Post Reply 
Change in Medicare [replacement supplies]
Author Message
hgite@cox.net
Unregistered

 

Machine:
Mask Type:
Mask Make & Model:
Humidifier:
CPAP Pressure:
CPAP Software:

Other Comments:

Sex:
Location:

Post: #1
Change in Medicare [replacement supplies]
my supplier says that medicare now requires reasons for ordering replacement supplies instead of just going by the recommended schedule(which they say is the minimum ) --does anyone know what is going on and --i use a quattro fx mask --what reason would i give to get replacements
11-08-2012 09:27 AM
Post Reply Quote this message in a reply

Donate to Apnea Board
Suzjohnson Offline

Preferred Members

Posts: 42
Joined: Apr 2012

Machine: Resmed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Fisher Pakel Pilairo
Humidifier: H5i
CPAP Pressure: 7-12
CPAP Software: ResScan SleepyHead Other Software

Other Comments:

Sex: Female
Location: So. Utah

Post: #2
RE: change in medicare
(11-08-2012 09:27 AM)hgite@cox.net Wrote:  my supplier says that medicare now requires reasons for ordering replacement supplies instead of just going by the recommended schedule(which they say is the minimum ) --does anyone know what is going on and --i use a quattro fx mask --what reason would i give to get replacements

I have not heard that! My husband and I are both on Medicare. Our DME never has called me regarding supplies but my husband gets called regularly. In fact they called just a couple of days ago to see if there was anything he needed. They are really sticklers for dotting i-s and crossing t-s. They are sending a new mask cushion because it's, well, time to do so. As far as reasons go, I feel it's important to have a spare of everything you use and the reason you give can be as simple as because I need a new one. Once you have accumulated your spares, I see no need to continue ordering stuff just because you can. I'm sure there's enough abuse of the system to justify asking why you need a replacement but it might be a DME issue and not Medicare.

Suz
11-08-2012 09:48 AM
Find all posts by this user Post Reply Quote this message in a reply
trish6hundred Offline

Advisory Members

Posts: 6,430
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #3
RE: change in medicare
Hi hgite@cox.net,
WELCOME! to the forum.!
I hadn't heard about this change but hang in there for more suggestions.
Best of luck to you.

trish6hundred
11-08-2012 10:11 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
JudgeMental Offline

Advisory Members

Posts: 324
Joined: Feb 2012

Machine: Respironics DreamStation Auto-CPAP
Mask Type: Full face mask
Mask Make & Model: Respironics Amara View
Humidifier: Respironics
CPAP Pressure: 11-14
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Florida USA

Post: #4
RE: change in medicare
I find that it is strange that your DME/provider has given you this info. Altho things change rapidly sometimes with Govt sponsored programs,,anything is possible. I have not heard of any Medicare statement to that effect..
However, Medicare is the one that set the standard sked of replacements for the durable medical equipment. Your DME's response about ordering unless its necessary, doesn't make any sense to me. The schedule of replacements is due to the fact that the Govt determined that the manufacturers product looses its intended medical value after a certain time. We all know that sometimes we use them for a lot longer periods of time.

Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
11-08-2012 11:55 AM
Find all posts by this user Post Reply Quote this message in a reply
cbramsey Offline

Advisory Members

Posts: 900
Joined: Mar 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: ResMed H5i with ClimateLine
CPAP Pressure: 6 - 12
CPAP Software: ResScan

Other Comments: Supreme Overlord of Web Darkness

Sex: Male
Location: NC, USA

Post: #5
RE: change in medicare
First of all, welcome to the forum!!! We are glad you joined us!!! Welcome

I am also on Medicare and am unaware of this. As long as your DME meets or exceeds the Medicare "standards" for equipment, Medicare shouldn't have an issue.

Keep us informed.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
11-08-2012 12:22 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
archangle Offline
Wiki Editor
Advisory Members

Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #6
RE: change in medicare
Scuttlebutt is that this is because a lot of DMEs were milking the system by always ordering many parts automatically every time they could.

Apparently, Medicare doesn't really care that much as long as the patient is initiating the request, not the DME.

Look at your mask parts and see if they're getting yellow and not sealing well. If this is happening, tell your DME and request replacements.

