Medicare Compliance For CPAP (Rent To Own)

osho_the_dog · Post by **osho_the_dog** » Mon Jul 01, 2019 11:20 am

Okay... I was diagnosed severe OSA in November and am 50-year-old cancer patient on disability. I was given a CPAP through the hospital medical supply company which, as i understand it, is rent to own. I jumped through the compliance hoops (sometimes wearing it while awake during day to do so) for the first 90 days to ensure that I would be able to continue with the rent-to-own for 13 months of the CPAP machine. I had a really bad battle of insomnia for several recent months and have not been anywhere close to compliant. Now, after reading more about the Medicare policy it sounds as if I may have hurt my chances of Medicare paying for the machine. I just talked to the med supply place (am waiting for a confirming call from billing) to see whether Medicare is still paying their 80% of the rental. It's all pretty confusing. I'm eligible for new supplies at this, just past the sixth month point, and according to her, Medicare will check compliance before issuing any new supplies. But she said that after the end of 13 months, the machine is paid for (given me paying my 20% share... I don't have supplemental insurance... young and disabled it is prohibitively expensive). Would I maybe be better off not re-ordering supplies and just letting the 13 months go by so that the machine is paid for? I can pay out of pocket for my own supplies, but unfortunately, would not be able to "test drive" any new masks, I guess. I'm also not sure if I achieve perfect compliance from now on if that'll be enough to satisfy Medicare for the longer term. I definitely don't want to have to re-do a sleep study as that was something like $700 out of pocket for me and now I know, through online info, how to check my own sleep quality and adjust the machine if needed. Damn... I feel like I'm having to game the system here, but I definitely need the CPAP, and don't want to lose it. I guess the Medicare price for the machine (humidifier is already paid for) is $776 and I might be out for part of that cost... which shouldn't be too terrible. The compliance stuff is driving me crazy because my insomnia sometimes has me sleeping only a couple of hours a night and I, foolishly, thought that I was good to go after getting through the initial 90 day compliance. I can see why I've read so much on these groups about people having problems with insurance and it seems a lot of CPAP therapy ends up being self-funded. Maybe if things get bad enough I won't be able to pay for what I owe and they'll have to send out a special team to repossess it /s. Sorry this is rambling. Just frustrated with this whole process and just want to sleep good again. Thanks for listening.

Okie bipap · Post by **Okie bipap** » Mon Jul 01, 2019 1:05 pm

Medicare compliance doe purchasing your machine is you must use the machine for four hours a day for 21 out of 30 continuous days. This must be accomplished within the first 90 days of getting the machine. You must have a face to face meeting with the prescribing doctor within 90 days of getting the machine to verify you met this 21 day requirement. As far as supplies, your doctor or DME can verify and certify you have been using the machine. You should be receiving a quarterly statement from Medicare saying what they have been paying in your name. This will show whether or not Medicare is paying for the machine. Once you have met the initial compliance, there is no minimum number of hours you must use the machine every day. They only have to verify you are using the machine and it is adequately treating your apnea.

Janknitz · Post by **Janknitz** » Mon Jul 01, 2019 1:42 pm

You don't state what machine you have, but most of them have modems and can transmit data to the DME and doctor (if the doctor even bother's to look). You can turn off the modem. Since they no longer have to verify hours of compliance, they only have to document that you are using it, they can call you and ask.

I get that you are having insomnia, but the CPAP sometimes helps me fall asleep when I'm dealing with insomnia issues (maintaining sleep is my insomnia issue). If nothing else you can relax with it on. Are you having problems with your CPAP that make it difficult for you to use? If you fill in your equipment, we may be able to help.

LSAT · Post by **LSAT** » Mon Jul 01, 2019 1:43 pm

Here are the Medicare Rules.....If you have complied, you are clear to have Medicare continue to purchase masks and supplies. There is no reason you cannot go to a DME and try on masks during the Compliance period.
https://www.verywellhealth.com/how-init ... ap-3015039

osho_the_dog · Post by **osho_the_dog** » Mon Jul 01, 2019 2:52 pm

Thank you so much for your replies. I think I'm okay now... I did pass the initial compliance within the 90 day period. I was worried that if I wasn't logging adequate time every month, after that, I might lose coverage of the machine and supplies. After many searches and your replies, I have not heard of that happening to anyone. I quit drinking alcohol (self=medicated sleep aid for years) in January to minimize it's effects on the apnea and have had a really tough time with the insomnia, since then, and am working with a doc on it... unfortunately, it was bad enough that I would have to fall asleep without the CPAP in order to be able to sleep. I know, that is not ideal and I am working diligently to acclimate myself to using it consistently through the night. I just know that I need the CPAP therapy and was afraid that I had messed up my Medicare coverage. I have and will be wearing it nightly from now on... I had to address the insomnia first as there were plenty of nights I wasn't sleeping at all and wasn't using the CPAP in hopes of getting at least a little sleep. Might not have been totally logical, but prolonged sleep deprivation will do that to you. I'm sure I'll have more questions as I am now a member of this forum. It's a whole new learning curve in terms of having to do a lot of this monitoring and adjusting yourself. I live in a rural area and the only sleep clinic is overburdened... not overly responsive. I'm just glad I was diagnosed OSA and can now treat it.

