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Susy is replying to a 2 year old post...rules/procedures may have changed since 2011.

I would not be surprised if redundant repeat documentation is required by Medicare.
Just as well chase the elderly around with a ball bat!

suzy rcp wrote:Medicare DOES require a new RX yearly (regardless of the lifetime CMN on file from initial servicing). They also require Dr.'s notes stating that the patient still needs CPAP therapy, yearly.

Could you please provide links directly to the Medicare site where either or both of those requirements are listed.

Still hoping to get those links.

Apparently, apnea IS curable! OMG! Tell me more!

chunkyfrog wrote:Apparently, apnea IS curable! OMG! Tell me more!

Tell me also as one who has had difficulty adjusting to therapy. Where is that cure?

49er

I am going to assume that your insurance company is requiring you to buy "in network" instead of from their approved vendors. While mostly the same idea, it actually means you can buy from any company in which they have a contract with. Many of these companies will be quite large with multiple locations. It can be amazing the difference in service from different locations in the same company. A lot of these companies have incentive programs for their employees. Thus some sales people are more motivated than others. One of the bigger national companies in my town also has four other locations within 45 minutes drive from me. My local office is like doing business with a brick wall. Two of their other offices are quite pleasant tk deal with. When I used to deal with them I would order out of the Athens office and they would put it on the next van coming tbis way. Sometimes it arrived same day, others the next day. Most importantly i had a repdesetative that listened and did her best working with the insurance company. You are not married to your DME. Sometimes you have to put effort into finding the est vendor for you.

I have since swapped DME's twice. No matter the doctor I always get a printed prescription for any equipment I need. They send electronic copies to the DME's. When my new doctor prescribed my bipap ASV machine they recomended two local DME's anx sent them prescriptions. When I talked to both of them I was informed they leased such expensive machines instead of straight sells. When I told them that my insurance plan always bought my machines and they replied again their company policy was leasing so that would be what happened. When I asked fbe lease price neithed said they could not know tbat till after I picked up the machine and processed the paperwork. I asked what would happen when benefits rolled over in January anx they said until I met my 2014 copays, I would be responsible for the lease payments. When I asked them to process it as a sale they said it.could not be done. I talked to my regular DME who ran tbe paperwork as a sale. It took two exfra calls from them to BC/BS and a call etween the insurance company doctor and mine but it was approved as a straight sale saving me $2,500 in lease payments till my 2014 out of pocket was met.

My DME repressntative told me that their is a little more money to be made by the DME on a lease, less paperwork and phone calls as the insurance company makes it easier knowing in most cases a lot of the financial responsibility rolls onto the patient. Learn what your plan pays for and dont let some lazy and greedy rep from the DME hose you.

StuUnderPressure wrote:

suzy rcp wrote:Medicare DOES require a new RX yearly (regardless of the lifetime CMN on file from initial servicing). They also require Dr.'s notes stating that the patient still needs CPAP therapy, yearly.

Could you please provide links directly to the Medicare site where either or both of those requirements are listed.

Hope this helps. It clearly states prescription is required.
http://www.medicare.gov/Pubs/pdf/11045.pdf

Sleeptherapync wrote:

StuUnderPressure wrote:

suzy rcp wrote:Medicare DOES require a new RX yearly (regardless of the lifetime CMN on file from initial servicing). They also require Dr.'s notes stating that the patient still needs CPAP therapy, yearly.

Could you please provide links directly to the Medicare site where either or both of those requirements are listed.

Hope this helps. It clearly states prescription is required.
http://www.medicare.gov/Pubs/pdf/11045.pdf

Could you please point me to a specific page & paragraph?

I scanned it online, but did not see that.
I have printed it & will read it more closely later.

By the way, that document is 5 years old.

Of course the document is 5 years old. Medicare does not update everything every year.
(do they update anything, ever? --except when they can create a galactic-sized cluster)
---Apparently, the idiots running Medicare still believe that apnea is curable.

There are cures for some people, at least for a few years, such as surgery. Perhaps one can be in a position to put the choice to the insurer.

Playing the digeridoo may help.

Nevertheless the practice of requiring prescriptions, which may require a referral thus a costly visit to a GP (due specialist policies or customer having moved to another region) is not cost effective. One insurer in the Puget Sound area smartened up and stopped that for known conditions.

Dr. Keith Roach, in his newspaper column, says he has heard of some cases of difficulty swallowing after surgery.

He did not detail what type of surgery, nor if ability improved with time (as - I speculate - scar tissue might dissolve).

http://www.timescolonist.com/life/your- ... -1.1067478