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Medicare and Medicaid-who picks CPAP
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #11
RE: Medicare and Medicaid-who picks CPAP
(02-12-2014 08:33 PM)Zorki1c Wrote:  A lot depend on the doc and insurance. I have a Medicare Advantage policy. The original doc perspiction specified a F&P Icon. When I went in for my one-moth review I told the Nurse Practitioner that I didn't like the Icon menu and asked if I could switch to the S9. She wrote a note to the DME and they swapped machine. Unfortunately, it appears that not all cpap patients receive that kinds of cooperation from providers.

Medicare advantage is not the same as having Medicaid which pays first and straight medicare. Each state has their own Medicaid rules and I don't know anything about what they are today and I don't know what they are for each state. Since Medicaid pays first (and I would hope they would follow Medicare guidelines if for no other reason than to simplify things), I would think the best place to start would be to check with their requirements/procedures.
02-12-2014 08:36 PM
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Lukie Offline

Preferred Members-2

Posts: 352
Joined: Nov 2013

Machine: Resmed S9 Auto
Mask Type: Full face mask
Mask Make & Model: Airfit F 10
Humidifier: H I heated tubing resmed
CPAP Pressure: 6-16
CPAP Software: ResScan SleepyHead

Other Comments: Masks: Simplus, Air, Quattro fx, Nano, Eson, Swift fx and Activ

Sex: Female
Location: Vermont

Post: #12
RE: Medicare and Medicaid-who picks CPAP
your doctor writes the prescription but you can choose which brand you want. I had the DME try to give me a Philips but I insisted on the ResMed S9 autoset. When they said they only deal in Philips I told them to forget it I would go online and they said wait a minute we can get you one from our other store. Thank you very much! YOU just need to be assertive. Medicare will pay the same no matter what the machine.
02-13-2014 05:08 AM
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Franklyspeaking Offline

Preferred Members

Posts: 68
Joined: Feb 2014

Machine: Resmed S10 autosense
Mask Type: Nasal mask
Mask Make & Model: Respironic blue gel mask
Humidifier: Resmed S10 autosense
CPAP Pressure: 4-18
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location: Longview, Texas

Post: #13
RE: Medicare and Medicaid-who picks CPAP
(02-13-2014 05:08 AM)Lukie Wrote:  your doctor writes the prescription but you can choose which brand you want. I had the DME try to give me a Philips but I insisted on the ResMed S9 autoset. When they said they only deal in Philips I told them to forget it I would go online and they said wait a minute we can get you one from our other store. Thank you very much! YOU just need to be assertive. Medicare will pay the same no matter what the machine.

Thanks to everyone for your suggestions and valued information. My mom goes for sleep study on March 5th. So we will see how it all goes down. Thanks
02-13-2014 07:18 AM
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