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Medicare changes--can't get mask--Youre next
#11
RE: Medicare changes--can't get mask--Youre next
me 50. You present simple solutions to a complex problem. Medicare is my network supplier. My supplemental insurance is from the job I retired from and will not pay for anything if Medicare does not approve it first. If I go to a medicare advantage plan I lose the supplemental insurance which for most things is much better than any currently offered medicare advantage plan and is also free at this point. If my mask is approved by medicare it is paid for 100% by the two plans.
Medicare would approve my mask but my DME is refusing to supply it. At this point I have gone on line and ordered a mask. I am going to try to change to another Medicare approved DME but they require that my current one send the information. My supplemental insurance is the one who informed me that many suppliers once they have been approved and have a monopoly in an area for medicare reduce the number and type of supplies to maximize profits.
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#12
RE: Medicare changes--can't get mask--Youre next
Don't forget to give your Congress critters hell every time you get screwed by Medicare. Nothing will change unless you do.
Get the free OSCAR CPAP 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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#13
RE: Medicare changes--can't get mask--Youre next
(02-19-2014, 02:05 AM)andora3 Wrote: me 50. You present simple solutions to a complex problem. Medicare is my network supplier. My supplemental insurance is from the job I retired from and will not pay for anything if Medicare does not approve it first. If I go to a medicare advantage plan I lose the supplemental insurance which for most things is much better than any currently offered medicare advantage plan and is also free at this point. If my mask is approved by medicare it is paid for 100% by the two plans.
Medicare would approve my mask but my DME is refusing to supply it. At this point I have gone on line and ordered a mask. I am going to try to change to another Medicare approved DME but they require that my current one send the information. My supplemental insurance is the one who informed me that many suppliers once they have been approved and have a monopoly in an area for medicare reduce the number and type of supplies to maximize profits.

I don't know why you would lose a supplemental plan if you get off of straight medicare and go to an advantage plan but that can't be done this year so not going to explore that one right now.

There is the option of ordering in network from the mail order accepted suppliers so you don't have to pay out of pocket.

As always, we post our thoughts and what the OP does with it is definitely up to them. I hope you find a solution that will help you long term.
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#14
RE: Medicare changes--can't get mask--Youre next
No problems here in Vermont. Got my heated hose and a new Simplus full face mask which seems to leak almost as much as the Quattro Air.
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#15
RE: Medicare changes--can't get mask--Youre next
(02-18-2014, 06:57 PM)PaulaO2 Wrote: Yeah, I'll just go to buying out of pocket or going on line. Don't like my DME anyway. Any doctor can write the script for the mask and the machine, it doesn't have to be a sleep doc.

Hey Paula02!

That last sentence is VERY interesting. Medicare won’t let my DME even consider 
my looking at a new mask until March. The N10 works well, but the N30i might
be better. 

Thanks for the tip!

Harv
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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#16
RE: Medicare changes--can't get mask--Youre next
FWIW: I had a Medicare Part C - Advantage plan several years ago. I could purchase replacement supplies directly out of pocket cheaper than what my co-pay was using insurance and going through a local DME. Don't be fooled by insurance. Check prices before you buy.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
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#17
RE: Medicare changes--can't get mask--Youre next
I'm on Medicare and have BC/BS as my supplemental insurance. My DME supplier is Rotech. I can change masks anytime I want to. I just have to let them know. 

I pay 0 out of pocket costs. Rotechs ends me a message when I'm due new supplies and checks with me to see if there are any changes to be made in regards to the type of equipment I'm using. 

I'm due new supplies on the 27th of this month. I'll go to their chat room about the 20th to confirm what they send me.
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#18
RE: Medicare changes--can't get mask--Youre next
Looked at online DMEs including 10, 14, 15, and 30.

Many get around the Rx required by splitting the complete mask and headgear order into two parts
and shipping them separately. That's bending the rule. But if your non-sleep doc can write the Rx,
you're good. Oh, and many suppliers have a 30-day return policy.

I like the idea of telling my DME that I'm getting a mask online.

Harv
Thanks to everyone who helps us get a better night's sleep.

Anything I post here or elsewhere on these forums is my opinion, not medical advice. Medical advice comes from a doctor.
An Advisory Member is a member of the Advisory Committee which helps shape Apnea Board's rules & policies.
Such membership does not imply medical expertise or qualifications for advising sleep apnea patients about their treatment.

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#19
RE: Medicare changes--can't get mask--Youre next
Just in case someone has missed who can write a prescription for CPAPs and supplies in the U.S.:
  • Medical Doctor.
  • Doctor of Osteopathy.
  • Psychiatrist.
  • Physicians Assistant.
  • Nurse Practitioners.
  • Dentist.
  • Naturopathic Physician.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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.
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#20
RE: Medicare changes--can't get mask--Youre next
Please note also this is a 7-year old thread!
Useful links
Download OSCAR (current version is 1.5.1)
Best way to organize charts
How to attach charts to your post

Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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