ResMed 10, doctor not receiving data, What will it cost to get ResMed 11, Medicare

My machine working great. 30/30 days used. Doctor office cancelled tele appointment as no data since April. They want me to get new machine. ResMed 11
I can not find actual costs of machine under Medicare Blue Cross. Not concerned about details of deductibles etc, just what is the Medicare allowed amount and how is that broken down over months “rental”?
I have tried and tried to search, find out.

Karn wrote: ↑

Sat Sep 03, 2022 5:43 pm

My machine working great. 30/30 days used. Doctor office cancelled tele appointment as no data since April. They want me to get new machine. ResMed 11
I can not find actual costs of machine under Medicare Blue Cross. Not concerned about details of deductibles etc, just what is the Medicare allowed amount and how is that broken down over months “rental”?
I have tried and tried to search, find out.

Something smells fishy so let me ask some questions.

How old is your current cpap?
What model resmed is it?
How long have you been on cpap?
Have you competed your Compliance Period?
Do you know why he wants you on a Resmed 11?
Which Model 11? (there are 3)
Medicare Blue Cross sounds like an a Medicare Advantage plan, is it?

You may get your best answer from Medicare Blue Cross as to cost.

But I'm thinking this doc may have a connection (money) with the DME he wants you to buy from?
Who is your DME?

btw - Welcome to this zoo.

How long have you been using the Airsense 10?
Does your doc have an "arrangement" with the DME? (Like kickbacks, hmmmm?)
You should be able to take the sd card with you to the doctor.
He should be able to get all the information he needs. Unless he's trucking unqualified.
Medicare might not be willing to replace a working machine even after 5 years.
--regardless of cellular availability in your area.

Is the machine set on airplane mode?

You should be able to take the machine in and have them pull data from it.

Agreed it sounds fishy.

But hey maybe medicare covers a nice brand new 11 that you would get right away?

Would be weird if they took current one without replacement on hand?

You can run docs thru here to see what companies kick back ie honoraria, speaking fees, etc.
https://openpaymentsdata.cms.gov/

Just put your docs name in there in case things get fishy. Messing with Medicare is a very costly thing to do when providers get caught doing it.

i hate to be mister gloom and doom, but i've got to agree with the others.

i DO see that you've been on cpap for at least two years, so that's not part of it.

still, the way you've presented it here does look like your doc is trying to push an unnecessary machine on you.

can't speak to medicare as i don't use it for cpap machine or supplies.

good luck!

)btw, to anyone looking on, you can see a users prior posts by clicking on their name.)

Nothing fishy going on here.

The machine is (likely) not sending data because its got a 3g modem, 3g cell towers are being shutdown all over the place.

There is no point in having a Dr appointment, if he hasn't got your data.

Ask if you can bring in an SD Card. If not, your choices are:

• Upgrade to a machine with 4g modem
• Get a new Dr
• Self manage like most of us.

Karn wrote: ↑

Sat Sep 03, 2022 5:43 pm

My machine working great. 30/30 days used. Doctor office cancelled tele appointment as no data since April. They want me to get new machine. ResMed 11

Does your current cpap even have data?

Most of the docs I've seen rely on the DME to email or fax (back in the day) the cpap data to them and don't bother messing with the equip - that is unless there is money in it for them.

Unless the doc owns the DME you could end up on a wait list for months waiting for an AS11.

If you want to get in to see the doc the fastest thing you can do is to download Oscar and print out your results. Go in with that in hand - I've been doing that for years now. Don't rely on the doc reading your SD card as many docs won't spend the money for the software and won't use Freeware (Oscar).

Get your charts here to see whats going on - esp. if you are having problems.
viewtopic/t184531/OSCAR-140-Released--June-17-2022.html

Had Dr appointment today. He is excellent doctor. Problem is the modem as mentioned in comments. I was so upset when this happened. They took all information off the SIM card.
I have used the resmed for her since 2016. Doctor said I can continue to just bring the card in. I think it is good time to upgrade, but want to know facts before I walk into a Medical Supply Company.
I was frustrated with how billing work first time. Extra charge for humidifer that is part of machine and the $99 headgear package being billed separately for each part so I think it was $169 and they were taking out the extra size nasal pillows to sell to others.
Doctor’s office gave me the newer under nose pillows I want to try today. Free. Wish I could do business directly with them.

Anyone know what the Medicare price for ResMed 11 will be? I didn’t know it came in different versions. I have heated tubing on the 10.
Thank you everyone for responding. I’m not as upset since figured out didn’t lose data and it’s not my machine, but everyone’s.

I found the 3 models. Auto set is what I have so I believe what I’ll get in 11

I’m not sure how to reply directly to people who answered by post. Thank you for taking the time and sharing knowledge. I appreciate it.

Karn wrote: ↑

Wed Sep 14, 2022 8:22 pm

I’m not sure how to reply directly to people who answered by post. Thank you for taking the time and sharing knowledge. I appreciate it.

see the quotation marks in the upper right?

that's how ya do it.

Karn wrote: ↑

Wed Sep 14, 2022 8:18 pm

Anyone know what the Medicare price for ResMed 11 will be?

Do you have straight Medicare with a supplement to cover your 20% copay or do you have a Medicare advantage plan?

It will depend on what kind of xpap machine you use. There are 3 main billing codes

HCPCS billing code E0601 covers the cpap/apap machine
HCPCS billing code E0470 covers a bilevel machine without a back up rate
HCPCS billing code E0471 covers a bilevel machine with a back up rate

Straight Medicare allowable fees pay a bit differently depending on where you live. There's not a lot of difference but there is a difference. There's a 13 month capped rental. You would need to call Medicare to get exact allowed amount for where you live. You pay 20 % of the allowed amount or if you have a supplement they pay.

Medicare Advantage plans are a whole different beast so if someone has an advantage plan they need to contact their insurance company directly because some are perpetual rentals and they could be paying a monthly co pay for eternity.

If you know the billing codes I don’t know if this will help.

https://www.cms.gov/medicare/physician- ... h/overview

Thanks. It helped