New CPAP Machine & Medicare Question

[charlesrshell]

I have an appointment tomorrow with my DME to pick up a CPAP machine. My sleep doc prescribed a S9 Autoset. This is my third machine since diagnosed with Sleep Apnea in 2004 and I went on Medicare a year and half ago. My question is, will I get a new or used machine since I am with Medicare now? My first machine in 2004 and replacement five years later in 2009 were new machines as far as I know. Thanks for any help.

[purple]

if they do not give you a loaner, then it should be a new machine. You can get the manual and check to see the number of blower hours, which can not be changed, so I am told, outside the factory. I was told that the machines never come in sealed bags. ??? but the same RT showed me the blower hours. Have you read the post by JanKnitz on what you need to know before you meet your DME?

http://maskarrayed.wordpress.com/what-y ... me-part-i/

However, I have found that all the DME's I have worked with have been honest, and never tried to lie to me. Keep in mind that not everyone at the DME knows everything. Like the actual people who supply the machine, knew nothing about billing, nor do they care (in my case) they are there to help me, and they do that, but can not tell me what I might end up owing and such.

If you are on Medicare, the policy used to be that you are entitled to as many different free mask trials in the first month that you want. Let us know if it is still true.

Edit: 2-28-2014: Yes you are entitled to a new machine, but some DME's (as I have heard) if they do not have the correct new machine, will give you a loaner machine until the new machine arrives. But yes, you should only be given a new machine. Just I might accept a loaner, if I was assured it was properly cleaned (and I do not mean just wipe down the outside) If that was my only option to continuing therapy, and I was sure we all understood it was only a loaner until the new machine could be delivered. Which better be PDQ

[charlesrshell]

if they do not give you a loaner, then it should be a new machine. You can get the manual and check to see the number of blower hours, which can not be changed, so I am told, outside the factory. I was told that the machines never come in sealed bags. ??? but the same RT showed me the blower hours. Have you read the post by JanKnitz on what you need to know before you meet your DME?

http://maskarrayed.wordpress.com/what-y ... me-part-i/

However, I have found that all the DME's I have worked with have been honest, and never tried to lie to me. Keep in mind that not everyone at the DME knows everything. Like the actual people who supply the machine, knew nothing about billing, nor do they care (in my case) they are there to help me, and they do that, but can not tell me what I might end up owing and such.

If you are on Medicare, the policy used to be that you are entitled to as many different free mask trials in the first month that you want. Let us know if it is still true.

Thanks for the link. I remember reading it several months ago but will check it out again. My DME tells me that the mask try out in first month is limited to one and it is their call not the mask manufacturer or insurance company. Back in December I wanted to try something new and tried a new mask out for several days. It didn't work out so took it back and tried out another mask. Didn't like it too but wasn't allowed to take it back and told had to wait till next six months, so I was stuck with it. So I just kept using my old mask.

Why would I get a loaner CPAP machine? Is that a DME or Medicare call? I would rather have a new one.

[Pugsy]

You shouldn't get a "loaner" machine since you are already an established cpap user. You should be given a new machine. You will still have to satisfy Medicare compliance requirements though. Use the machine for at least 4 hours or more for 70% of the nights within a 30 day time frame and have a face to face doctor visit sometimes between the 30th and 90th day after you get the machine. Medicare will do the rent to own thing for 13 months on the blower unit. The humidifier and other equipment including mask are considered a one time up front purchase. It will roll over into a new deductible in 2015 for the blower rental. If you have a supplement that picks up the part B deductible and the 20% co pay you won't care anyway.

The mask thing... DME often do set up their own in house rules if they want to. It sucks but not much we can do about their not honoring the manufacturers warranty short of shopping for a new DME (which you can do at anytime if you wish).
My DME does it a bit differently....with every mask I get in my 6 month allowance I can swap it out as many times as I need or want to in 60 days. After 60 days..no more swapping for another 6 months with the next allowed mask. The kicker is they make me return the mask I don't like before they will give me a swap. Still a better deal than most DMEs offer.

