NEW MACHINE

justauser · Post by **justauser** » Sun Jun 02, 2019 2:32 pm

DMA notified me that I am entitled to a new CPAP machine after 5 years.
My Resmed S9 AutoSet 36005, paid by Madicare, was used regularly. Current Settings: EPR: Off, Min 7.2, Max 16 (cmH2O).

I would appreciate some Info:
- What is the procedure?
- Do I need an appointment with the doctor? ( Haven't seen him for a while).
- Will I need another sleep test?
- Which machine should I request?

Any other info appreciated

LSAT · Post by **LSAT** » Sun Jun 02, 2019 3:20 pm

If you had medicare for your first machine, I don't believe you need anything except a prescription from A doctor and some documentation from him indicating that you have been compliant. I would request the ResMed Airsense 10 Autoset. Find a DME that works with Medicare.

ChicagoGranny · Post by **ChicagoGranny** » Sun Jun 02, 2019 4:48 pm

If a PAP machine is replaced following the five-year RUL,
there must be a face-to-face evaluation by the treating
physician documenting that the patient continues to
use and benefit from the PAP machine.

There is no
requirement for a new sleep test or trial period.

Note:
If a DME item reaches its five-year life expectancy, is
in good working order and meets the patient’s medical
needs, it should not automatically be replaced.

https://www.resmed.com/us/dam/documents ... achine.pdf

RogerSC · Post by **RogerSC** » Sun Jun 02, 2019 7:31 pm

Interesting. I just got a new cpap after more than 7 years, and Medicare is doing a rental of it for a year. Apparently, during that year they'll be evaluating my compliance, even though I have been fully compliant for 7 years. And I had to have a followup visit to my sleep doctor after a month, to verify that I was complying and answer any questions about the new machine.

I guess one's experiences may vary. I certainly don't mind seeing my sleep doctor, I like him. It was a surprise to me that Medicare would pay the extra year's rental before purchasing the new cpap though. My compliance has been reported to them every year via my sleep doctor, so they should be well aware of the fact that I'm a compliant guy *smile*. Oh well, up to them, I'll just continue to use whatever cpap I have *smile*. Seems like Medicare's creating expense and extra work for themselves, though.

ChicagoGranny · Post by **ChicagoGranny** » Sun Jun 02, 2019 7:43 pm

RogerSC wrote: ↑
Sun Jun 02, 2019 7:31 pm
It was a surprise to me that Medicare would pay the extra year's rental before purchasing the new cpap though. My compliance has been reported to them every year via my sleep doctor, so they should be well aware of the fact that I'm a compliant guy *smile*. Oh well, up to them, I'll just continue to use whatever cpap I have *smile*. Seems like Medicare's creating expense and extra work for themselves, though.

Gubmint ain't logical.

LSAT · Post by **LSAT** » Sun Jun 02, 2019 7:58 pm

RogerSC wrote: ↑
Sun Jun 02, 2019 7:31 pm
Interesting. I just got a new cpap after more than 7 years, and Medicare is doing a rental of it for a year. Apparently, during that year they'll be evaluating my compliance, even though I have been fully compliant for 7 years. And I had to have a followup visit to my sleep doctor after a month, to verify that I was complying and answer any questions about the new machine.

I guess one's experiences may vary. I certainly don't mind seeing my sleep doctor, I like him. It was a surprise to me that Medicare would pay the extra year's rental before purchasing the new cpap though. My compliance has been reported to them every year via my sleep doctor, so they should be well aware of the fact that I'm a compliant guy *smile*. Oh well, up to them, I'll just continue to use whatever cpap I have *smile*. Seems like Medicare's creating expense and extra work for themselves, though.

You pay 20% of the 13 month rental..(about $15). After 13 months you own the machine. Medicare has always don it this way. They do not pay 13 months rental before buying the machine.....Your 13 month rental pays for the machine.

chunkyfrog · Post by **chunkyfrog** » Sun Jun 02, 2019 8:04 pm

As suggested in the above posts, medicare management can be very anal.
If documentation of breakdown is required, cite "intermittent/breaking noise".
(Surely, after 5 years of regular use--it cannot be as quiet as when new.)
Hard to disprove--you never heard it here.

Janknitz · Post by **Janknitz** » Mon Jun 03, 2019 3:20 pm

You pay 20% of the 13 month rental..(about $15). After 13 months you own the machine. Medicare has always don it this way. They do not pay 13 months rental before buying the machine.....Your 13 month rental pays for the machine.

Plus two Medicare DME deductibles unless your medi-gap covers those.

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