[Equipment] Moved And Need New Supplier

[Avign0n323]

We recently moved from Lakewood, CO (just west of Denver) to Waco, TX.  The place I got my equipment and supplies from (via Medicare), Preferred Homecare, doesn't operate in Texas, so what do I need to do to find a new supplier, and does this mean I need to get a new machine?  I believe I had rented it long enough that I got a letter from them or Medicare saying that I owned it.

Do I just go to my PCP (need to get one of those in new location, too...<G>) and they'll set this up?  Call Medicare?

Thanks!

[SleepyTexasGirl]

I'm not on medicare, and not in Waco, but I did a little research. I'm new to this whole sleep apnea thing myself.

Because I'm new it wont let me post links, but try googling "Medicare Coverage of DME" and look for a pdf link on the medicare site that includes the number 11045. Or really anything on the medicare site - ignore the ads.

It also suggested calling 1-800-MEDICARE

[SarcasticDave94]

I'm supposing there should be a website or customer service number (like the info SleepyTexasGirl mentioned) for Medicare to check for in network DME and new primary docs. I'm not yet on Medicare, but I'd assume this would be the way to find out.

[70sSanO]

I can't tell you about Waco, hopefully someone here will have a good reference. But this is what I did for finding a DME in my area.

1. Never let you doctor send a prescription to a DME of their choice. Get a hard copy for yourself.
2. Go to Medicare.gov supplier directory.
3. Pick out a few and look for reviews, Yelp is helpful.
4. Know what you want, by model number, just saying a CPAP or APAP, isn't going to cut it. In your case it may just be supplies for now.
4. Call the best ones and talk to them, maybe even visit them and see how they respond to different questions.

My doctor's office didn't like that I wanted a prescription in hand and gave me a list of the usual suspects, (Apria, Lincare, etc.), to contact that most people hate. I did research, and even still, you might not get a good one, but at least you are getting the best you can. Some people are content with someone showing up at their house and dumping junk on their night stand, but I'd rather go and get what I want from them. If I have to drive an hour, so be it. I know some people can't drive to get their machine, but if you can...

A funny, but actually sad, story happened when I went by my doctor's office to pick up my sleep study. As an older couple was walking with the doctor, I heard the doctor say, "Well they should have given you a Bi-level machine, you need to get back to them..." That was all I needed to hear.

John

[Mosquitobait]

You are under no requirement to get a new machine unless it is so old that they no longer have parts for it.  If your machine is not yet 5 years old, Medicare won't give you a new one anyway since yours works. 

Do look at the Medicare site to find out if you are in a mandatory bid area for cpap and supplies.  If so, you are restricted to only those who are currently contracted with Medicare. That list changes around June every year.

If you need a new machine (i.e. machine over 5 years old), then you need to get either your primary or a sleep certified doctor to sign off on it.  Check with your supplemental to see if they cover the 20% Medicare doesn't cover.

[Sleeprider]

Check for Medicare Participating Providers in your new Zip Code here https://www.medicare.gov/supplierdirectory/search.html
Under the search criteria be sure to select CPAP, RADS and Related Supplies and Accessories. Call around and decide who you want to use, then ask them to transfer your records from your previous DME in Colorado. This new provider will be providing masks, tubing, filters and related supplies until you are read for a replacement machine. This will ensure you have continuous coverage and will possibly avoid a sleep test.

Similarly, you will have a new doctor in Waco, so be sure your new doctor has all relevant records and sleep study reports he will need to prescribe a new machine when you are ready. You do not need a sleep specialist if your new primary doctor accepts the management of your CPAP therapy. You only need a specialist if you need to change your therapy or have issues your doctor or you cannot address. The new doctor will ask about your use of CPAP and comfort at regularly scheduled exams, along with any other health issues he manages. This new doctor should be advised of your selection for DME and allowed to share records with them.

[Hydrangea]

When I moved to a different state, I experienced the same thing.

My insurance was still willing to pay the rental $ to my old DME for my machine, so I kept my machine.

I looked on Yelp for DMEs, and went to a few of them. I found that most of them have no clue about CPAP, and just sell wheelchairs. I finally found some CPAP DMEs, and called a few.

I found that the DME would not accept my Rx from another state. So I had to find a doctor, in my new state, who would write an Rx for supplies. I just went to my general practitioner; thankfully he's a new hosehead, so he was sympathetic. He wrote me an Rx for supplies. (He wasn't comfortable writing an Rx for a machine. I'll cross that road when I need to, I guess.)

Even though my insurance covers supplies (I pay a cost-share, as well as toward a deductible), I often order supplies from Amazon because it's cheap enough, no hassle, and I receive them within 2 days... plus, no hassle.

[SleepyTexasGirl]

Talked to my parents, and in DFW Lincare (closest to you is Temple) and Aero Care (in Waco) are Medicare DMEs. Lincare called telling one of them that 5 years were up so it was time for a new CPAP. But apparently never told him he’s entitled to new mask frequently and he’s been using the same mask most of that time. The existing cpap is a good model-one recommended by this board. Then found out he’d have to get another sleep study for Medicare to pay for the machine. Aerocare is disorganized about filling CPAP machine prescription and pushy on ordering supplies as often as required.

For just supplies (mask parts, and filters) ordering online might be cheaper than paying a percentage of what a local DME charges Medicare. Or worth trying for one order while finding a new PCP.

[BAZZA]

If you're on Medicare, it actually is almost never cheaper to buy online with your own money vs going through the trouble to set up an account with a DME that is in-network for Medicare, or your Medicare supplemental insurance company plan.  

Every bit of CPAP equipment and supplies is coded with a "Medicare Allowed Amount" - so the DME's "list price" means nothing to the patient who pays only the coinsurance on the DME (with Medicare, that's 20 percent of the Medicare Allowed Amount)

So a DME might "bill" Medicare $450 for a new mask, but the Medicare Allowed amount for that Mask is going to be around $80, so you - the patient - pay 20 percent of $80 for that mask frame and cushion ($16).  Online prices are good, but not quite that good.  

Anyway, using Medicare and a DME, I get CPAP supplies every 90 days:  
- new mask frame
- 3 to 5 mask cushion replacements (depending on type of mask - I mostly use a ResMed N30i nasal mask and get 5 cushions each 3 mos - online, those nasal cushions alone sell for $25-30 each)
- new heated hose for my AirSense 10 machine
- four new filters for the CPAP machine

The above list means I must pay $37 for all of it every three months.  Twice a year, I can get a replacement humidifier chamber and new headgear for the mask and replace my chinstrap too if I need any of those things.   

That said, I have to watch all of the billing carefully as all of the DME's I've used over the years have made mistakes that need to be corrected promptly to prevent billing problems  -- Just as with nearly everything else associated with healthcare in the USA.  

  Keeping your CPAP gear clean and refreshed is key to mitigating other problems.  I've been at this for over 8 years and never had a bacterial issue from using the CPAP.  I can't imagine using the same mask for 4-5 years as another poster mentioned here.  The rubbers get stiff, and the masks leak which means you are putting up with CPAP without getting the benefit of the therapy.  Use SleepyHead or the ResMed Resscan (or online MyAir) to monitor your mask leak.  It is important. 

Hope this helps as you adjust to being a CPAP user.