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Medicare Denial
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Tony Brown Offline

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Posts: 7
Joined: Sep 2015

Machine: ResMed Airsense 10 Auto-Set
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro Air
Humidifier: ResMed SX556-0204
CPAP Pressure: 6-16
CPAP Software: Not using software

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Sex: Male
Location: Australia

Post: #11
RE: Medicare Denial
Hmm Sad I was diagnosed with Sleep Anea back in late June/early July of this year. Did a sleep study and all that and was told I had the problem.The doctor suggested a clinic not too far from where his practice is situated and I went there.I was on a manual machine for awhile and then got switched to the "Resmed Airsense 10". Medicare did not refund me any of the purchase price of the machine ($3,000.00) and only refunded the sleep study ( $500.00 ) Feel a bit ripped off here but I suppose that's progress nowadays Sad
09-15-2015 01:41 AM
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justMongo Offline

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Posts: 3,853
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: #12
RE: Medicare Denial
Just a footnote. The OP is in the US and the US has a program called Medicare.
Australia also has a program called Medicare.

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.
09-15-2015 11:18 AM
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Kidnap Offline

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Posts: 20
Joined: Sep 2015

Machine: Respironics DreamStation
Mask Type: Full face mask
Mask Make & Model: Quatro Air 62703
Humidifier: DreamStation
CPAP Pressure: 5cm - 20cm
CPAP Software: SleepyHead Other Software

Other Comments: I'll try DreamMapper

Sex: Male
Location: Pittsburgh, PA USA

Post: #13
RE: Medicare Denial
Bigwink A Big Thanks to everyone who responded. It is great to have somewhere you can discuss your sleep problems.

All of your suggestions are great. Some things I left out or am answering.

1. My doctor did test my hormone levels and I am not in replacement therapy. He said the next logical reason for high hemocrit count is when oxygen levels drop and the body tries to make more red blood cells to compensate.
2. I did put this in my Doctors hands. His head nurse has been making phone calls for at least 2 weeks.
3 The calls from my DME said at first that I had been selected to receive the Resmed Autosence 10 , no real mention of Medicare approval. She then said I had to wait for Medicare final approval. The second call she just said I was denied because I didn't see the Doctor "face to Face" before he wrote the order. I explained that I did see him & she said it had to be less than 6 months.
4.My Doctor wrote a new order the last week of July but it was by phone. Then I had a home sleep study, which I failed, and an in hospital titration test. With the denial these are the only bills I may have to pay. The next round would be paid. The machine & accessories should be covered completely between Medicare and my top of the line Plus Plan.
5.To Tony Brown I feel so bad for you. Who could have seen that 3K bill coming. I guess you can't get a replacement for any reason until the time limit is up.
6.I will be away from my computer until Saturday or Sunday. I will reply to new posts after that.

Your Friend Kidnap
09-15-2015 08:25 PM
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Tony Brown Offline

Members

Posts: 7
Joined: Sep 2015

Machine: ResMed Airsense 10 Auto-Set
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro Air
Humidifier: ResMed SX556-0204
CPAP Pressure: 6-16
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: Australia

Post: #14
RE: Medicare Denial
(09-15-2015 08:25 PM)Kidnap Wrote:  Bigwink A Big Thanks to everyone who responded. It is great to have somewhere you can discuss your sleep problem.
To Tony Brown : I feel so bad for you. Who could have seen that 3K bill coming. I guess you can't get a replacement for any reason until the time limit is up.
Hi "Kidnap" Here in Oz we have Medicare which is the public health insurance program and is subsidised by the Goverment.Then we also have a lot of Private Insurance Health Schemes which you have to pay for.
At the moment,I'm paying about $1700.00/year for one of these and as I said,it did not reimburse me a single plugged nickel for the machine Sad
09-17-2015 05:51 PM
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Mosquitobait Offline

Advisory Members

Posts: 746
Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #15
RE: Medicare Denial
Make an appointment to see your doctor face-to-face to confirm that it is helping you and file an appeal. Mention that you didn't KNOW you were supposed to see the doctor again within a specified period of time. In addition, mention in your appeal letter than it makes no sense to go through the sleep lab again because that has been done AND diagnosed! This is all new to you and Medicare nor the DME provided you with detailed information as to what you were supposed to do when. You are not an experienced CPAP patient. You needed guidance and others failed to provide said guidance.