Okie bipap · Post by **Okie bipap** » Mon Jul 01, 2019 3:09 pm

I understand the insomnia problems and machine usage. This past spring I had a very bad asthma attack, and was on high dose steroids for several days. These really mess up my sleep, and I did not use my machine during that time. I was only sleeping a few minutes at a time, and doing so in a recliner. Later on, I ended up having a lot of allergy problems which messed up my sleep, and I missed using my machine a few more nights because I was only sleeping short periods. Luckily, things have straightened out and I am back to using my machine every night. I had my six month check at the sleep doctor, and nothing was said about the nights I did not use my machine.

john6012 · Post by **john6012** » Wed Jul 10, 2019 6:10 pm

A bit off subject, but I had a Medicare issued CPAP, it started making odd noises so took it back to the medical supply that issued it 3 months later. Then I found out thru Medicare billing that the company had been billing Medicare for payments! I never heard another word regarding repair from the time I turned the machine back in until Medicare billing 8 months later! Grrrrr!

Janknitz · Post by **Janknitz** » Wed Jul 10, 2019 6:48 pm

john6012 wrote: ↑
Wed Jul 10, 2019 6:10 pm
A bit off subject, but I had a Medicare issued CPAP, it started making odd noises so took it back to the medical supply that issued it 3 months later. Then I found out thru Medicare billing that the company had been billing Medicare for payments! I never heard another word regarding repair from the time I turned the machine back in until Medicare billing 8 months later! Grrrrr!

When you took it back, they should have repaired or replaced the machine. Are you saying they did NOT and kept billing you for the rental?

Olhankster · Post by **Olhankster** » Thu Jul 11, 2019 2:33 pm

osho_the_dog wrote: ↑
Mon Jul 01, 2019 11:20 am
Okay... I was diagnosed severe OSA in November and am 50-year-old cancer patient on disability. I was given a CPAP through the hospital medical supply company which, as i understand it, is rent to own. I jumped through the compliance hoops (sometimes wearing it while awake during day to do so) for the first 90 days to ensure that I would be able to continue with the rent-to-own for 13 months of the CPAP machine. I had a really bad battle of insomnia for several recent months and have not been anywhere close to compliant. Now, after reading more about the Medicare policy it sounds as if I may have hurt my chances of Medicare paying for the machine. I just talked to the med supply place (am waiting for a confirming call from billing) to see whether Medicare is still paying their 80% of the rental. It's all pretty confusing. I'm eligible for new supplies at this, just past the sixth month point, and according to her, Medicare will check compliance before issuing any new supplies. But she said that after the end of 13 months, the machine is paid for (given me paying my 20% share... I don't have supplemental insurance... young and disabled it is prohibitively expensive). Would I maybe be better off not re-ordering supplies and just letting the 13 months go by so that the machine is paid for? I can pay out of pocket for my own supplies, but unfortunately, would not be able to "test drive" any new masks, I guess. I'm also not sure if I achieve perfect compliance from now on if that'll be enough to satisfy Medicare for the longer term. I definitely don't want to have to re-do a sleep study as that was something like $700 out of pocket for me and now I know, through online info, how to check my own sleep quality and adjust the machine if needed. Damn... I feel like I'm having to game the system here, but I definitely need the CPAP, and don't want to lose it. I guess the Medicare price for the machine (humidifier is already paid for) is $776 and I might be out for part of that cost... which shouldn't be too terrible. The compliance stuff is driving me crazy because my insomnia sometimes has me sleeping only a couple of hours a night and I, foolishly, thought that I was good to go after getting through the initial 90 day compliance. I can see why I've read so much on these groups about people having problems with insurance and it seems a lot of CPAP therapy ends up being self-funded. Maybe if things get bad enough I won't be able to pay for what I owe and they'll have to send out a special team to repossess it /s. Sorry this is rambling. Just frustrated with this whole process and just want to sleep good again. Thanks for listening.

CPAP user since mid 2011. At the time I had been unemployed and unable to work and had filed for SSD. I received Medicare through my state, NY at no cost. My Pulmonary Dr setup my sleep test after I told him about aspirating a few times while I sleep. I found out later Medicare or Medicaid had paid for the machine at the time the script was written. I did have to go back for a 90 day compliance test which I sailed through with no problems. I also have sleep issues but found napping 2-3 times a days helped me pass the compliance part. I also kept a log book next to my bed. When I went to bed and when I woke up, I recorded all this, including any naps during the day. They wanted to see at least 6 hours of use per day. That was the only Compliance test I ever had to do. Also if not mistaken the memory card in the CPAP only records a certain amount hours. For instance, 90 days at 8 hours would be 240 hours. Purely informational. I average about 330 minutes a day per month. 5h 30m. I use a fitbit to track my sleep among other things.
My point here being you have the option of an appeal. Get an Attorney that will handle your case for you. Without an Attorney you're chances are slim.
Point 2. I was getting my CPAP supply's from an online source that accepted Medicare as full payment. No 20% charge to me for out of pocket expenses. As of April 2019 that ended because they did not have a Sleep Apnea Therapist on sight. They told me NY was the 4th state they had been regulated out of. The cost of adding a therapist meant they would have to start charging me the other 20%. Thinking about writing The White House to get that regulation struck down with an EO.
Another thing I found that helps me is laying a few degrees inclined. Stack some pillows up.

Medicare Compliance For CPAP (Rent To Own)

Medicare Compliance For CPAP (Rent To Own)

Re: Medicare Compliance For CPAP (Rent To Own)

Re: Medicare Compliance For CPAP (Rent To Own)

Re: Medicare Compliance For CPAP (Rent To Own)

Re: Medicare Compliance For CPAP (Rent To Own)

Re: Medicare Compliance For CPAP (Rent To Own)

Re: Medicare Compliance For CPAP (Rent To Own)

Re: Medicare Compliance For CPAP (Rent To Own)

Re: Medicare Compliance For CPAP (Rent To Own)