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Medicare and 2nd machine
#11
Once again, let me encourage everyone who runs into medicare BS to complain to their Congressmen.

They probably won't listen much, but nothing good will happen unless they become convinced that there are lots of unhappy voters.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#12
Thanks for the helpful list and information about Medicare.

If in some parts of the country, Medicare is now being administered by a 3rd party "Management" firm, there might be more resistance to the procedures, I suppose. This is perhaps the first step to privatizing the entire Medicare/Medicaid process. I've seen what that does to a hospital, in terms of patient care. We should all pay close attention to this. And contact your elected officials, as archangle said.
Where I am, this is not the case, at the moment. I've had near-perfect service from my DME up to now, all under Medicare and my secondary insurance.

I'm waiting for the USPS to deliver copies of the documents which have already been sent to my DME. Then I'll ring them, depending on what the document called "Dr's notes" which I assume is also the prescription, says. If I run into any problems, I'll get back to my cardiologist who I saw yesterday. He understands the importance of treatment for sleep apnea as it relates to his speciality.

Thanks to the information I've learned from this forum, my new pulmonologist's nurse told me "You're not like most of the patients we see; you're so much more informed."
Thumbs-up-2




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#13
(03-16-2015, 12:30 PM)AirSign Wrote:

Nurse said this is because of Medicare rules.
If the MD writes the prescription, that's not enough. He also has to certify that the therapy I've been using for 6 years every night is benefitting me?

My first response was to say "well, I'm still alive."

Has anyone else had this required from Medicare for a second machine after 5+ years?

Actually, your doctor is supposed to SEE you to confirm that it is helping you. However, yes, it is a requirement every time you get a new machine. I read it on the Medicare site and also confirmed it with Medicare (I'm trying to get a new machine for my brother - he's had his 8 years).
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#14
(03-16-2015, 06:32 PM)Mike1953 Wrote: Medicare may allow a new machine every 5 years but each time a new machine is issued you have to show the compliance and meet face to face with your Dr. who has to file that it is a benefit to your health. Then you have to meet with him within the 90 days compliance for Medicare to continue to pay for your new machine. Compliance is at least 4 hours each night for 70% of the time during the first 90 days of using a new machine.
Medicare and most private insurers cover scheduled replacements of all mask parts and other supplies (including CPAP machines, but we’ll talk about those in an upcoming blog post). Ask your insurance provider how often it will cover the replacement of each part. Your equipment supplier can answer any questions about this and even help you fill out and process any necessary forms. Based on Medicare coverage, we suggest that you replace:
Every month
• Mask cushions and/or nasal pillows
• CPAP machine filters
Every 3 months
• Mask frame (not including the headgear)
• CPAP tubing
Every 6 months
• Mask headgear
• Chin strap (if applicable)
• Humidifier water tub

I'm new to Medicare. My Senior Advantage is with my HMO, which I've had for 50 years. The second day of Medicare, I put in for a new full face mask and head gear. No hassle. From this Board, I learned that I can get new face cushions every month. I was given a three month supply. In July, I'm looking for a new BiPAP.
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#15
(05-23-2015, 07:43 PM)2PAPs Wrote: In July, I'm looking for a new BiPAP.

Hi 2PAPs, welcome to the forum.

The PRS1 760 model with Heated Tube (DS760TS) has the nice feature that the PS can be given a range and will vary itself within this range (very slowly) to provide only as much PS as needed to eliminate Flow Limitation (and resulting RERA, Respiratory Effort-Related Arousal). Armed with this info (how much PS he machine is finding necessary to eliminate FL) one can set a fixed number for PS, or one can continue to let the machine continually self-titrate PS.

The machine also reports an estimate for the number of RERAs which are occurring.

The corresponding S9 VPAP Auto or AirCurve 10 VAuto machines from ResMed provide neither of these features.


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#16
(05-12-2015, 02:08 PM)Mosquitobait Wrote:
(03-16-2015, 12:30 PM)AirSign Wrote:

Nurse said this is because of Medicare rules.
If the MD writes the prescription, that's not enough. He also has to certify that the therapy I've been using for 6 years every night is benefitting me?

My first response was to say "well, I'm still alive."

Has anyone else had this required from Medicare for a second machine after 5+ years?

Actually, your doctor is supposed to SEE you to confirm that it is helping you. However, yes, it is a requirement every time you get a new machine. I read it on the Medicare site and also confirmed it with Medicare (I'm trying to get a new machine for my brother - he's had his 8 years).

