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Insurance (Medicare) and Machine Choices
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sir_sleeps_alot Offline

Preferred Members-2

Posts: 58
Joined: Oct 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Mirage FX
Humidifier: Hi5
CPAP Pressure: 14 cm h2o
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: New England

Post: #1
Insurance (Medicare) and Machine Choices
I visited the website of the DME provider who is supposed to be supply my CPAP and found a list of the cpap machines they provided.

They are:

Resmed S8 AutoSet™ II with Easy-Breathe
Resmed S8 Elite
Resmed S8 Escape
Resmed S9 AutoSet

REMstar Plus CPAP System
REMstar Plus M Series with C-Flex
REMstar Pro
REMstar Auto Smart CPAP System
REMstar Pro M Series with C-Flex

Archangle's Machine Choice wiki page (found on this site) recommends the following:

ResMed S9 AutoSet
Philips Respironics PRS1 Auto (PRS1 = Philips Respironics System One)
ResMed S9 Elite
Philips Respironics PRS1 Pro

It sounds like I should really push for the S9 Autoset as they provide none of the other recommended machines.

Does Medicare specify what machines it will and will not cover? Does the doctor specify a machine or machines when he or she writes the prescription? If not, does the DME get to pick which machine to offer me or do I have some say in the matter? Do I have a legal right to choose?

Also, I read about about someone receiving a "new" machine only to find that it had been used previously. Does Medicare specify whether machines should be new or used?

My understanding is that Medicare will "rent" the machine for 13 months and if I continue to need/use it, they will "purchase" it for me after that. If I find I need a new / different machine during this time, will the DME take it back and give me a different one?

Thanks for all the help,
Sid
10-18-2013 05:01 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #2
RE: Insurance (Medicare) and Machine Choices
Medicare works with codes. Everything has a freakin' code. CPAP machines, auto and "regular" have the same code. Bilevels have another code and ASV have yet another. And what that code does is set a price. For CPAP machines, they only pay X amount. Doesn't matter if it is an S9 Autoset or an S9 Escape, they pay X amount. So of course a supplier is going to want to give you the Escape since that gives them the biggest profit margin.

The supplier has to provide you with what your doctor writes the prescription for. So have the doctor write the prescription for an autoPAP. And make sure the doctor's prescription says "dispense as written".

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-18-2013 05:24 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #3
RE: Insurance (Medicare) and Machine Choices
Oh, and do not accept possession of an S8. They are outdated. They use a proprietary data card (you can only use ResMed's card) and proprietary card reader (you can only use their reader). Both are difficult to find.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-18-2013 05:25 PM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #4
RE: Insurance (Medicare) and Machine Choices
what Paulo02 said
10-18-2013 06:13 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #5
RE: Insurance (Medicare) and Machine Choices
Hi Sid
As Paula said ask your doctor specify type of machine on the prescription (for example, S9 AutoSet - pressure 8-12, H5i humidifier, ClimateLine, mask of choice) and dispense as written so you exactly get what wanted and avoid any confusion (its illegal for the DME to give you other than whats on the script)
Machines names are confusing and some lousy DME can easily slip the wrong machine while one is not looking (it happen to a lots of folks)

ResMed machines are identifiable by the model name (avoid S9 Escape and S9 Escape Auto models), look next to stop/start button for the model name. S9 series specifications guide and comparison chart
http://www.resmed.com/us/products/s9_ser...nc=dealers

Respironcis are even more confusing, REMstar with everything. You want Phillips and System One in the name
The model number tells you whether the machine data capable or not, models numbers below 460 are not data capable machine. Model number on the bottom of the machine (remove water tank before checking)
System One comparison guides
http://www.healthcare.philips.com/asset....-guide.pdf

Its always better to get an autoPAP (AutoSet not Escape Auto), you can use it at fixed pressure and gives the option of auto-adjust/titration otherwise this option is not available on fixed pressure machine
10-18-2013 06:44 PM
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justMongo Offline

Monitors

Posts: 3,843
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #6
RE: Insurance (Medicare) and Machine Choices
(10-18-2013 05:01 PM)sir_sleeps_alot Wrote:  My understanding is that Medicare will "rent" the machine for 13 months and if I continue to need/use it, they will "purchase" it for me after that. If I find I need a new / different machine during this time, will the DME take it back and give me a different one?

Thanks for all the help,
Sid

On this point -- Medicare rents it for 13 months; at the end of 13 months it belongs to you. Medicare considers it paid in full after 13 months of rental.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-18-2013 07:12 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #7
RE: Insurance (Medicare) and Machine Choices
Yeah, and in that 13 months, they could have bought you 3 of them. It's one of their stupidest things.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-18-2013 09:13 PM
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sir_sleeps_alot Offline

Preferred Members-2

Posts: 58
Joined: Oct 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Mirage FX
Humidifier: Hi5
CPAP Pressure: 14 cm h2o
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: New England

Post: #8
RE: Insurance (Medicare) and Machine Choices
Thanks for the responses. I don't have a copy of the prescription as it was sent directly to the DME company. The nurse practitioner I met with to get my sleep study results said that they would write a script for a cpap and said that they tend to use ResMed or Respironics. The impression I got was that it was up to the DME as to what machine I got... but sounds like this is not the case.

I will call on Monday to see what I find out. I also have some concerns about the DME they contacted for me. Even though there are a couple of local companies who take both of my insurances, they set me up with a company that is in another state and that probably isn't covered by my in-state secondary plan. Soooooo frustrating. All this "hurry up and wait" stuff is making me nuts.

Thanks for the info!
Sid
10-20-2013 07:26 PM
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bwexler Offline

Advisory Members

Posts: 563
Joined: Mar 2012

Machine: PRS 1 BiPAP autoSV Advanced, with Heated Tube humidifier
Mask Type: Nasal mask
Mask Make & Model: Sleepweaver Élan
Humidifier: Resperonics Heated Tube humidifier
CPAP Pressure: Max pressure 25.0 cm H20, Max
CPAP Software: SleepyHead EncorePro

Other Comments: CMS 50i with Software for SpO2

Sex: Male
Location: San Marcos, CA, USA

Post: #9
RE: Insurance (Medicare) and Machine Choices
I believe the way it works is the DME gets to pick the most profitable machine within the code on the prescription, unless YOU tell the doctor exactly what you want him to put on the prescription. Then you must verify that what you received is actually what you requested and is new.

If you don't like the DME you were assigned, you should be able to switch, as long as your insurance, your medical group and your doctor all are willing to work wit your choice. You must speak up for yourself, lowed clear and often.

I think there are 3 types of DMEs, lazy, dumb, crooked. Caveat emptor.
10-20-2013 08:12 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,065
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #10
RE: Insurance (Medicare) and Machine Choices
There are some good suppliers out there. Sadly, however, they are few and far between. CPAP suppliers seem to be in it for the money and not for the patient.

I would stick with one within your state.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-21-2013 02:16 PM
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