insurance question

hello everyone I have a question my DME which happens to be j&L medical tells me that my insurance which happens to be medicaid will only cover my bi-pap machine if its broken I thought most insurances will cover bi-pap machines every 5 years so why is my DME telling me something different?

p.s. my bi-pap machine is not broken. I think i'm due for another one next year thats why i'm asking

You need to speak directly with medicaid with your question. Medicaid is administered by individual states so the dme could be correct. having said that, a good doctor and dme know how to word the request to get a replacement instead of repair. I would look for another dme and see what their answer would be. if their answer is better, switch to them.

With insurance, the trend is you get what you PAY for.
If you get more, keep it to yourself.

springman946 wrote: ↑

Mon May 11, 2020 8:23 pm

hello everyone I have a question my DME which happens to be j&L medical tells me that my insurance which happens to be medicaid will only cover my bi-pap machine if its broken I thought most insurances will cover bi-pap machines every 5 years so why is my DME telling me something different?

p.s. my bi-pap machine is not broken. I think i'm due for another one next year thats why i'm asking

You're *due* for one, when you *need* one, not just because you want another one.

You paid for Medicare..not for Medicaid. States pay for Medicaid and they are not very liberal when it comes to needless replacements.

While it used to be fairly common for insurance companies to just automatically okay a new machine after the 5 year mark it's becoming more and more common for insurance companies (including Medicare and state Medicaid) to adopt a "only if it is broken" standard as well.

Medicaid often adopts Medicare regulations and even Medicare is now seeming to adopt the "only if broken" rule. Doesn't surprise me that your Medicaid might also adopt the same rule.

To know for sure though you would need to contact your state Medicaid office and ask them directly.
DMEs have been known to not tell the truth but I would imagine they would love to sell you another machine if they could and have Medicaid pay for it. That's how they make money. They probably already know that Medicaid in your state has decided to adopt the "only if broke" rule.