One correction, if Medicare says that $76 is the allowable portion, Medicare pays 80% of that and you pay only the additional 20%. So the out of pocket payments are low and may be covered by your Medicare supplement insurance.

[chunkyfrog]

Redundant sleep studies are outrageous!
Medicare knows that!
Any provider who advocates one probably should be charged with fraud.
Who still believes that apnea will "go away"?
Dream on, Cleopatra.

[klm49]

Hi all. I just hit Medicare yesterday. Is it a given that you'll have to have a new full sleep study before moving forward with new mask or supplies? Does years of SleepyHead data help any? Thanks!

I'm just gonna make a guess but I would say it entirely depends on your cpap data and your Dr. When I had to change Dr.'s I showed new Dr. some desaturation issues I was having and she ordered a new Titration. I was glad she did.

[chunkyfrog]

Diagnostic studies are redundant unless additional medical issues are present.
Medicare accepts old sleep studies. It saves them money.

[Okie bipap]

However, if your doctor has not taken all of the proper steps prior to ordering your sleep study, you will have to repeat them. When I had knee replacement surgery, the nurses noted my blood oxygen was dropping while I slept. My doctor ordered a sleep study for me, then the titration study. When he sent the prescription to the DME, Medicare would not approve the machine because the doctor did not document a face to face meeting where we discussed sleep apnea. I ended up getting two more sleep studies after I found a new doctor. From the time the nurses noted my blood oxygen dropping to when I got my machine was over 10 months. During that time, I was on oxygen while sleeping.

[kwikwater]

Well, since I wrote this 4 months ago, it's been a hassle!! Under my old corporate insurance I found that it had been long enough since I had ordered supplies, that I was considered Inactive on Lincare records. So,, after Medicare kicked in I asked about new supplies. Supplies only. The local rep said I needed a new sleep study. GGGrrrr!!! I've had 2 since 2005 and only slept for 2 hours on the first one and not at all on the 2nd. I use Sleepyhead regularly, including pulse ox, occasionally.

Today, I called Medicare. they told me if it had been more than a year since I had ordered any supplies, I have to have a sleep study. WHAT?? For supplies?? I can't submit data for consideration?? And we wonder why health insurance at any level is so expensive!!!

Dow anybody have experience on how to avoid a 10 hour session in the middle of the night where I don't sleep??!!! Thanks!!!

[ChicagoGranny]

Today, I called Medicare. they told me if it had been more than a year since I had ordered any supplies, I have to have a sleep study.

Someone gave you some bad information. Medicare eligibility has nothing to do with "when you last ordered supplies". When you turn 65 (Medicare eligible), you need a doctor to submit to Medicare that you are a compliant CPAP user and that there is a sleep study on file showing you are diagnosed with sleep apnea. You need to have a face-to-face meeting with this doctor before he submits the info.

Who did you really talk to? That information you posted sounds like it came from a typical DME employee who doesn't know their ass from a hole in the ground.

Here you can see the actual documentation requirements from Medicare site - https://www.cms.gov/Outreach-and-Educat ... 905064.pdf

BTW, you may be able to get a new machine even if your old machine is usable. I recommend you do this if possible and keep your old machine as a backup.

Don't let some incompetent person tell you a new sleep study is required!

[kwikwater]

I appreciate your response! Yes, I've thought the DME rep was full of it. I really appreciate the PDF of the guidelines!! In my 4 months on Mediecare I wasn't' sure who to even ask about coverage and limitations!! Round 2 starts tomorrow. Report to follow!!

[ChicagoGranny]

Round 2 starts tomorrow.

Knock 'em out.