Medicare and Machines

[roster]

A buddy is 69 and his machine is 12 years old. What's the deal with Medicare?

[OldLincoln]

Unlike forcing the banks to take bailout money, you have to ask Medicare for a new machine to get it.

[Slinky]

No, you don't. That is a line of BS that some local DME suppliers try to cram down clients' throats.

A new titration study and a new script for a new device are totally appropriate and reimbursable by Medicare.

[GumbyCT]

Sounds like his DME dropped the ball.

[OldLincoln]

My point assumes that the machine is an xPAP and that buddy has actually used his machine for 12 years. Given that, he probably has not seen a DME for at several years and nobody is going to beat down his door to see if he wants a new one. You can be on auto-supply for new gear but not active with a DME. I cannot imagine a DME not renewing a machine when they have the opportunity.

Now, if buddy is 69 (and lives in the US) he probably has had Medicare for 4 years. They have some funny rules regarding new machines and they may not allow a new one until they have covered the insured's machine for 5 years. I had some strange dealings with my DME the same month I went on Medicare with them "swapping out" my CPAP for a new APAP. Even though my CPAP was 2 months away from becoming mine, they started Medicare on a new payment cycle and kept my old machine. They wouldn't even let me buy it.

PS: Since it was Rooster that started this I suspect he is witholding information to see who takes the bait.

[roster]

.........
A new titration study and a new script for a new device are totally appropriate and reimbursable by Medicare.

Thanks Slinky, like I said before, I can always depend on you.

Buddy has been seeing his sleep doc occasionally and is complaining of discomfort because the doc keeps raising the pressure (and buddy doesn't look healthy - like maybe his therapy is not optimal).

I will recommend that he call his doc's office and ask about a new titration study reimbursable by Medicare.

I have also showed him my Encore reports and (sigh) he was amazed that patients have this capability. I will encourage him to get a data-capable machine and software.

How the hell can a doc have a clear conscience at night when he is adjusting pressures based on 12-year old PSGs?

[Guest]

Rooster, here is a link to a thread about the new requirements for Medicare in regards to CPAP therapy.

http://www. cpaptalk. com/ viewtopic. php ?f=1&t=36025&hilit=

Sigh can't post a link because I can't login from work, take the space out of the above link and copy and paste and it should work.

It really is fairly simple to get a new CPAP from Medicare IF they have never bought him one. Once they have bought you that first CPAP, there are a few hoops you have to jump threw to get a new one, but they aren't big hoops!!!


AKCPAPGUY

[roster]

Rooster, here is a link to a thread about the new requirements for Medicare in regards to CPAP therapy.

http://www. cpaptalk. com/ viewtopic. php ?f=1&t=36025&hilit=

Sigh can't post a link because I can't login from work, take the space out of the above link and copy and paste and it should work.

It really is fairly simple to get a new CPAP from Medicare IF they have never bought him one. Once they have bought you that first CPAP, there are a few hoops you have to jump threw to get a new one, but they aren't big hoops!!!


AKCPAPGUY

AKCPAPGUY,

Holy crap! After seeing all that I am just going to tell buddy that the experts here said he should call his doctor's office and see if he can get a PSG and a new machine paid for by Medicare.

Any more questions and buddy is on his own.

[Guest]

LOL Rooster, that's probably the best option for him, given the length of time since his last PSG. Feel free to ask any questions you or he have, either here or in PM.

AKCPAPGUY