It may take a while before the DMEs figure out the best way to ease the process for patients to order replacement parts.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
11-08-2012 01:30 PM
Find all posts by this user Post Reply Quote this message in a reply
StuUnderPressure Offline

Members

Posts: 52
Joined: Jun 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage SoftGel with Camo Headgear
Humidifier: ResMed H5i Heated Humidifier
CPAP Pressure: 13 - 19
CPAP Software: ResScan

Other Comments: ResScan Version 4.3.0.7081

Sex: Male
Location: U.S.A.

Post: #7
RE: change in medicare
(11-08-2012 09:27 AM)hgite@cox.net Wrote:  my supplier says that medicare now requires reasons for ordering replacement supplies instead of just going by the recommended schedule(which they say is the minimum ) --does anyone know what is going on and --i use a quattro fx mask --what reason would i give to get replacements

This IS in fact a new requirement by Medicare.

DMEs can NO longer just send you out supplies on a pre-determined schedule withOUT 1st determining that you DO need those supplies.

And Yes, just asking you whether or not you need those supplies does seem to meet the Medicare requriements.

This change will only affect those of you who have agreed to let your DME just send you out supplies every 3 months, 6 months, etc without 1st determining a need - So, Yes it is aimed at the DMEs.
(This post was last modified: 11-08-2012 02:53 PM by StuUnderPressure.)
11-08-2012 02:50 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Dawei Offline

Preferred Members-2

Posts: 342
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Other
Mask Make & Model: Respironics "FitLife"
Humidifier: H5i
CPAP Pressure: 10-20
CPAP Software: ResScan SleepyHead

Other Comments: Began CPAP in 2006; spent the first 6 years with a "brick"

Sex: Male
Location: Western North Carolina

Post: #8
RE: change in medicare
My information agrees with what Archangle and Stu have described. Medicare hasn't changed their xPAP supplies' replacement schedule (i.e., 3 months for replacement mask, etc.). It's just that now you need to request a replacement from your DME. It's aimed at saving some taxpayer money, and it's easy to understand. Previously, some DMEs were automatically sending out replacement supplies to patients on Medicare's replacement schedule, whether or not they were needed by the pt. And I've read posts where the pt. didn't need or request replacement supplies but continued to receive them from the DME. It's my understanding that Medicare has also tightened up somewhat on replacing a pt.'s machine after the 5 year period has been completed. The DME now, as I understand it, needs to indicate to Medicare that the machine needs to be replaced, not simply because it's been used for five years. If the type of machine is to be changed, it must be backed up by a script from the pt's doctor.
11-08-2012 04:10 PM
Find all posts by this user Post Reply Quote this message in a reply
zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #9
RE: change in medicare
Medicare can save more money (real money Not peanuts) if they include online providers on their DME approved list
so the patient get the right machine and Not get screwed by the DME
11-08-2012 04:46 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
StuUnderPressure Offline

Members

Posts: 52
Joined: Jun 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage SoftGel with Camo Headgear
Humidifier: ResMed H5i Heated Humidifier
CPAP Pressure: 13 - 19
CPAP Software: ResScan

Other Comments: ResScan Version 4.3.0.7081

Sex: Male
Location: U.S.A.

Post: #10
RE: change in medicare
(11-08-2012 04:46 PM)zonk Wrote:  Medicare can save more money (real money Not peanuts) if they include online providers on their DME approved list
so the patient get the right machine and Not get screwed by the DME

But the online DME also has to agree to accept Medicare.

If they don't now accept any insurance, what are the chances of that happenning?

Letting me buy online & then file my own Medicare claim could be the best solution. But then, who wants to deal with paperwork with Medicare?
11-08-2012 04:53 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Medicare Advantage Coverage for APAP Evie 3 184 11-30-2016 08:22 PM
Last Post: Mike1953
  [Pressure] How to change pressure - Respironics Solo slgoltz 5 19,973 11-30-2016 06:32 PM
Last Post: randx2
  Headgear replacement ? worthog 3 184 11-27-2016 02:03 AM
Last Post: GP49
  [CPAP] Whining siren noise and bearing replacement/repair clintga 23 6,308 11-22-2016 02:52 PM
Last Post: Sleeprider
Question Change Humidity Level Seasonally txpap 9 504 11-21-2016 06:58 PM
Last Post: Sleepster
  Where to get Inexpensive Supplies margy72 21 947 11-06-2016 06:59 PM
Last Post: big_dave
  Medicare Denial Kidnap 48 4,213 10-29-2016 01:46 PM
Last Post: Kidnap

Forum Jump:

Who's Online (Complete List)