I didn't have to see my doctor to see that treatment was helping me. The DME would do the download and see that I was compliant and that was reported to my insurance company. It might be different because I have been on treatment for a few years now. I have never been told to see the sleep doc again (except by the office staff) and I choose to see my primary doc that is internal medicine and is quite capable of handling my issues as they arise. If ever there are issues she cannot handle, then I am sure she will tell me and then I will go to a specialist but I am just not willing to pay a $45 copay to a specialist for something my primary doc can handle. If she can't, then I will pay the copay and go to a specialist.
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#17
(03-16-2015, 06:32 PM)Mike1953 Wrote: Medicare may allow a new machine every 5 years but each time a new machine is issued you have to show the compliance and meet face to face with your Dr. who has to file that it is a benefit to your health. Then you have to meet with him within the 90 days compliance for Medicare to continue to pay for your new machine. Compliance is at least 4 hours each night for 70% of the time during the first 90 days of using a new machine.
Medicare and most private insurers cover scheduled replacements of all mask parts and other supplies (including CPAP machines, but we’ll talk about those in an upcoming blog post). Ask your insurance provider how often it will cover the replacement of each part. Your equipment supplier can answer any questions about this and even help you fill out and process any necessary forms. Based on Medicare coverage, we suggest that you replace:
Every month
• Mask cushions and/or nasal pillows
• CPAP machine filters
Every 3 months
• Mask frame (not including the headgear)
• CPAP tubing
Every 6 months
• Mask headgear
• Chin strap (if applicable)
• Humidifier water tub
IMO, there's no reason to replace all the above items as frequently as Medicare allows. Examples:
Mask cushions: I've been using the same mask cushion for three months, and it is good as new. At the rate the DME is sending them to me, I'll need a new closet to store them all.
Filters: The replacement frequency depends on the environment, but the filters are cleanable and reusable. I have about 20 now, and I'm still using the original one.
Mask frame: Mine is just a piece of plastic. Unless it somehow gets damaged, it will last for years.
Tubing: Cleanable and reusable. It should last for years.
Headgear: I agree with this one. The velcro does lose its adhesion after a while and the elastic can get brittle.
Chin strap: Ditto - the elastic can get brittle after a few months.
Humidifier water tub: There's nothing to wear out. It is just a plastic container with a hinged lid. Should last for years.

When it comes time for the next three month supply cycle, I'm going to tell my DME what I need, and tell them not to send anything else. There's enough Medicare fraud without me adding to it.
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#18
(05-24-2015, 12:24 AM)Jim Bronson Wrote:
(03-16-2015, 06:32 PM)Mike1953 Wrote: Medicare may allow a new machine every 5 years but each time a new machine is issued you have to show the compliance and meet face to face with your Dr. who has to file that it is a benefit to your health. Then you have to meet with him within the 90 days compliance for Medicare to continue to pay for your new machine. Compliance is at least 4 hours each night for 70% of the time during the first 90 days of using a new machine.
Medicare and most private insurers cover scheduled replacements of all mask parts and other supplies (including CPAP machines, but we’ll talk about those in an upcoming blog post). Ask your insurance provider how often it will cover the replacement of each part. Your equipment supplier can answer any questions about this and even help you fill out and process any necessary forms. Based on Medicare coverage, we suggest that you replace:
Every month
• Mask cushions and/or nasal pillows
• CPAP machine filters
Every 3 months
• Mask frame (not including the headgear)
• CPAP tubing
Every 6 months
• Mask headgear
• Chin strap (if applicable)
• Humidifier water tub
IMO, there's no reason to replace all the above items as frequently as Medicare allows. Examples:
Mask cushions: I've been using the same mask cushion for three months, and it is good as new. At the rate the DME is sending them to me, I'll need a new closet to store them all.
Filters: The replacement frequency depends on the environment, but the filters are cleanable and reusable. I have about 20 now, and I'm still using the original one.
Mask frame: Mine is just a piece of plastic. Unless it somehow gets damaged, it will last for years.
Tubing: Cleanable and reusable. It should last for years.
Headgear: I agree with this one. The velcro does lose its adhesion after a while and the elastic can get brittle.
Chin strap: Ditto - the elastic can get brittle after a few months.
Humidifier water tub: There's nothing to wear out. It is just a plastic container with a hinged lid. Should last for years.

When it comes time for the next three month supply cycle, I'm going to tell my DME what I need, and tell them not to send anything else. There's enough Medicare fraud without me adding to it.