[charlesrshell]

You shouldn't get a "loaner" machine since you are already an established cpap user. You should be given a new machine. You will still have to satisfy Medicare compliance requirements though. Use the machine for at least 4 hours or more for 70% of the nights within a 30 day time frame and have a face to face doctor visit sometimes between the 30th and 90th day after you get the machine. Medicare will do the rent to own thing for 13 months on the blower unit. The humidifier and other equipment including mask are considered a one time up front purchase. It will roll over into a new deductible in 2015 for the blower rental. If you have a supplement that picks up the part B deductible and the 20% co pay you won't care anyway.

The mask thing... DME often do set up their own in house rules if they want to. It sucks but not much we can do about their not honoring the manufacturers warranty short of shopping for a new DME (which you can do at anytime if you wish).
My DME does it a bit differently....with every mask I get in my 6 month allowance I can swap it out as many times as I need or want to in 60 days. After 60 days..no more swapping for another 6 months with the next allowed mask. The kicker is they make me return the mask I don't like before they will give me a swap. Still a better deal than most DMEs offer.

Thanks Pugsy, good to hear from you again. Yep, your DME is better than mine on the mask allowance.

[Sclark08]

Sometimes Medicare requires a sleep study if you have t had one for a while. Just to show need. I had been on cpap for a year moved joined up with new DME and in order to lease through Medicare had to take another sleep study.

[charlesrshell]

Sometimes Medicare requires a sleep study if you have t had one for a while. Just to show need. I had been on cpap for a year moved joined up with new DME and in order to lease through Medicare had to take another sleep study.

I just had a two-night study, baseline and titration completed couple of weeks ago. DME said Medicare is good to go. I read so many issues of CPAP mask I just wish there was a better way to determine the best mask. You just have to try them out to know for sure. It can take years to finally find the best mask. There must be a better way, somehow!

[Pugsy]

It can take years to finally find the best mask. There must be a better way, somehow!

Years if going by insurance replacement schedule with a DME that's being a butthead.
Find a different DME...now that you have Medicare that should open up the provider list. Call them up and ask them what their mask swapping policy happens to be. You aren't tied to using the same DME that you get the machine from....this is assuming they get you the machine you want.

The other way is expensive but there's a way to try a lot more masks within a given period of time so that it doesn't take years to find a suitable mask. Cpap.com has return insurance available...some free and some at moderate cost.

It doesn't take me a month to decide if I hate something or not...most often it takes less than a week...sometimes less than one night.

[charlesrshell]

It can take years to finally find the best mask. There must be a better way, somehow!

Years if going by insurance replacement schedule with a DME that's being a butthead.
Find a different DME...now that you have Medicare that should open up the provider list. Call them up and ask them what their mask swapping policy happens to be. You aren't tied to using the same DME that you get the machine from....this is assuming they get you the machine you want.

The other way is expensive but there's a way to try a lot more masks within a given period of time so that it doesn't take years to find a suitable mask. Cpap.com has return insurance available...some free and some at moderate cost.

It doesn't take me a month to decide if I hate something or not...most often it takes less than a week...sometimes less than one night.

Thanks for the tip Pugsy, I might just do the Cpap.com thing later on. I really want to stick with this DME, as they are lot closer to me. I swapped to them last December. They have been real nice to deal with so far and have a good reputation. Yesterday when I talked with them and confirmed that I am getting the CPAP I want, S9 AutoSet with H5i w/Climate Control kit. She said that is what the sleep doc prescribed. I just hope it is new and not a loaner.

Last December I tried out a Simplus but the leak rate was kinda high. Took it back and got a Quattro Air and it had high leak rate too, but I was stuck with it because of the 30 day rule they have. Both mask are really comfortable, maybe I just didn't have them tight enough. So since then I have been using my trusty Mirage Quattro. The DME said it is close enough in time to try out another mask. So she is getting me a ResMed AirFit F10 that I want to try out. If that one doesn't work out I will take it back and get me a Quattro FX. That is what I used in the Titration study and it performed real good. At least that is the plan for now. Appointment is 13:30 today so time will tell if it all works out.

[charlesrshell]

Back from my DME appointment. Got everything I wanted and she said it is a new S9 Autoset machine. Will check the hours later today to make sure. I hope my new mask works good, ResMed AirFit F10.