Can I get a new CPAP sooner than 5 years through Medicare?

Auricula · Post by **Auricula** » Thu Feb 15, 2007 1:42 pm

I have been told that Medicare will only cover a new machine every 5 years. When I first received my RemStar Pro 2 C-flex last summer I was a real babe-in-the-woods and knew nothing about treatment. It was billed the day I got it and it took months of educating myself about sleep apnea and therapy to realize that there are many other available options.

The only data being collected is on compliance, and I would like a machine that would collect additional data and software to analyze it so I would have an objective standard on how successful the therapy is. My mood and energy level are highly variable and it's very frustrating to never know how well I can expect to feel on a given day.

Reading the experience of others on this forum has been very educational. I can't find my sleep study report but remember that I had 89 events/hour, more hypopneas than apneas, and was prescribed a pressure of 9.

A call to Medicare left me believing that I am stuck where I am until 2011, by which time my heart and other health problems could be substantially worse if I don't improve my CPAP therapy.

Linda3032 · Post by **Linda3032** » Thu Feb 15, 2007 1:47 pm

If you really have a Remstar Pro 2, then it does collect data.

Or do you have a Plus or just a Pro?

PM me if you have a Pro 2 please.

Slinky · Post by **Slinky** » Thu Feb 15, 2007 1:58 pm

Well, until you can get some straight answers about trading up to an AutoPAP w/Medicare, to solve your more immediate problem you need to talk to your sleep doctor again.

Your DME can NOT change your pressure settings w/o an order from your sleep doctor no matter how much they would like to help you in that regard. He "could" script a loaner AutoPAP for 2 weeks to see if that will help to tweak your settings to better fit your needs.

Goofproof · Post by **Goofproof** » Thu Feb 15, 2007 2:40 pm

What Linda says is true, The Pro 2 w/Cflex, Will give all the data you need for good treatment. Encore Pro and the reader you are in business. Jim

badgolfer · Post by **badgolfer** » Thu Feb 15, 2007 3:54 pm

Don't know if any one else has had this experience but I am caught in a catch 22 CPAP situation. Don't have a copy of my original sleep study (9 yrs. ago in another state) and recent study (pressure striation ?? in Nov. 2005) does not qualify me for a new CPAP machine according to Medicare.
They want me to take a complete new study to qualify. I suggested that after nine years of every night use, it should be obvious that I am a viable candidate and it shouldn't be necessary to spend all that money on a new study to re-qualify.
Adamant answer - no test no Medicare coverage. Funniest part - Medicare didn't pay for original machine as I had private insurance at the time. Go figure - our tax dollars at work.
Just venting I guess. Need a newer machine (with humidifier) and will scrape up the money to buy a less expensive used machine without Medicare help.

Linda3032 · Post by **Linda3032** » Thu Feb 15, 2007 4:07 pm

badgolfer,

Even though re-testing is a pain, alot can change in 9 years. And if it helps you get a new machine, it might be a good idea to go ahead and endure the hassle.

Otherwise, how will you know that your old titration pressure is still valid?

badgolfer · Post by **badgolfer** » Thu Feb 15, 2007 4:25 pm

Linda,
I have had two subsequent tests - 4 yrs ago (changed from original 16 CFM down to 13) and another test 14 months ago (recommended CFM - . Guess my biggest problem is the sleep lab which admittedly didn't do the correct test to qualify me for a new CPAP machine. Must be my Irish temper - can't and won't go back there again.

badgolfer · Post by **badgolfer** » Thu Feb 15, 2007 4:27 pm

Sorry - don't know how I managed to get a smily face in there - thought I typed numeral 8!

Slinky · Post by **Slinky** » Thu Feb 15, 2007 4:35 pm

If that is the only sleep lab in town it might be worth your while to travel to a nearby larger city where you have a choice of sleep labs. Visit a couple and talk turkey w/them. Make sure you find one that will work w/you as you need them.

Or - less desirable but if you are adamant about not wanting to do another sleep evaluation - you can find brand new in the box, complete, RemStar Autos w/C-Flex and humidifier for about $450 at yahooauctions. I've seen about 4-5 of them go thru at that price in the last 3-4 months.

You can get the software and reader thru cpap.com or elsewhere.