Private Insurance to Medicare

In June, while covered under my employer's insurance, I completed a sleep study and rented a cpap machine. On September 1, I will be covered under Medicare. My DME tells me that Medicare will continue to pay for the supplies but not for the rental of the machine since the sleep study wasn't done under Medicare. Has anyone faced this problem before?

Thanks,

You might want to check with Medicare directly and not rely on second information from the DME.
Find out from Medicare directly to see if they have some sort of provisions to cover situations like this.
Your private insurance...was it a strict month to month lifetime rental or a rent to own after so many months?
If rent to own..how many months are left?

Thanks Pugsy,

Since this all happened just last June, my insurance company only approved three months of rental (they knew I was going on Medicare in September).

Dirty dogs.

What machine do you have right now?

You need to call Medicare. They can tell you what your options are. Wonder if there is some way to start all over with a new machine entirely? 3 month rental ends..start a new contract with Medicare?

Medicare only does capped rentals, so they will probably want you to start all over again with the capped rental under Medicare. This is where it can get troublesome, because the DME will not want to give you a new machine for the start of the Medicare capped rental period, but really that's what they should do.

It's important to arm yourself with information. You can call Medicare directly and ask (1-800- MEDICARE) or ask for help from your local Medicare absolutely free counseling program (SHIP in most states, HICAP in California) There should be a number for your state's program on the back of your Medicare and You book if you've received it, if not you can look online at Medicare.gov or call the number above.

What you need to ask is specifically what you need in order to be covered for a machine under Medicare and also what your DME's obligations are since you've already paid 3 months of rental with the existing machine. Ask specifically if the DME has to provide you with a new machine to start the rental process all over again, or if they can roll over the existing machine and STILL get the full 13 months of capped rental on it. I'm not sure what the answer is, please share with us if you find out.

You should also ask if you are going to have to have another sleep study under Medicare to get any coverage for the machine--I think you may have to. If that's the case, you may be able to find a certified Medicare provider that does home testing so you don't have to put up with the lab stuff again.

Since there may be a wait before you get set up again;
I would definitely express concern about going without treatment to your Medicare representative.
They may have a temporary contingency plan.
Depending on your general health, you should get on the fast track, at least.

garringt,

I have run into this situation with many patients and this is how it works, however keep in mind I am in Region D and your specifics may be different....but I doubt it.

1. You DO NOT need a new sleep study.

2. You will have to go see your Dr. AFTER you become Medicare eligible and have him reference in the visit notes that you are on CPAP and do fine and intend to continue using CPAP.

3. You will start a new 13 month capped rental period under Medicare.

4. If you go back to the same DME that you are currently using they are under no obligation to issue you a new CPAP. Infact all DME's are under no obligation to issue you a new CPAP until the CPAP is purchased. So DME's are perfectly within their rights giving patient's a used CPAP and then swapping it out for a new one after the 13th month of rental. FYI this is not how my DME operates, we always give out new CPAP's, just putting that out for information.

5. If you do not use the same DME that you are currently using you will need to get the same machine you are currently use from the new DME. Medicare will not pay for a another humidifer this soon. Even though they did not purchase this humidifier, the new DME will need to know the last date of all supplies billed from your old DME.

Gotta get to patients but post any further questions you have and I will try to answer them.