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How to get a new machine ?
#1
Does anyone know the process for getting a new cpap machine when the current machine warranty is over and one has Medicare insurance?  The DME where I received my first machine has gone out of business, so when that machine developed a problem with the bearing going out, it was cheaper for me to buy a 'gently used' machine from Supplier #2 which I did.  My original machine warranty is over at the end of May 2017.  My current machine still works just fine and I'm sure Medicare is not going to come knocking on my door to tell me "it is time for a new cpap machine."  Could anyone give me their thoughts on the best course of action?
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#2
Well, I may be completely wrong, as I will be facing this in about 2 years.

Being that Medicare changes their rules from year to year, I wonder if they will force another Sleep Study. I'm hoping not. I plan to call my Sleep Doc way ahead of time,
and try to get a newly dated script for the DME. I hope it's that easy!

The DME, Doctor nor Medicare need to know you have another machine.

Hopefully, someone else who has been through this will chime in.
OpalRose
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#3
(05-02-2017, 05:30 PM)OpalRose Wrote: Well, I may be completely wrong, as I will be facing this in about 2 years.  

Being that Medicare changes their rules from year to year, I wonder if they will force another Sleep Study.  I'm hoping not.  I plan to call my Sleep Doc way ahead of time,
and try to get a newly dated script for the DME.  I hope it's that easy!  

The DME, Doctor nor Medicare need to know you have another machine.

Hopefully, someone else who has been through this will chime in.

Medicare has some 'strange' rules - for example:  my insulin pump is guaranteed for 5 years also.  At the end of the 5 yr period, Medicare required the same blood tests that I had before I got the pump 5 years prior.  I don't think my type 1 diabetes was cured in 5 years, but nope, I had to do the blood tests all over again.  I, too, am hoping the process of getting a new cpap doesn't turn into a fiasco. Sad
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#4
The best advise is to get your records together. Most recent prescription, any sleep reports and any information from the dispensing of the original machine. Set an appointment with your doctor and tell him your machine has broken down and you need a replacement. You can guide the replacement process towards the machine of your choice. You understand your needs, have copies of your sleep studies and experience from using your first CPAP. For now, you will ignore / not mention the fact you have replaced the machine on your own dime. Hopefully you will be prescribed a replacement, and you will know what Medicare provider you want to use.

The DME will take your prescription, and you may want to also provide them with the broken machine so they know, and can document, it needs replacement. Get a clear understanding of what machine you expect to receive. The DME should take it from there to get authorization. If you have prescriptions and sleep studies and can provide copies of those documents, you will avoid a sleep study. If those records don't exist, you will probably not avoid a study. Medicare will want the proof of diagnosis based on a clinical sleep study. It does not have to be current. With regard to the broken machine..."it just happened and I'm desperate for a replacement. I use this every night".
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#5
Medicare will approve a new machine every 5 years. My sleep doc would not write a prescription without a new sleep study.
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#6
I just got a new machine in January. My original machine was 10 years old. My sleep study was also 10 years ago. I have a medicare Advantage plan but I don't think the rules are different than for standard Medicare. I was able to get a new machine without a sleep study based on having had compliance confirmed by my Dr. within the 6 month period before the machine was ordered. It did, however, require a new prescription. I was told by the nurse practitioner at his office that a new prescription for supplies is required every 6 months. Fact or fiction? I don't know.

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#7
Your machine is still in warranty. Get your paperwork together and pick another Medicare supplier. Contact them about the process of getting your machine repaired or replaced by Medicare. Don't WAIT! Your options are more limited and lengthy once you pass the warranty period!
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