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How long does Medicare take to approve cpap?
#1
Hi, new member here. From experience of you "oldtimers", how long does it take Medicare to approve MD order for Cpap?
Thanks.

Inspired
Inspired
Bigwink
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#2
US Medicare has traditional Medicare and Medicare Advantage Plans.

For traditional Medicare, pre-approval is not required. Medicare Part B will rent to own a machine for 13 months as long as the diagnosis was confirmed by a sleep study and you show compliance by using it 4 hours or more per night for a certain number of days. I think you need a followup visit with the prescribing doctor also.

If in an advantage plan; then you are under the thumb of an insurance company.

And Welcome
[Image: 1F4m9Ift.jpg]
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#3
Medicare covered my home study, lab titration, as they were done, script was wrote and i could have had a machine in two days but that was waiting on the script for the machine not Medicare.
I have an advantage plan. Buy its ppo not managed and doesnt need preapproval or staying in network.
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#4
Hi Inspired,
WELCOME! to the forum.!
Much success to you with your CPAP therapy and hang in there for more responses to your post.
trish6hundred
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#5
(12-30-2015, 04:43 PM)justMongo Wrote: US Medicare has traditional Medicare and Medicare Advantage Plans.

For traditional Medicare, pre-approval is not required. Medicare Part B will rent to own a machine for 13 months as long as the diagnosis was confirmed by a sleep study and you show compliance by using it 4 hours or more per night for a certain number of days. I think you need a followup visit with the prescribing doctor also.

If in an advantage plan; then you are under the thumb of an insurance company.

And Welcome

Thanks, and I am so impressed with all the info on this site...it will be such a great help to me.

Inspired
(12-30-2015, 04:45 PM)Ghost1958 Wrote: Medicare covered my home study, lab titration, as they were done, script was wrote and i could have had a machine in two days but that was waiting on the script for the machine not Medicare.
I have an advantage plan. Buy its ppo not managed and doesnt need preapproval or staying in network.

Thanks, Ghost. I just found out from the DME that the delay is because Medicare wants a signed (not stamped) sleepstudy report from my MD. Of course his office is now closed until Monday.
C'est La Vie!

Inspired
Inspired
Bigwink
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#6
Inspired, I ran into the same problem(s). I could had my machine the day after the PSG but Medicare requires the pre PSG visit, the PSG and a post-PSG visit reports. It took me almost a month to get the post-PSG report. My doctor did not know a post-PSG visit was required!

The compliance that Medicare B requires is the card recording that you used the machine for at least 4 hours a night for 30 consecutive days or the it was used for at least 4 hours a night for 75% of the time over a 90 day period and that the doctor has reviewed either with you.

The post PSG and post reviews seem a bit bogus to me and a waste of time (as was the Post-PSG visit) if you understand the PSG (sleep study report) but the government is good for doing that.

I know: I am not my doctor even though I more years in school and advanced degrees than he has and understand the subject far better than he does. One does not self prescribe! (But I will guarantee you this: you damn well better know your body better than the physicians that treat you: When I had cancer, it took four different physicians <and I think that the first, third and fourth were very good physicians> to get them to perform a biopsy to confirm it. Admittedly, it was a very rare cancer. I caught it early and hopefully treated it very early so there is only a low chance that anything more will come of it.)
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#7
The approval is immediate. They can do it right over the computer. The DELAY is by the DME making sure that they have all the proper paperwork. Sometimes the doctor's office is at fault for not sending the right stuff. Sometimes it's the DME. Sometimes both. Lincare had everything ready for me within a couple of days, but then I had to wait about 10 days for my appointment for set-up (training is required by Medicare). My brother only had to wait 5 because they had a cancellation.
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#8
(12-31-2015, 12:04 PM)Mosquitobait Wrote: The approval is immediate. They can do it right over the computer. The DELAY is by the DME making sure that they have all the proper paperwork. Sometimes the doctor's office is at fault for not sending the right stuff. Sometimes it's the DME. Sometimes both. Lincare had everything ready for me within a couple of days, but then I had to wait about 10 days for my appointment for set-up (training is required by Medicare). My brother only had to wait 5 because they had a cancellation.

You are right: While the approval is immediate, the delays are getting all of the things they want done!
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#9
IU lucked out. Had a sleep study on a Saturday night saw the sleep doc for the results the next Wednesday. He faxed the Rx to the DME company and told me to call them when I got home. Got an appointment for the next day and walked out with my new machine. I'm on Medicare.
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#10
Everyone is correct about authorization. The time consuming part is having your doctor provide all of the necessary and proper documentation to your DME provider.
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