Medicare Refuses To Replace My CPAP

[Auricula]

Today is the 5th anniversary of receiving my CPAP machine. My doctor sent a FAX for an APAP to my provider and I have been told that I cannot get a new machine because I had received "the same or similar equipment" within the past 5 years." This is not true. I rented an APAP in Jan.-Feb. this year around the time of my open-heart surgery for aortic valve replacement because I thought I would have more restful sleep. Last summer my sleep doctor requested a trial on an APAP to determine my need for a higher pressure because my card showed substantial large leaks. At no other time did I use any machine other than my old CPAP.

Has anyone else had problems with Medicare on equipment replacement? I would appreciate knowing how they were resolved. Thanks, Pat

[purple]

Medicare has the wrong date for when I received my CPAP. Get the date for the delivery of your five year old CPAP from - from the DME you got it from, and add that to your Medicare request.

Please, Let us know how this turns out.

[LSAT]

There are appeal procedures.......take the time to file one and explain the circumstances.

[KatieW]

I remember reading a previous forum discussion re medicare. I believe the 5 years starts from the time you own it, which is after your initial 13 month (?) rental period.

[leejgbt]

I remember reading a previous forum discussion re medicare. I believe the 5 years starts from the time you own it, which is after your initial 13 month (?) rental period.

The clock starts ticking from the delivery date not when you own it. A redetermination is needed to correct the initial date as it changed when you used the CPAP temporarily. You will need the discontinue order from your physician for the usage in Jan-Feb along with a pickup ticket. The most likely outcome is Medicare will subtract the Jan-Feb months rental from the 13 month rental period unless you prove a break in need occurred. If the underlying condition, OSA, did not change then only a break in need occurred and the rental months will be applied. With redeterminations be sure all documentation backs up your claims. Be sure to read the LCD (local coverage determaination) prior to submitting you redetermination to be sure all medical necessity has been met.

[avi123]

Pat, I don't understand your post. Please disregard the stories and just tell when did you get a CPAP machine under Medicare?

What the Dr asks is not relevant in this case.

[Auricula]

I received my CPAP on June 14, 2006.

[avi123]

Pat please see if you comply with these Medicare rules:

http://www.activehealthcare.com/medicare_insurance.asp

[tata]

I guess you should go to your medicare to tell that issue.