Update (If Yew Care to Read?)

So two years into the CPAP, my machine BROKE. ("Broke" in the sense that it stopped blowing air.) This was a ResMed S8 Elite II. I took it to the DME and she gave me a (*groan*) RemStar M Series Plus as a loaner. Turns out I missed the warranty on the ResMed by 12 days!

The M series It was terrible LOUD and had no humidifier. The humidifier was on the prescription but DME flat out refused to give it to me, even though I asked her over and over again. So I went to the doctor and the nurse called DME and DME gave me humidifier.

But the gadget was still very loud and it was hard to sleep.

So for quite a while (a few weeks even) I was having this M series Plus and I was so angry at the DME for giving me grief about the humidifier that I done went and bid on a PR System One Auto. ($249.00 with 135 hours.) Tracking says it will arrive tomorrow. I pray I did the right thing with my $249.00 ...

Meanwhile, just yesterday, the DME finally calls me and tells me the ResMed is fixed. I had NO problem giving the M series back to her and taking my much quieter RedMed. The bill for the repair comes to $155.19 and the DME tells me insurance will NOT cover it?

Hullo? Isn't this kinda situation the very reason we have insurance?

I have Medicare and a United Health Care supplement. Can anyone tell me if this will be covered?

I set up the ResMed and when I woke up today I felt like it was the first time I got any sleep since it broke. The AHI was 4.3 (I usually do lower than that) and I felt much better than I have in weeks. I have no idea what the AHI was on the M series (cuz it was a PLUS and not a PRO), but based on how I felt that whole time I had it, I am guessing it was much higher.

I am hoping that M series was just a single bad machine since I am getting a Respironics tomorrow. I did check the hours since it was a loaner and it had 67 total blower hours before I started on it. When the ResMed came back, it was with a new motor and 00 blower hours. ResMed is a lot uglier looking than M series, but it is quieter and it works. The water tank is easier to fill as well, but harder to clean.

I have to say that after this experience, I do feel better knowing I will have a backup. For those of yew who have read others on here talk about getting a backup and have wondered if it is worth getting one, the answer is YES IT IS.

Medicare is my primary, BC/BS thru my hubby's union our secondary. I recently had to part w/my Resmed S8 VPAP Auto for repair. It was out of warranty (March 2008 to April 2011). My provider got authorization from Medicare for the repair. The motor was replaced and the acoustic foam bottom case replaced. I was provided w/a PR S1 BPAP Auto 'and' humidifier whilst my Resmed VPAP Auto was in for repair.

Cost to me? $35 at the time they picked up my VPAP Auto and deliver the PR S1. (Resmed had quoted me $55).

Slinky wrote:Medicare is my primary, BC/BS thru my hubby's union our secondary. I recently had to part w/my Resmed S8 VPAP Auto for repair. It was out of warranty (March 2008 to April 2011). My provider got authorization from Medicare for the repair. The motor was replaced and the acoustic foam bottom case replaced. I was provided w/a PR S1 BPAP Auto 'and' humidifier whilst my Resmed VPAP Auto was in for repair.

Cost to me? $35 at the time they picked up my VPAP Auto and deliver the PR S1. (Resmed had quoted me $55).

Am I reading this right? Are yew suggesting that my DME may have been negligent in not getting a prior authorization? ACK! I hope I am wrong about that!

Moi??? Suggesting your DME provider was negligent?? Goshes, all I was doing was relating my experience. Far be it for this sweet little ole gray haired lady to suggest any DME provider is less than fully supportive of their clients or negligent in providing services to their clients or even mistaken in their understanding of their clients' needs.

There is a HCPC code for machine repairs and YES, Medicare WILL cover it. I found this on another thread by Crayon Girl:

Medicare will pay for repairs - labor and parts as long as they are necessary for the item to function. If the company doing the repairs will not bill Medicare, you can submit your claim to your Region or Zone carrier.

Repairs are billed as K0739, replacement parts as E1399. If you submit the claim yourself make sure you submit an itemized bill from the company doing the repairs and documentation that the unit will not function as intended without the needed repairs.

So you tell the DME to bill Medicare for it. And if they screwed up and didn't get a required prior authorization (I don't think it's necessary but I'm not positive) it's THEIR fault so they can eat the repair. Call 1-800-MEDICARE for assistance or your local SHIP/HICAP office (800 number on the back of your Medicare and You book for FREE Medicare help).

Whatever you do, don't pay them a penny until they've billed Medicare (unless you've signed something agreeing to bill Medicare yourself). You may owe something like a 20% co-pay, but remember it's a co-pay on the Medicare allowable, NOT whatever they feel like charging. And your supplemental policy may pick up that 20%, be sure to ASK.

Janknitz wrote:There is a HCPC code for machine repairs and YES, Medicare WILL cover it. I found this on another thread by Crayon Girl:

Medicare will pay for repairs - labor and parts as long as they are necessary for the item to function. If the company doing the repairs will not bill Medicare, you can submit your claim to your Region or Zone carrier.

Repairs are billed as K0739, replacement parts as E1399. If you submit the claim yourself make sure you submit an itemized bill from the company doing the repairs and documentation that the unit will not function as intended without the needed repairs.

So you tell the DME to bill Medicare for it. And if they screwed up and didn't get a required prior authorization (I don't think it's necessary but I'm not positive) it's THEIR fault so they can eat the repair. Call 1-800-MEDICARE for assistance or your local SHIP/HICAP office (800 number on the back of your Medicare and You book for FREE Medicare help).

Whatever you do, don't pay them a penny until they've billed Medicare (unless you've signed something agreeing to bill Medicare yourself). You may owe something like a 20% co-pay, but remember it's a co-pay on the Medicare allowable, NOT whatever they feel like charging. And your supplemental policy may pick up that 20%, be sure to ASK.

Yes I was planning to call that number soon. The whole thing about Medicare not covering it was kinda fishy to me from the beginning. I have learned not to trust that particular DME, and this just confirms it.