Medicare - BiPaP and ASV machine accounting code EO471

Thanks to everyone for your comments. I was unsuccessful in my efforts to get a Certificate of Medical Necessity from my sleep doctor.
My next steps are to talk to: a different specialist, machine distributor and directly with Medicare.
Thanks

Dammit!
Are you in an HMO?
That would explain his unwillingness to provide the letter.
Their bottom line is the almighty buck--not your health.

Mahonetd wrote: ↑

Tue Mar 01, 2022 10:54 pm

Thanks to everyone for your comments. I was unsuccessful in my efforts to get a Certificate of Medical Necessity from my sleep doctor.
My next steps are to talk to: a different specialist, machine distributor and directly with Medicare.
Thanks

What was the reason given to you why your doctor would not certify the medical necessity?

Not in an HMO. Just have doctors that refuse to fight for the benefit of the patient.
Talked a number of people at Medicare. All very pleasant, but unable help.
Still working on other alternatives. I don’t want do nothing for an unscheduled meeting to take place.
Thanks

The doctor claimed that the Certificate of Necessity would not do any good until Medicare can meet with the experts to straighten out the same accounting code for two different machines. Not sure of any other issue. I will get someone to write so I at least have a piece paper saying I tried. If no tries, the panel may say there is no problem. Thanks

Mahonetd wrote: ↑

Fri Mar 04, 2022 10:06 pm

The doctor claimed that the Certificate of Necessity would not do any good until Medicare can meet with the experts to straighten out the same accounting code for two different machines. Not sure of any other issue. I will get someone to write so I at least have a piece paper saying I tried. If no tries, the panel may say there is no problem. Thanks

Time for another doctor this one is getting money from where he is sending you.
He is just making $hlt up.
Bail now or pay the price - you are just feeding his habit.

SleepGeek wrote: ↑

Fri Mar 04, 2022 10:13 pm

Mahonetd wrote: ↑

Fri Mar 04, 2022 10:06 pm

The doctor claimed that the Certificate of Necessity would not do any good until Medicare can meet with the experts to straighten out the same accounting code for two different machines. Not sure of any other issue. I will get someone to write so I at least have a piece paper saying I tried. If no tries, the panel may say there is no problem. Thanks

Time for another doctor this one is getting money from where he is sending you.
He is just making $hlt up.
Bail now or pay the price - you are just feeding his habit.

I second that.
You need a doctor who has a pair.

Still no luck talking to anyone at Medicare. The are trying to be pleasant, but do not understand the problem.
Using a rebuilt ResMed S9 machine with good results. Even though refurbished, it is still a ten year old machine. AHI is down and sleeping better. Unfortunately this machine does not have wireless communications with the doctor and parts supplier. It makes compliance difficult repotting and ordering difficult.
Recently, the machine has been generating a number of error messages. Difficulty reading card. I download data every day to save it on my PC. I have used different cards etc. Still a problem. Losing data when transferring to Oscar.
Always something.
Thanks

So, you returned the Philips machine?
What model is the S9?--where did you get it?8>
Be sure to document the trouble with data for ammunition.
Sometimes the only way to get it right is DIY--on your own dime.
It's all wrong, but that is bureaucracy for you--or whoever it is "for".

Just curious, if you had your machine for 5 years would there still be a problem? I probably need a ASV - got my Resmed Airsense 10 in March 2018. Not on Medicare at that time as I had BCBS that paid for it. Wonder if that will make difference now that I have Medicare and need a new machine that is more costly.

Fredo48 wrote: ↑

Tue Sep 06, 2022 10:28 am

Just curious, if you had your machine for 5 years would there still be a problem? I probably need a ASV - got my Resmed Airsense 10 in March 2018. Not on Medicare at that time as I had BCBS that paid for it. Wonder if that will make difference now that I have Medicare and need a new machine that is more costly.

Medicare doesn't care about a machine that you had before you were on the Medicare rolls. However, you will need a letter of medical necessity from a doctor.

ChicagoGranny wrote: ↑

Tue Sep 06, 2022 3:53 pm

Fredo48 wrote: ↑

Tue Sep 06, 2022 10:28 am

Just curious, if you had your machine for 5 years would there still be a problem? I probably need a ASV - got my Resmed Airsense 10 in March 2018. Not on Medicare at that time as I had BCBS that paid for it. Wonder if that will make difference now that I have Medicare and need a new machine that is more costly.

Medicare doesn't care about a machine that you had before you were on the Medicare rolls. However, you will need a letter of medical necessity from a doctor.

And very likely a repeat sleep study. But no medicare won't know or care what your insurance paid for or when.

Thanks for the responses!