Medicare Denial

[Tony Brown]

Hmm 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

[justMongo]

Just a footnote. The OP is in the US and the US has a program called Medicare.
Australia also has a program called Medicare.

[Kidnap]

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.

[Tony Brown]

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

[Mosquitobait]

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.

[eseedhouse]

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.

[Kidnap]

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?

[OpalRose]

Kidnap,
At the top of this page, right side, click on HELP. You will find loads of helpful threads.

[Kidnap]

to OpalRose thanks a million I'll check this out tomarrow. Bed time now without my CPAP.

[Kidnap]

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 ...................