Better to use Medicare for new apap, or buy used/new?

[PopIsGettingGrumpy]

I can't believe how helpful everyone is on this forum is but it's very much appreciated. Downloaded OSCAR and looking forward to seeing the upcoming results.

[PopIsGettingGrumpy]

It dawned on me that our prescription, as currently written by the sleep doc (with supply quantities and frequencies) will also limit our ability to buy complete masks online (out of pocket) from cpap.com while still receiving our medicare supply schedule. As such, I really want this resolved through the sleep doc although I'm making little progress. Are we within our right to demand a new (or even separate) rx that simply states "cpap masks and supplies of patients choice" with no qty or frequency listed? We already want to purchase multiple mask types so my father can try them each side by side, while having the option of interchanging masks/headgear if/where possible. He does NOT want to return/exchange, he wants to buy some himself so he can compare and decide what he likes. Am I wrong in assuming there is absolutely no reason why the sleep doctor isn't obligated to give us this option via an rx, seeing as we've already paid for his clinics sleep study and pre/post visits. Can he legally deny this request?

Also, I don't feel we should have to contact his office every time we want to switch masks via our paid medicare schedule. To comply with medicare, if a code is really required, what exact code should be listed on the rx along with the phrase "mask of patients choice"? Considering the sleep clinic already got paid, I feel like this issue should be resolved without having to go through more hassle of trying to get his primary care to write yet another rx.

[ChicagoGranny]

I feel like this issue should be resolved without having to go through more hassle of trying to get his primary care to write yet another rx.

Yep, you are right about that.

Can he legally deny this request?

He certainly can. He is under no legal obligation to treat you at all.

I really want this resolved through the sleep doc

This is not just about Pop. You are dealing with a practice-centered organization, not a patient-centered doctor. You are up against established procedure and many sheep-patients who went before you and accepted this crap. So sorry. (I've had to fire a few doctors over my lifetime.)

[Pugsy]

If I remember right all you need to buy any complete mask package at cpap.com is just the RX for the cpap machine itself.
Masks are implied with the cpap machine RX.
Unless they have changed things.
Might call them up and just ask.

Now the duration limit the sleep doc put on the RX does put a monkey wrench in things.
My original script that I sent cpap.com just said the 99 month thing..this was back in 2009 and I bought a mask from cpap.com last year using that 2009 script.

[PopIsGettingGrumpy]

Unfortunately, I believe even the qty limits will kick us for purchasing privately if we want the option of keeping and comparing different masks now. I see the following info under FAQ's at cpap.com:

If a prescription notes a number of refills, it will be valid to dispense the listed equipment the referenced number of times. If a prescription notes an expiration date, it is valid through the listed date.

So while we would be able to buy them, we would still be limited by the "qty" and possibly "frequency" restrictions this sleep doc has listed on our RX. And since we already got a mask from the DME, it sounds like we can't purchase another one using this RX until the specified amount of time. We want to purchase a few different types now out of pocket for my father to try.

[Pugsy]

Check Amazon for masks...they don't require RX at all. Unfortunately all masks not available but most of the new models are.

Also you can always get a script from PCP to use that doesn't include any specific limitations.

[PopIsGettingGrumpy]

Thanks. I'll try contacting his primary care today as well. I'm still pushing the sleep clinic but not making much progress yet.

[Pugsy]

That sleep doctor would have already pissed me off so bad I wouldn't be going back to him anyway.
Choice is yours how much time and energy you wish to devote to him/her.
I don't usually take to well to being lied to and given a hard time.
I usually vote with my feet and walk away.

[PopIsGettingGrumpy]

I won't lie... I'm pretty aggravated at the whole process so far and I've wasted a lot of time on this. We don't have a lot of medicare approved sleep docs in our area though, and I thought we still needed the 31-90 day follow up for medicare compliance if nothing else, so I'm treading somewhat lightly.

For another laugh, the sleep clinic *just so happened* to send the first statement for our sleep study balance yesterday. I'm sure that's just a coincidence. I can only imagine how much more helpful they would be right now if we had already paid our share in full.

[Pugsy]

I thought we still needed the 31-90 day follow up for medicare compliance if nothing else, so I'm treading somewhat lightly.

You do need a face to face with someone to make Medicare happy...doesn't have to be the sleep doctor....but might as well let it be that doc and later you can investigate alternatives if you wish.
The face to face has to be documented prior to the 91st day.

You have plenty of time to decide. You don't have to decide today or even next week. It would be really hard to get a new one within this time frame anyway.

[PopIsGettingGrumpy]

Some tiny success! After a few more calls they did finally write me a generic rx for whatever masks/supplies my father wants to buy on his own, which will be faxed to cpap.com and mailed to us by my request. I didn't bother pushing for the altered rx for the dme as I'm just done at the moment, but we can deal with it later if wanted, and for now at least we can buy whatever masks/supplies out of pocket like we wanted.

[ChicagoGranny]

I didn't bother pushing for the altered rx for the dme

You can give the DME a copy of the altered Rx you are getting.

[PopIsGettingGrumpy]

I didn't bother pushing for the altered rx for the dme

You can give the DME a copy of the altered Rx you are getting.

Will it still work for medicare reimbursement as long as we stick to the medicare schedule? Assuming, of course, that it doesn't have quantity or frequency restrictions again (which I wont know until I see the script myself).

[ChicagoGranny]

Will it still work for medicare reimbursement as long as we stick to the medicare schedule?

It works for Medicare coverage per the schedule. I don't know what you mean by reimbursement. My DME gets reimbursed by filing with my Medicare plan. After getting reimbursed, my DME bills me for the copay.

[Janknitz]

For another laugh, the sleep clinic *just so happened* to send the first statement for our sleep study balance yesterday. I'm sure that's just a coincidence. I can only imagine how much more helpful they would be right now if we had already paid our share in full.

Make sure you have the Medicare Summary Notice before you pay anything. Providers bill a fantasy amount, but you are only responsible for the 20% that Medicare doesn't pay. If you overpay, it takes an act of G-d to get a refund of the overpayment in most cases.