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Medicare and CPAP supplies HELP!
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Kate Offline

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Posts: 85
Joined: Dec 2013

Machine: ResMed S9 VPAP S
Mask Type: Full face mask
Mask Make & Model: Philips Resperonics FitLife
Humidifier: ResMed S5i
CPAP Pressure: 8/4
CPAP Software: ResScan

Other Comments: VPAP always makes me feel like my avatar.

Sex: Female
Location: Poulsbo, Washington

Post: #1
Medicare and CPAP supplies HELP!
This month, I became eligible for Medicare. When I switched to a Medicare approved DME, they said to get my CPAP supplies, I would have to call them each and every time before they would send me my monthly supplies. EVERY single time that I need scheduled filter, I am supposed to call a phone number and wait on the line while all the other Medicare people are calling, too.

I don't understand. I have a second insurance part D plan that is the number one in N. Carolina.

This seems terribly inefficient and it is hard to believe. Does anyone else have experience with this?

Thanks,
Kate

:Using cpap then vpap since Feb.2013,
Kate
04-23-2014 03:40 AM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: Medicare and CPAP supplies HELP!
I think, once you establish rapport with them, they,ll send your supplies as per replacement schedule

Coverage under Insurance and Medicare wiki
http://www.apneaboard.com/wiki/index.php...6_Medicare
04-23-2014 04:20 AM
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justMongo Offline

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Posts: 3,854
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: #3
RE: Medicare and CPAP supplies HELP!
CPAP supplies are under Part B US Medicare. Over the past several years, Medicare has gone to using only approved suppliers.
Calling every month is not supposed to be how it works. You do have to call and ask for supplies because too many suppliers were just sending out unnecessary supplies that were not requested. However, you should be able to get a 6 month supply of filters, a new tank every 6 months, 3 new mask cushions, et cetera. I call about every 6 months.

And since my DME is located in the same complex as my sleep doctor, I just tell them I'll be dropping by after my visit with the doc to pickup: X, Y, and Z.

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.
04-23-2014 06:36 AM
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JimZZZ Offline

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Posts: 370
Joined: Dec 2013

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: ResMed H5i (not using)
CPAP Pressure: 9 - 14
CPAP Software: ResScan SleepyHead

Other Comments: CareFusion PureSom Ultra Chinstrap

Sex: Male
Location: Western North Carolina

Post: #4
RE: Medicare and CPAP supplies HELP!
The DME told me Medicare will not allow automatic replacement of supplies. To get around that rule, the DME automatically sends me an e-mail each time resupply is authorized. If I answer the e-mail in the affirmative, the supplies are shipped to me. This arrangement was not automatically set up. I discovered its existence in a conversation with the DME clinician, called the resupply center for a form and applied to be included in the program. When I have a mask change, the e-mail erroneously assumes I want supplies for the previous mask so I have to call them to bring their database up to date.
04-23-2014 07:41 AM
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PaulaO2 Offline
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Posts: 8,068
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #5
RE: Medicare and CPAP supplies HELP!
What Jim said. I live in NC and what my DME does is call me once every 3 months to ask if I am ready for the next shipment. They then send me everything I need for the next 3 months. Sometimes I have to call them, but only because Bless His Heart Ron hasn't gotten to my name yet.

Used to, some DMEs would automatically ship out your supplies, whether you needed or wanted them. To most, this was convenient but of course it opened the door to some easy ways for insurance fraud. Automatic delivery by Medicare was dropped.

I've never had to call a Medicare number or anything like that. I call the supplier. And I am not speaking to someone who only does Medicare, because BHH Ron always asks what I have.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
04-23-2014 06:17 PM
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PollCat Offline
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Posts: 1,576
Joined: Feb 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: H5i Cleanable with ClimateLine
CPAP Pressure: 10 - 18
CPAP Software: SleepyHead

Other Comments: CPAP-ing since 1995; Type 2 Diabetes; Chronic Asthma; Gout

Sex: Male
Location: Westfield, IN

Post: #6
RE: Medicare and CPAP supplies HELP!
In the past, even though I was eligible for Medicare, I'd found that it's more economical, and less stressful, to buy my supplies out-of-pocket and then try to get reimbursement from Medicare or my health insurance company.

Now that Medicare has "approved DME vendors", I'll have to rethink my process. I have stockpiled enough filters, masks and tubing to last for at least two years and I'll keep an eye out for sales. Then I'll worry about complying with the new, improved Medicare process. Oh-jeez


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.
04-24-2014 08:33 AM
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