These items are usually replaced this often because of infection concerns. Bacteria have ways of sneaking into worn or old items even if you clean them.

Just don't discount this risk.
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#19
(05-24-2015, 02:51 AM)multime Wrote:
(05-24-2015, 12:24 AM)Jim Bronson Wrote:
(03-16-2015, 06:32 PM)Mike1953 Wrote: Medicare may allow a new machine every 5 years but each time a new machine is issued you have to show the compliance and meet face to face with your Dr. who has to file that it is a benefit to your health. Then you have to meet with him within the 90 days compliance for Medicare to continue to pay for your new machine. Compliance is at least 4 hours each night for 70% of the time during the first 90 days of using a new machine.
Medicare and most private insurers cover scheduled replacements of all mask parts and other supplies (including CPAP machines, but we’ll talk about those in an upcoming blog post). Ask your insurance provider how often it will cover the replacement of each part. Your equipment supplier can answer any questions about this and even help you fill out and process any necessary forms. Based on Medicare coverage, we suggest that you replace:
Every month
• Mask cushions and/or nasal pillows
• CPAP machine filters
Every 3 months
• Mask frame (not including the headgear)
• CPAP tubing
Every 6 months
• Mask headgear
• Chin strap (if applicable)
• Humidifier water tub
IMO, there's no reason to replace all the above items as frequently as Medicare allows. Examples:
Mask cushions: I've been using the same mask cushion for three months, and it is good as new. At the rate the DME is sending them to me, I'll need a new closet to store them all.
Filters: The replacement frequency depends on the environment, but the filters are cleanable and reusable. I have about 20 now, and I'm still using the original one.
Mask frame: Mine is just a piece of plastic. Unless it somehow gets damaged, it will last for years.
Tubing: Cleanable and reusable. It should last for years.
Headgear: I agree with this one. The velcro does lose its adhesion after a while and the elastic can get brittle.
Chin strap: Ditto - the elastic can get brittle after a few months.
Humidifier water tub: There's nothing to wear out. It is just a plastic container with a hinged lid. Should last for years.

When it comes time for the next three month supply cycle, I'm going to tell my DME what I need, and tell them not to send anything else. There's enough Medicare fraud without me adding to it.

These items are usually replaced this often because of infection concerns. Bacteria have ways of sneaking into worn or old items even if you clean them.

Just don't discount this risk.
Can you please provide citations for your statement please?

As for the list above, the only objection I would have is with the filters. they are not reuable filters. Not on the Resmed unit and they are not very expensive. You can get them in packs of 6 or 12 for much less than via the DME is most cases and there is no reason to try to extend them. Clogged, they affect the air flow of the machine.

Current Settings PS 4.0 over 10.6-18.0 (cmH2O) BiLevel Auto
TNET Sleep Resource Pages
CPAP Machine Database
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#20
(05-24-2015, 11:19 AM)krelvin Wrote:
(05-24-2015, 02:51 AM)multime Wrote:
(05-24-2015, 12:24 AM)Jim Bronson Wrote: IMO, there's no reason to replace all the above items as frequently as Medicare allows. Examples:
Mask cushions: I've been using the same mask cushion for three months, and it is good as new. At the rate the DME is sending them to me, I'll need a new closet to store them all.
Filters: The replacement frequency depends on the environment, but the filters are cleanable and reusable. I have about 20 now, and I'm still using the original one.
Mask frame: Mine is just a piece of plastic. Unless it somehow gets damaged, it will last for years.
Tubing: Cleanable and reusable. It should last for years.
Headgear: I agree with this one. The velcro does lose its adhesion after a while and the elastic can get brittle.
Chin strap: Ditto - the elastic can get brittle after a few months.
Humidifier water tub: There's nothing to wear out. It is just a plastic container with a hinged lid. Should last for years.

When it comes time for the next three month supply cycle, I'm going to tell my DME what I need, and tell them not to send anything else. There's enough Medicare fraud without me adding to it.

These items are usually replaced this often because of infection concerns. Bacteria have ways of sneaking into worn or old items even if you clean them.

Just don't discount this risk.
Can you please provide citations for your statement please?

Citation

Please read the hoses section. Also this is very common knowledge and as such before asking others to provide citations you should spend the one minute it takes with a Google search.

As for the list above, the only objection I would have is with the filters. they are not reuable filters. Not on the Resmed unit and they are not very expensive. You can get them in packs of 6 or 12 for much less than via the DME is most cases and there is no reason to try to extend them. Clogged, they affect the air flow of the machine.

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