Change in Medicare [replacement supplies]

[PaulaO2]

Forcing a patient and a DME to justify a $5 filter is just nonsense. But typical Medicare, make a blanket policy and force everyone to fit it.

[zonk]

I prefer the US insurance system ... cover machines and other stuff including replacements
My insurance only pay some $500 toward the purchase of new machine
That is all ... nothing for masks, hoses, other stuff or replacements
Beside I've to buy the machine locally to get the rebate and pay inflated prices ... what a rip-off
Shame on you .. insurance companies, CPAP manufactures and CPAP sellers

I bought my S9 autoset from supplier number 10 for $999.00 US and it came with the carry bag, a climate line hose, SD card and the dishwasher safe water tub for the humidifier. My nasal mask was only $104.00 US and because I bought from a US online store I didn't need to send a copy of my prescription, the postage was $84.00, but even if you take your lousy $500.00 rebate off the cost of a machine supplied in Australia you are still paying more than I did.
I currently have another mask and climate line hose on order which cost $192.99 US including postage and should arrive next week as the USPS tracking showed it had arrived in Australia yesterday.
The only things I buy here are my filters and chin straps when needed

http://www.apneaboard.com/forums/Thread-...ndwindcpap
http://www.apneaboard.com/forums/Thread-...h-1800CPAP

I've dealt with both suppliers and both good reliable source ... machines and masks cheaper from Supplier #2

My point was about the Australian insurance system comparing to US insurance system
You and I plus some folk (not many) know where to source our equipments but the majority don,t so they end up paying the higher prices and some might have an issue with the warranty requirement as machine have to be sent back for any repairs

I.m going to start lobby my MP ... for the insurance system to change to allow ongoing reimbursements for supplies as the US insurance system
Also I want ResMed and other manufactures gives us the same service as they do in US ... mask return within 30 days to get the right mask
The right mask is the key to PAP therapy compliance

[SuperSleeper]

The reason "because its been a month" for replacement cushions..is NOT good enough. Medicare is getting very VERY tough on there guidelines.

I would imagine that we're going to see a much stricter stance as far as documentation for many health-care related items that are paid via Medicare/Medicaid. It's already very, very complicated, and as Obamacare comes into play, integrating millions of patients into a new and even more complicated governmental health care system will also involve a slew of new rules & regs in order to keep costs down. Heck, there's a ton of confusing regulations now, and Obamacare hasn't even kicked in yet.

2013 is going to get more confusing for patients and workers in the healthcare industry as so many changes will be coming into play during the transition and official start of the bulk of these programs on Jan 1, 2014.

Who is John Galt?

[zonk]

Who is John Galt?

http://en.wikipedia.org/wiki/John_Galt

[PaulaO2]

2013 is going to get more confusing for patients and workers in the healthcare industry as so many changes will be coming into play during the transition and official start of the bulk of these programs on Jan 1, 2014.

Pfft. They've had how long to prepare and figure it out? Oh, wait, that's right. We're a nation who likes to take their time to follow laws. The ADA was 22 years ago and I still can't go places.

I ain't holding my breath. Well, unless I'm asleep and it's an obstructive apnea event, then, yeah.

[SuperSleeper]

Any time government completely overhauls medical regulations like this, there's bound to be confusion. This health care overhaul is vastly more complicated that the relatively straightforward ADA regs.

While companies have had time to review all the new Obamacare regulations, a lot of the "how do we implement the rules" is problematic. They need to design and test new software programs, new insurance company apps, new Medicare and Medicaid reimbursement data systems, etc. [much of which have yet to be fully developed by the government]. The software and systems must be first designed, then fully best-tested over several months and finally integrated with other systems and tested a second time over several months of beta testing to ensure proper integration between all the separately-designed systems. It's an integration nightmare.

It's not simply a matter of "abiding by the new rules" and it becomes reality overnight. These are the unintended consequences of new government mandates - it takes a massive amount of work, time and money to get to a new interconnected system that is fairly error-free and able to be used effectively.

[Kristen]

I have read here and on other websites that Medicare will pay for a new mask every 3 months but the home health company where I get my supplies says it is every 6 months. I told the therapist what I had seen but she insists she is right. How can I find out for sure and if it is 3 months, does anyone have any suggestions for getting another mask.

[PaulaO2]

This is a 2012 replacement schedule from ResMed. It has codes and all sorts of stuff. I would assume that the schedule for all masks are the same no matter the manufacturer.

http://www.resmed.com/us/documents/10134...sories.pdf

[zonk]

I have read here and on other websites that Medicare will pay for a new mask every 3 months but the home health company where I get my supplies says it is every 6 months. I told the therapist what I had seen but she insists she is right. How can I find out for sure and if it is 3 months, does anyone have any suggestions for getting another mask.

welcome to the board
according to Medicare replacement schedule ..... new mask per 3 months and full face mask cushion per month
(not sure if anything has been change)
http://www.healthcare.philips.com/pwc_hc..._Hints.pdf

choosing a mask like choosing shoes ..... everyone different
you have to try any mask to find if going to work for you
most go thru several masks to find what works best
be aware of the 30 days mask return ... so you can return the mask and try another at no cost to you within the allowable 30 days period
on the whole nasal and nasal pillows masks can works better than full face mask

[trish6hundred]

Hi Kristen and WELCOME! to the forum.!