You are getting wrong information from a jackass. Medicare never requires you to go through testing AGAIN when tests already done have provided a diagnosis. Imagine if you had to have another CT scan? Ridiculous.
09-17-2015 06:41 PM
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eseedhouse Online

Advisory Members

Posts: 882
Joined: Dec 2014

Machine: ResMed Airsense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: SimPlus
Humidifier: ResMed
CPAP Pressure: 7-10
CPAP Software: SleepyHead

Other Comments: Also on supplemental O2 at 3L/min. while sleeping.

Sex: Male
Location: Victoria, British Columbia

Post: #16
RE: Medicare Denial
(09-15-2015 11:18 AM)justMongo Wrote:  Just a footnote. The OP is in the US and the US has a program called Medicare.
Australia also has a program called Medicare.

As does Canada. In Australia and Canada I believe it covers everyone whereas in the USA it covers only those 65 or older. Well, I know for sure it covers everyone in Canada - I don't live in Australia.

Ed Seedhouse
VA7SDH

I am neither a Doctor, nor any other kind of medical professional.

Actually you know, it is what it isn't.
09-17-2015 07:53 PM
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Kidnap Offline

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Posts: 20
Joined: Sep 2015

Machine: Respironics DreamStation
Mask Type: Full face mask
Mask Make & Model: Quatro Air 62703
Humidifier: DreamStation
CPAP Pressure: 5cm - 20cm
CPAP Software: SleepyHead Other Software

Other Comments: I'll try DreamMapper

Sex: Male
Location: Pittsburgh, PA USA

Post: #17
RE: Medicare Denial
Tony Brown wrote:I'm paying about $1700.00/year for one of these and as I said,it did not reimburse me a single plugged nickel for the machine.

My U.S. Medicare is $99.00 USD and my insurance is about $1200.00 USD per year but my old employer reimburses me $825.00 USD per year. It pays for everything Medicare doesn't UNLESS Medicare denies the claim. My Problem! I just have to wait until the Doctor exhausts his efforts then fight for myself.

Mosquitobait wrote: You are getting wrong information from a jackass.

YES. that would be my DME. I got to go around them.
Are the Mosquitoes in the great country of Canada really so big they have Red Crosses painted on their sides? lol

Thanks Again Guys.

PS: how do you get those neat quote boxes?

Your Friend Kidnap
09-18-2015 06:28 PM
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OpalRose Offline

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Posts: 3,181
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #18
RE: Medicare Denial
Kidnap,
At the top of this page, right side, click on HELP. You will find loads of helpful threads. Wink

OpalRose
09-18-2015 06:48 PM
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Kidnap Offline

Preferred Members

Posts: 20
Joined: Sep 2015

Machine: Respironics DreamStation
Mask Type: Full face mask
Mask Make & Model: Quatro Air 62703
Humidifier: DreamStation
CPAP Pressure: 5cm - 20cm
CPAP Software: SleepyHead Other Software

Other Comments: I'll try DreamMapper

Sex: Male
Location: Pittsburgh, PA USA

Post: #19
RE: Medicare Denial
to OpalRose thanks a million I'll check this out tomarrow. Bed time now without my CPAP.

Your Friend Kidnap
09-18-2015 10:21 PM
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Kidnap Offline

Preferred Members

Posts: 20
Joined: Sep 2015

Machine: Respironics DreamStation
Mask Type: Full face mask
Mask Make & Model: Quatro Air 62703
Humidifier: DreamStation
CPAP Pressure: 5cm - 20cm
CPAP Software: SleepyHead Other Software

Other Comments: I'll try DreamMapper

Sex: Male
Location: Pittsburgh, PA USA

Post: #20
RE: Medicare Denial
Well ! It's been a year and a month since my U.S. Medicare "6 month rule" fiasco. A reminder I was denied a CPAP because I waited over 6 months between seeing my doctor and getting my tests. I had a total hip replacement soon after my doctor visit. I then ask if Medicare would pay to retest or if I had to wait a year. After being passed off from rep to rep, to DME and finally a DME manager. His only SOLUTION was go ahead take the test then we can determine if we'll pay or not. WHAT ! I could get stuck with approximately $7,000 USD if they said no. So I waited over a year. This Tuesday I saw my doctor "Face to Face" and last night I took the home apnea test. More to follow ...................

Your Friend Kidnap
09-16-2016 10:43 AM
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