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Help!!! Medicare Nightmare
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Papit Offline

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Other Comments: Licensed Professional Engineer, California

Sex: Male
Location: USA California

Post: #11
RE: Help!!! Medicare Nightmare
No, it does not make sense to me either, Anthony. I would make an appointment with my sleep doc and seek his help in unraveling this nonsense. Best of luck, -- Papit

(08-19-2015 12:44 PM)Anthony P Wrote:  Hopefully someone with experience can help.
In 2007 I was diagnosed with sleep apnea and prescribed CPAP. I was ultimately non-compliant at the time and discontinued it.

In 2012 I realized this was still an issue I had to deal with so I had another sleep study. Part of the study was done without CPAP and part with CPAP, however CPAP alone did not resolve the issues so a follow-up study with BIPAP was recommended.

For a variety of reasons I did not get around to the study on BIPAP until this past February (2015). The study was not split but was done only on CPAP and BIPAP.
I received an order for and was started on BIPAP in June and have been generally happy with it and compliant.
My homecare company contacted me today and said Medicare requires me to do another sleep study because I was non-compliant in 2007.
This makes no sense. I hope someone can help out by sharing some insight and their experiences.
Thanks for taking time to read this and thanks in advance for any replies I may receive.
08-19-2015 11:26 PM
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OpalRose Offline


Posts: 3,167
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
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Other Comments: Started CPAP Therapy October 23, 2014

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Post: #12
RE: Help!!! Medicare Nightmare
(08-19-2015 10:37 PM)Ghost1958 Wrote:  Personally i havent had problems with medicare but twice. Both times it wasnt medicare at all but the DME demanding stuff and claiming it was Medicare demanding it
Quick call to my Medicare insurance ended quickly with a threeway call initiated by Medicare , with me , DME and Medicare during which Medicare Rep told the DME to "knock it off and stop making false demands".
Also, Medicare will pay for whatever machine your doc prescribes after the sleep study.
I also began with a home study.
I still bey its your DME playing cya

Anthony P,
I, too suspect it's not Medicare so much as the DME making demands.

I've been dealing with the same DME for 10 months. For the last two months, when I call to place an order they try to tell me that my insurance won't cover an item.

They even went as far as to tell me last month when I ordered a new humidifier chamber that they didn't think it was needed, and that my insurance wouldn't pay
for it. They told me to just keep washing it. Instead of arguing with this "know it all", I did the same and contacted my Medicare insurance and had a 3 way conversation in which Humana Medicare then had to straighten them out.
I know this isn't about supplies, but don't put up with crap from a DME, call your
insurance directly to see what they require.

08-20-2015 07:47 AM
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Baja Offline

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Post: #13
RE: Help!!! Medicare Nightmare
Medicare requires a new sleep study if you fail compliance, so the 2007 report cannot be used. The 2015 study was titration only (cpap + bipap), so that won't work either.

Chances are the doctor's office or sleep lab forgot to send the supplier your 2012 report. That is especially true if there are multiple doctors (e.g. GP & sleep specialist) or if you went to different sleep labs.
08-20-2015 11:21 AM
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Anthony P Offline

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Post: #14
RE: Help!!! Medicare Nightmare
Thanks to everyone for you thoughtful responses.
It seems a repeat will be necessary because of the amount of time between when sleep apnea was "rediagnosed" 12/2012 and the study done only on BIPAP 02/2015.
Also there was a lapse in doctor face to face visits.
So it seems like I will be doing a study with no therapy and then going onto the Bipap settings I have been using for over 2 months now.
Thanks again for taking the time to help a newbie out.
08-20-2015 02:52 PM
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