New Medicare rule for CPAP supplies

[midnight_skulker]

I'm on Medicare. I've been on Bipap for 688 days per Bipap machine. I received a letter from my DME in mid 2013 that stated that they had lost the Medicare contract and would not be able to furnish supplies after June, 30, 2013. I stocked up on supplies at that time. In January 2014, I contacted my sleep doctor. She let me choose which Medicare DME I wanted to use and faxed my prescription to the new DME. The new DME called me and to make sure that we had the right stuff, I carried my Bipap machine and mask to the new DME. She furnished all the supplies that I was eligible for (through Medicare) at that appointment. She said in the future she will automatically mail supplies at the appropriate time.

[GreyEagle1]

As I read through the comments one thing comes to mind...Whether Medicare pays for it or not, in most cases you have paid for these benefits all your working life. And under the new standards for insurance coverage in the US if you are over 65 you will probably have to deal with Medicare as your primary or secondary coverage for Health Care, and the waste that is inherit in the system. For proof of what I said, you can call your DME provider, ask your physician, or go to Medicare.gov website. I am a certified Counselor for Medicare-Medicaid in the State of Indiana and simply would not post something without doing research. In this case I experienced this event myself. What my point is, is that it is a shame for the waste this creates in the system. All, I suppose, in the name of trying to cut fraud.

[Leadhead]

imsleepynomore
Are you saying that in every 90 day period you have to see you doc face to face three times? That's worse than crazy.

[wardmiller]

I would still like to read the regulation for myself.

My original DME lost its Medicare contract at the end of last December. I found another DME in January that appears to be acceptable. They sent me some consumable supplies a couple of weeks ago. I did not have to go to any doctor. I did not have to climb over any fences or jump through any hoops. Medicare and my insurance cover the costs 100%.

Frankly, after my experiences with the prior DME and after reading all the problems members here have had with their DME's, I would not trust most of them to tell me the time of day. I called several DMEs when I was looking for a new one last month. All but one told me things I knew were untrue.

The whole subject of health care has become so politicized it is difficult to sort out what statements are actually true and what are just furthering someone's political agenda. Doctors, nurses, therapists, DME clerks, and salesmen have each told me untruths in the past year or so.

So, I'll keep searching for this new regulation. . . .so far, no luck.

[Guest]

For proof of what I said, you can call your DME provider, ask your physician, or go to Medicare gov website. I am a certified Counselor for Medicare-Medicaid in the State of Indiana and simply would not post something without doing research.

if you don't know how to post a link to the website where you read this
then simply say so

[LSAT]

As I read through the comments one thing comes to mind...Whether Medicare pays for it or not, in most cases you have paid for these benefits all your working life. And under the new standards for insurance coverage in the US if you are over 65 you will probably have to deal with Medicare as your primary or secondary coverage for Health Care, and the waste that is inherit in the system. For proof of what I said, you can call your DME provider, ask your physician, or go to Medicare.gov website. I am a certified Counselor for Medicare-Medicaid in the State of Indiana and simply would not post something without doing research. In this case I experienced this event myself. What my point is, is that it is a shame for the waste this creates in the system. All, I suppose, in the name of trying to cut fraud.

As a Counselor or the state of Indiana, you should be able to show us the regulation. You say you have done the research. Show us!

[StuUnderPressure]

As of January 1st, 2014 any CPAP user who is turning 65, and on Medicare will have some Hoops to jump through to get replacement CPAP supplies. Even if you have been using a CPAP for several years prior to now, the following must be on file with your supplier in order to be able to purchase supplies. A Letter of Record of a face to face meeting with your prescribing Doctor. This letter of record must include his comments on the benefits of you using the CPAP, a new prescription, your name, date of birth, date of order, diagnosis, the Doctor's signature and his or her "National Provider ID number". The National Provider ID number is not the same as your physician's professional number. I am simply astounded by this new rule, as I have been using a CPAP for the last 7 years, and just visited my Doctor 9 months ago. The cost, and additional paperwork are simply a waste.

GreyEagle, can you provide the reference for that?

I would also love to see a link to something on the Medicare website that says that.

EDITED TO ADD:

I posted this BEFORE I read the posts just before mine.

I see that GreyEagle1 is just like most of the DMEs & Sleep Doctors.
They believe something is fact & continue to spout it as fact.
But, when someone asks them to support their contention, they can never do that.

I have yet to have ANYONE show me PROOF of this OR all the other "yearly" Medicare requirements that they claim exist.

