What are the current Medicare rules for

a person with OSA obtaining a Medicare paid for, (at least the 80 percent) Bi Level machine?

While a person with MS directly gets a Bi Level machine, else it is my understanding that if the individual does not have centrals, then that person is restricted to a straight CPAP or APAP machine. Centrals can be either neurological or "Can Not Exhale against prescribed Pressure."

That is also said as, to get a Bi Level machine, an individual must fail CPAP.

While I feel the DME is not going to misquote Medicare Policy that would allow them to sell a Bi machine. Well, with Medicare policies changing month to month, they may not know.

I feel the DME is familiar with knowing about those who applied for Bi Level machines, and Medicare refused to pay. I also feel Medicare can act like any insurance company, and simple make a ruling that keeps them from spending money.

I also raise the thought, that if I am taking an opioid acting medication, would that create a justification for a bi level machine?

May I say, that Medicare rules are restrictive and prevent care, not protect the government (Medicare) against unnecessary expense.

EDIT: If it matters, http://www.resmed.com/us/documents/1013 ... ilevel.pdf

I would think that the best option would be getting your doctor on board to help you qualify for the bilevel.
Medical necessity trumps a lot of red tape. (example: complaining about aerophagia)

Chunkyfrog , you must NOT have Medicare. To Social Security and Medicare rules are rules, and rules are more important than peoples health or people. Of course that is because the rules are supposed to create better health. LOL.

My question is exactly how the rules are applied now.

EDIT: FYI: My doc simply send the DME an instruction to come to my house and install an S9 VPAP with all tubing, masks Et Cetra. So yes he is willing to think I need the Bi Pap. But his standard is my health, including comfort. IF he has a professional opinion that i have, "failed cPAP." he did not tell me.

Medicare rules clearly state that improvement based upon comfort are NOT part of what Medicare covers. Just like Medicare will not pay any part of a Humidifier. The patient must buy it for themselves. Nearly everyone here would say that, unless one lives in the rain forest, a Humidifier is not an option, it is a requirement to stay on treatment.

Who told you Medicare doesn't/wouldn't pay for the humidifier?
It's done all the time.
Are you saying you finally got a S9 VPAP delivered and they tell that the humidifier isn't covered? That's BS.

Strangely, that is what I was told. by the DME. The deal would include a humidifier, but I would be required to pay for it.

If you are curious Pugsy, the docs office is pushing for me to get another machine because they can not download the info off an S7 Malibu, they claim that they must be able to have to data because of Medicare rules that I must prove compliance to continue to get supplies, they would not accept the data I downloaded and then put on an SD card, saying that they can not put a strange SD card into one of their computers. LOL

And thank you guys for replying.

I just got a new humidifier and a heated hose from Medicare and my supplemental insurance.

Here's the deal on Medicare and machines..
the machines are on the 13 month rent to own thing...then it's yours.
Humidifiers ARE covered and medicare will pay but they won't break it down into monthly installments. It's considered a non returnable piece of equipment so the full purchase price is charged the first month.
So yes, it is a one time purchase now but Medicare does indeed cover it and Medicare pays the 80% of the allowed amount and you pay the 20 %.
So yeah, you do have to pay for your 20% but Medicare still pays their 80 %.

Last year the reimbursement rate was this.
E0562 Heated humidifier...allowed amount range 278.87 to 237.04...depends of course on where you live and all you would have to come up with is 20 % of the allowed amount.
http://www.resmed.com/us/documents/1018 ... rd2011.pdf page 2
Now after Jan 1 CPAP equipment is part of the Part B deductible that you have to meet before Medicare pays their 80 %

General requirements for the bilevel unit itself.
http://www.resmed.com/us/documents/1013 ... et_rad.pdf

We just went through a month long hassle trying to get a Vpap since it's been over 5yrs. We've been using a Vpap for a year that I purchased almost new from a forum member and Mike does much better with it. Our Dr got involved with several letters stating the necessity for a bipap, "failed cpap,compliant and doing well on bipap,etc", even our DME Manager got involved but the end result was that Medicare insisted on a new sleep study showing first that he failed cpap. We weren't willing to put Mike through that trauma and he probably wouldn't have failed cpap anyway,he just sleeps better with bipap in my opinion. The DME was willing to provide us with a new S9 Autoset that we were entitled to but I refused. Why waste gov't money when we wouldn't be using it and we already have an auto for backup. I hope your situation is different.

I just got a new PRS 1 960 Bipap Auto ASV with heated hose and humidifier, all covered by my Medicare Advantage Plan.

You may need to look into changing your coverage during open enroment, befor Dec 7.