mandated doctor appointments for supplies?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
gadgetgrl
Posts: 9
Joined: Thu Sep 02, 2010 9:33 pm

mandated doctor appointments for supplies?

Post by gadgetgrl » Thu Jan 13, 2022 9:29 am

I've been using a CPAP machine for 13 years. The only time that I had to see a doctor was when, at the ten-year mark, my machine broke and I needed an order for a new one.

So I saw my ENT in 2019 and just got a call from their office saying that I need to come in to see him again. I called my supply company and they said that I need to see the doctor once a year. It seems that they contacted my doctor to contact me and to arrange for an office visit.

I'm pre-Medicare so it's not a Medicare requirement. Does everyone have to see a doctor just so they can report that the CPAP is being used? I order supplies from this company every month and they probably have access to MyAir. It seems silly.

Just wondering if this is unique or it's a requirement for everyone and I'm just behind the times.

Thanks.

User avatar
Pugsy
Posts: 59920
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: mandated doctor appointments for supplies?

Post by Pugsy » Thu Jan 13, 2022 9:47 am

It depends.
Depends on your insurance (what they require) and depends on your doctor and depends on the in house policy of your equipment supplier.

Your primary care doctor could easily cover it by adding a note in your files to "continued successful use of cpap machine for sleep apnea"...
That's what I ended up doing and I haven't seen a doctor for sleep apnea (aka..sleep doctor) since Aug 2009.

Check with your specific insurance company as to what THEY require.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

User avatar
Goofproof
Posts: 16080
Joined: Mon Dec 05, 2005 3:16 pm
Location: Central Indiana, USA

Re: mandated doctor appointments for supplies?

Post by Goofproof » Thu Jan 13, 2022 10:08 am

I had my Dr. bugging me to make a yearly appt, I am no longer able to visit his office. I use Lincare as my supplier, they still supply my O2 Pump and XPAP supplies, I haven't tested them on a new machine, mine are still going after 17 years, and I have two backups, I'm not going to rock the boat.

I suspect the money is so good Lincare, don't care... :lol: Jim

I have private ins by my union, and they file the medicare paperwork, the Dr wouldn't do phone visits, so he's out the $$$, too bad I liked him.
Use data to optimize your xPAP treatment!

"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire

User avatar
Wulfman...
Posts: 6585
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: mandated doctor appointments for supplies?

Post by Wulfman... » Thu Jan 13, 2022 12:08 pm

gadgetgrl wrote:
Thu Jan 13, 2022 9:29 am
I've been using a CPAP machine for 13 years. The only time that I had to see a doctor was when, at the ten-year mark, my machine broke and I needed an order for a new one.

So I saw my ENT in 2019 and just got a call from their office saying that I need to come in to see him again. I called my supply company and they said that I need to see the doctor once a year. It seems that they contacted my doctor to contact me and to arrange for an office visit.

I'm pre-Medicare so it's not a Medicare requirement. Does everyone have to see a doctor just so they can report that the CPAP is being used? I order supplies from this company every month and they probably have access to MyAir. It seems silly.

Just wondering if this is unique or it's a requirement for everyone and I'm just behind the times.

Thanks.
I've been using XPAP therapy since May of 2005 and have never relied on my insurance (employer provided or Medicare) to pay for my machines or supplies. All have been purchased out-of-pocket. The ONLY time they did pay was to reimburse me 80% for my very first machine and supplies......and that was because I had met my deductible with my sleep study and doctors' appointments. I had purchased all of my initial equipment through CPAP.COM.......and most of my additional supplies since then.
I'll NEVER put my therapy, equipment and supplies at the mercy of a doctor, insurance provider or some A--HOLE brick & mortar DME. I've done the math and I've come out ahead this way. And, got what I wanted and when I wanted.
I also look at the supplies as "consumables". My auto insurance policy doesn't pay for tires, oil changes and that sort of thing......why should my health insurance pay for masks, headgear, hoses, filters and stuff like that?

Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

Scott_G
Posts: 30
Joined: Thu Dec 20, 2012 12:01 pm

Re: mandated doctor appointments for supplies?

Post by Scott_G » Thu Jan 13, 2022 1:30 pm

As Pugsy said, "It depends on your insurance". And the Insurance companies are increasingly adding hoops and obstacles to avoid paying benefits.

I've been on CPAP and with the same Insurance for 18 years. But in 2020, the insurance company started requiring a doctor's visit within the last year to provide coverage of supplies.

It doesn't have to be a sleep specialist / pulmonologist. I now have my GP write a new prescription at my yearly physical appointment, and that satisfies the insurance company (without an additional sleep medicine appointment).
Resmed Airsense 11 Autoset
Resmed ClimatelineAir-11 Tube
Resmed P30i Mask

User avatar
LSAT
Posts: 12604
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin

Re: mandated doctor appointments for supplies?

Post by LSAT » Thu Jan 13, 2022 3:12 pm

I use my Primary Physician....Every year when I go in for a physical, I remind him to ask me about my CPAP use. Every year my DME contacts him to verify that I am compliant....It's on record. I use so few supplies every year it really wouldn't matter to me if Medicare didn't cover them. Normally I use 1 hose and 2 mask cushions a year. About $70 if I purchased them on Amazon.
oscar -
https://www.sleepfiles.com/OSCAR/

Machine: ResMed Airsense 10 Autoset 12/20
Mask: Fisher & Paykel Simplus FF

Janknitz
Posts: 7819
Joined: Sat Mar 20, 2010 1:05 pm

Re: mandated doctor appointments for supplies?

