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Medicare rejected my replacement Cpap after 4.5 years
#1
Medicare rejected my replacement Cpap after 4.5 years
Hi 

I have a 4.5 year old recalled dreamstation and was lucky to find an approved dme with a Resmed s10 in stock.  It may take a year or more for Philips for it to be fixed or replaced.
Medicare has rejected my claim .   Does anyone have suggestions what to say in the appeal.  
I am willing to pay the pro-rata portion for the remaining 6 months if necessary.

Thanks
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#2
RE: Medicare rejected my replacement Cpap after 4.5 years
What was the reason to deny the claim? I think I would resubmit it again with a Dr. note.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Medicare rejected my replacement Cpap after 4.5 years
It depends on their policy and how flexible an adjuster or his/her supervisor can be.  I agree with the previous poster, if the Dr. says in writing to start using another machine due to recall, and you have a current script, you should do what the Dr. says to do.  It's for your health.  I would see what appeal you have, but you can always submit the claim again in six months when your 5 years are up.
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#4
RE: Medicare rejected my replacement Cpap after 4.5 years
Under 5 years your DME is obligated to provide a loaner CPAP if the one you have is not usable. It is my understanding they will not foot the cost to replace if the device is less than 5 years old. Not sure how the repair/replacement by Philips is going to work, but I would get a loaner from the DME and when the 5 years comes up have your doc write a prescript for your CPAP of choice. Below is a screenshot of the email I received from Medicare (relevant info highlighted) .


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