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Machine replacement by Medicare
#1
Machine replacement by Medicare
My Resmed machine will be 5 years old this month. I understand Medicare will cover replacement after 5 years but am not sure what is required. I have a United Healthcare Advantage plan which follows Medicare guidelines. I phoned their customer service and was told a new machine will be covered but that Medicare requires a new sleep study to verify medical necessity. I pressed the rep a little about the sleep study requirement and it was clear she was unsure. My sleep study was in 2007 but I had no trouble getting my present machine in 2017 with this plan without a new sleep study. I'm wondering if Medicare requirements have changed. Has anyone had recent experience with this?
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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.

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#2
RE: Machine replacement by Medicare
I've dealt with UnitedHealthCare Community as they were my Medicaid coverage before Disability approval. Regardless, I'd be a bit suspicious of new tests to prove existing medical necessity to get a new machine. Now, when it comes to compliance, they may require that.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Machine replacement by Medicare
Since I've probably missed only 4 or 5 nights in the last 5 years I don't think compliance will be a problem.
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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.

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#4
RE: Machine replacement by Medicare
Just stating the obvious.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Machine replacement by Medicare
If you were changing from an Apap to a Bipap, then Medicare sometimes wants proof of medical necessity for that higher level machine via a Sleep Test.

But if you're replacing with another Apap, there shouldn't be a problem.  If you've been seeing a Sleep doctor or even your regular Doctor for your SA and they have documented your use, then the Doctor only has to send a Script to your DME for replacement.  

I would be surprised if this was an issue to get a new machine.
OpalRose
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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.
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