Post by Janknitz » Thu Jan 13, 2022 8:30 pm

I had a party when I lost my DME coverage because it means no more Crapria (only vendor covered by my HMO). I buy what I want, when I want it, either from our hosts at CPAP.com (initial prescription said it was good for "99 years") or on Amazon (no RX needed). It costs me a lot less out of pocket than the co-pays and deductibles I used to have and not having to deal with Crapria is priceless.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

User avatar
gadgetgrl
Posts: 9
Joined: Thu Sep 02, 2010 9:33 pm

Re: mandated doctor appointments for supplies?

Post by gadgetgrl » Tue Jan 18, 2022 12:51 pm

Thanks. It turns out that this is what my supplier does each year. It's pretty annoying. I'll have my primary doctor add a note in the future.

User avatar
chunkyfrog
Posts: 31672
Joined: Mon Jul 12, 2010 5:10 pm
Location: in a nice, moist, Nebraska bog

Re: mandated doctor appointments for supplies?

Post by chunkyfrog » Tue Jan 18, 2022 4:17 pm

I have seen my pulmonologist every year since I started cpap.
A little bonus: Due to his influence, all his patients and their close family members
were able to get our covid vaccines at least 2 months before our bloodthirsty,
conservative governor had dictated.
I might owe my sleep doctor my life.
Resmed Airsense 10 Autoset FOR HER, p10 mask

User avatar
ChicagoGranny
Posts: 12057
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: mandated doctor appointments for supplies?

Post by ChicagoGranny » Tue Jan 18, 2022 5:37 pm

gadgetgrl wrote:
Tue Jan 18, 2022 12:51 pm
Thanks. It turns out that this is what my supplier does each year. It's pretty annoying. I'll have my primary doctor add a note in the future.
My supplier does the same. My insurance company doesn't require it, but some insurance companies do. It would be a difficult job for the supplier to keep up with which insurance companies require it and which don't. So, the supplier requires it of everyone.

It's not a problem for me because the doc takes care of it at my annual visit.

stevenal
Posts: 47
Joined: Fri Jun 10, 2011 2:00 pm

Re: mandated doctor appointments for supplies?

Post by stevenal » Tue Jan 18, 2022 6:26 pm

Scott_G wrote:
Thu Jan 13, 2022 1:30 pm
As Pugsy said, "It depends on your insurance". And the Insurance companies are increasingly adding hoops and obstacles to avoid paying benefits.
Sounds penny-wise and pound-foolish to pay for unneeded doctor visits while ultimately paying for supplies anyway.
AirSence 10 Autoset, System One awaiting recall, Swift FX, Freedom V2 battery, Z1 for travel.

User avatar
Goofproof
Posts: 16080
Joined: Mon Dec 05, 2005 3:16 pm
Location: Central Indiana, USA

Re: mandated doctor appointments for supplies?

Post by Goofproof » Tue Jan 18, 2022 7:54 pm

stevenal wrote:
Tue Jan 18, 2022 6:26 pm
Scott_G wrote:
Thu Jan 13, 2022 1:30 pm
As Pugsy said, "It depends on your insurance". And the Insurance companies are increasingly adding hoops and obstacles to avoid paying benefits.
Sounds penny-wise and pound-foolish to pay for unneeded doctor visits while ultimately paying for supplies anyway.
It's a wind fall for the medical industry, doctors get paid, tests are done, insurance pays a little which they all get higher rates from us. Jim
Use data to optimize your xPAP treatment!

"The art of medicine consists in amusing the patient while nature cures the disease." Voltaire

User avatar
HD4Mark
Posts: 41
Joined: Wed Oct 21, 2020 3:06 pm
Location: Marathon, FL or Cicero, NY

Re: mandated doctor appointments for supplies?

Post by HD4Mark » Wed Jan 19, 2022 6:46 am

I need to "see" my sleep Dr. in order to receive supplies. Since insurance pays 100% for them it's worth the $30 specialist "visit" copay. My visit can be virtual so I sit in front of my laptop and see a NP. She seems more interested in how much usage I had than anything else even though the initial compliance period is over.

In order to get any new stuff from my DME they need to write a prescription and no prescription without a "visit". I have noticed what my insurance gets billed and what I could have purchased the stuff online is shockingly different. The sleep industry looks kind of like a giant scam. I did kind of ask why I needed 2 "visits" a year when nothing seems to change and they did offer to make it yearly.

User avatar
SleepGeek
Posts: 357
Joined: Mon Feb 09, 2015 2:56 pm

Re: mandated doctor appointments for supplies?

Post by SleepGeek » Wed Jan 19, 2022 8:44 am

HD4Mark wrote:
Wed Jan 19, 2022 6:46 am
The sleep industry looks kind of like a giant scam.
It is a money maker.
HD4Mark wrote:
Wed Jan 19, 2022 6:46 am
I did kind of ask why I needed 2 "visits" a year when nothing seems to change and they did offer to make it yearly.
It's for the boat payments.
Why folks dont like it when you treat em the way they treat you?
If you can be anything why not choose to be kind?
AC VAuto 20/14
palerider aka GrumpyHere wrote: What exactly do you think you're adding to this thread?

User avatar
ChicagoGranny
Posts: 12057
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: mandated doctor appointments for supplies?

Post by ChicagoGranny » Wed Jan 19, 2022 8:58 am

HD4Mark wrote:
Wed Jan 19, 2022 6:46 am
what my insurance gets billed
You need to look at what your insurance company pays, not what they are billed. They have contracts with the supplier. What they pay is a fraction of what they are billed.

The naive see giant scams where there is no scam.