[chunkyfrog]

I found that Apria wanted more than Medicare requires (per their site).
That is the company's choice. I comply, because they are the only contracted provider, and they have what I want.
--and it's no big deal.

[wardmiller]

Here is one explanation from the Medicare.gov we site, Sleep apnea & Continuous Positive Airway Pressure (CPAP) therapy, but it does not include the issues claimed at the beginning of this thread.

http://www.medicare.gov/coverage/sleep- ... erapy-html

[StuUnderPressure]

I found that Apria wanted more than Medicare requires (per their site).
That is the company's choice. I comply, because they are the only contracted provider, and they have what I want.
--and it's no big deal.

I understand what you are saying.

I did just that 6 days ago.

My DME calls to tell me that to fill my most recent order of supplies, they will need another Rx from my Sleep Doctor since the old 1 is over a year old.

The guy I deal with at the DME just loves me because I am so organized & I make his job so easy. I go in with a list of what I need INCLUDING the actual ResMed product numbers.
He doesn't need to know I do that to make sure "they" don't screw up my order AND that I get EXACTLY what "I" want & not that generic crap they would rather give me because they make more money on it.

Because of my decent relationship with him, I asked him if he could provide me with a link to that specific requirement. He says he doesn't have a link, but "that is what they do for everyone".

Well, what they do for everyone does NOT make it a Medicare requirement!

Anyhow, to speed up my order, I told him he could contact my Sleep Doctor & ask for a new RX.

After I received my order, I called him & made him mail me a copy of that Rx.
I actually asked him to E-Mail it to me, but he rathered mailing it, so I did not object.

At the same time, I called my Sleep Doctor & asked them to also mail me a copy.
I only spoke to the front desk girl, but she gave me the same story as the DME:
Medicare does require a new Rx yearly. How do we know that? "We do it for everyone".

Had the Sleep Doctor not been willing to just fax a new Rx to the DME & had required me to go in to see them first, I would have objected strongly.
Because I have been using the same Sleep Doctor for my entire 16 years on XPAP, they know I just don't roll over & play dead like most of their patients.
I "think" that is the reason they did not require me to see the Sleep Doctor to get this Rx.

Needing to see my Sleep Doctor to get a new Rx yearly for supplies is just a waste of my time.

Even with the Sleep Doctor faxing my Rx to the DME delayed my receiving my order by almost a whole week.

Since I did NOT have to see my Sleep Doctor, Medicare won't have to pay anything.

But, making everybody go see their Sleep Doctor every year to get a new Rx just to continue purchasing supplies is just a waste of Medicare dollars that I am sure could be better spent on providing some medical service to someone who really needs it. ESPECIALLY IF THERE IS NOT A MEDICARE REQUIREMENT THAT BE DONE.

So, "I" for one would like it to be determined once & for all whether there is such a Medicare requirment.

[purple]

I did not intend to offend. For that I apologize.

[GreyEagle1]

I posted where to find the information on my previous post. Obviousley this person is too lazy to look for himself. I don't need this kind of forum, so good luck and adios!

[wardmiller]

I posted where to find the information on my previous post. Obviousley this person is too lazy to look for himself. I don't need this kind of forum, so good luck and adios!

I looked at your previous post and found: "For proof of what I said, you can call your DME provider, ask your physician, or go to Medicare.gov website. " That was not very specific. Previously in this thread we have seen where a doctor told a patient something not true (Medicare does NOT require you see your sleep doctor once a year), and have seen where DME's said certain things were required by Medicare, when they were not. Finally, you said to go to the Medicare web site. I did and here is what I found:

http://www.medicare.gov/coverage/sleep- ... erapy-html That does not support the claims in your original posting in this thread.

What I'm trying to point out in this thread is there is a lot of undeserved and erroneous blame placed at Medicare's doorstep. When someone says so-and-so is required by Medicare, we should all ask the speaker to point to the specific paragraph on the Medicare web site.

[wardmiller]

I am pretty sure there is a Medicare requirement that I see whoever does my cpap stuff once a year to continue to receive supplies.

That is NOT a Medicare requirement.

It has been almost two years since I last saw my sleep doctor and Medicare has paid for my machine and many consumable supplies since that time.

[Guest]

I posted where to find the information on my previous post. Obviousley this person is too lazy to look for himself. I don't need this kind of forum, so good luck and adios!

how can one find something that does not exist
if you dont know how to post a link say so

he or she sounds like a moderator from one of those other sites
where you are forbidden to know anything
take your ball and go home