(11-24-2013, 06:43 PM)sleepy_one Wrote: I am now worried about the heated hose the equipment company sold me. Will medicare pay for a heated hose a month after they paid for a non-heated one? They said "it's a different code" but what does that mean?
And now I'm feeling that the doctor is costing us money too, as she ordered the expensive at home study instead of a new machine, which is what I think my husband will eventually end up with. (She is a sleep specialist and seems really good except for this new machine issue.) So then we will end up paying for the home study and machine rental AND a new machine.
Sleepy_One, it's not necessarily a bad thing for the doctor to order a new sleep study if your husband's last one was 5 years ago when he got his machine. She needs to determine if the pressure setting from his previous study is correct for him or needs to be adjusted. Many things can affect the setting over the years such as losing weight, gaining weight, general health conditions, etc. Some insurance companies (including Medicare) require a sleep study before they will pay for a new CPAP machine. My sister's insurer required a home study to determine if a study was needed in a sleep lab and when the study showed that she did have enough events to be diagnosed OSA, then she had to have the sleep lab study done before they would pay for the CPAP! There's so many rules and regulations now that it's hard to know what's required.
As for Medicare paying for the heated hose, when my friend got her machine, the DME didn't provide the heated hose either and she had problems with "rainout" (water condensation in the tube). She asked her doctor to write a prescription for the heated hose within just a few days of getting the CPAP machine. Medicare paid for the heated hose since it's a separate billing number (not considered part of the original machine but like an accessory), and was a "medical necessity". Your situation sounds similar, so I doubt you'll have any problem with them paying for your heated hose. If they do, just ask your doctor to write the prescription for it and have the DME submit that.
Good luck and try not to worry. All these things will work themselves out.