Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

Your thoughts on DME choice?
#1
Your thoughts on DME choice?
If I do a home test, and I am on medicare, is the choice of DME important (so long as they take medicare)? My PCP is willing to provide me with a script for a home test and I am having him document my daytime sleepiness, etc.  But wondering about your thoughts of DME choice.  I can go online and use one of the recommended suppliers from the supplier list or use the local DME my doctor has used?
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: Your thoughts on DME choice?
First thing is to go to Medicare.gov and get a list of suppliers who accept Medicare. I “think” most online suppliers do not take insurance, so they would probably not accept Medicare and a supplement. However, that does help them to offer lower prices.

I found a great DME, more luck than anything else, but I found the list of Medicare providers, looked up reviews, and called them.

It is never a good sign when a DME won’t even return a call. But there was one that had an unheard of rating on Yelp (5 stars!!!). Answered the phone, and my questions. I physically took my prescription to their office and talked to them. As I said, I got lucky that this DME even exists.

John
Post Reply Post Reply
#3
RE: Your thoughts on DME choice?
Thanks for your repsonse.   Am I correct to  assume you used a local DME, not an online DME?
Post Reply Post Reply
#4
RE: Your thoughts on DME choice?
Medicare has many requirements for CPAP, and the first one is a face to face meeting wth a physician prior to obtaining a Medicare Approved sleep study and diagnosis by Polysomnograph (PSG) evaluation. In general, a home sleep study will not be eligible for new coverage. Medicare will provide up to 80% reimbursement for the rental of a medically necessary CPAP that comes from a "Medicare Participating Provider" DME. Note, it is not enough for a supplier to be "Medicare Approved". That only means they accept Medicare patients, but they can also legally balance bill you for what Medicare does not provide.

At this point, I will suggest that if you do not have excellent supplemental insurance for Medicare, you are better off using a home study, or even using a questionnaire from an online supplier and buying a machine out of pocket. The cost of a new auto CPAP like the Resmed Airsense 10 Autoset from an online supplier, and up to $200 for testing and prescriptions, may be less than copay with Medicare. Medicare will require several physician appointments: one before the test, and a follow-up within 90 days of starting therapy; an expensive attended PSG sleep test; and you will very likely get talked into a titration test, as well as much more expensive equipment that must be rented for 13 months before you will own it.

I'll be glad to answer questions, but the home sleep study will not be covered by Medicare https://www.medicare.gov/coverage/sleep-studies and the home sleep study may not be adequate to demonstrate medical necessity of a CPAP. A physician must order a clinical sleep study and it must meet Medicare requirements.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: Your thoughts on DME choice?
Your answer was so interesting.  Elsewhere on this board in previous post , I had posted that I had a sleep study done 3 years ago at a sleep center.  And ultimately did not qualify under medicare guidelines,  My pulmonologist gave me a used machine and I have used it for the past three years and actually sleep better with it.  The pulmonolgist thought then and still thinks given that my apnea is mild, that I do not have to use the machine every night (some times we go RVing and do not have electrical access) and he has told me to lose 25 pounds and I could definitely get off it.. (however, I have not lost the weight)  Recently, in a social setting out of state, I met a sleep doctor who I told about how  that medicare turned me down but I was using a cpap anyways.  He said I should go for "home test" to try again and even tried to find on his home computer online DMEs who were in my area where I could possibly bypass my pulmonolgist or PCP who could do everything needed (including having a physician employed by the DME to meet with me). However, he was not successful finding one for my area when he did a search on his computer and said he would get back to me (but never has).  All that being said, I have been thinking about just buying a newer machine since I am probably still not be able to qualify with medicare, and forget taking a home study test given the hassles involved and the great possibliity that I still would not qualify under medicare guidelines.  You seem to agree with me.
Post Reply Post Reply
#6
RE: Your thoughts on DME choice?
Sleeprider Wrote: Wrote:I don't know how good your insurance is, however if you can get a script, you can buy a Resmed Airsense 10 Autoset for $569 new from [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List]Supplier #2 or used with warranty for $429.  Compare that cost with copays for studies, machines at about 2-3x that price and physician follow-ups.  No hassle at all.  Please be sure to get the Autoset, not Elite or CPAP model.

Once you start using hte machine, you should include a discussion of its use with your doctor, and you will become an existing CPAP user. Medicare should cover supplies for an existing user of CPAP.
So just to be sure:   are you saying the following:
1.   I should buy a new/used  autoset machine using the script I got last month  from my pulmonologist? 
2.  Then after using the new machine, I shold  have a discussion with him (or my PCP) about its uses and possibly medicare would cover the supplies for medicare even though I do not qualify for a cpap as medically necessary according to medicare? Keep in mind that my pulmonologist and PCP both know I have using a used machine.  Only out of pocket has been replacement masks and a couple of dollars for change of filter periodically.  And neither of them have ever said I could possibly get supplies covered.
Post Reply Post Reply
#7
RE: Your thoughts on DME choice?
Sleeprider Wrote: Wrote:I don't know how good your insurance is, however if you can get a script, you can buy a Resmed Airsense 10 Autoset for $569 new from [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List]Supplier #2 or used with warranty for $429.  Compare that cost with copays for studies, machines at about 2-3x that price and physician follow-ups.  No hassle at all.  Please be sure to get the Autoset, not Elite or CPAP model.

Once you start using hte machine, you should include a discussion of its use with your doctor, and you will become an existing CPAP user. Medicare should cover supplies for an existing user of CPAP.
So just to be sure:   are you saying the following:
1.   I should buy a new/used  autoset machine using the script I got last month  from my pulmonologist? 
2.  Then after using the new machine, I shold  have a discussion with him (or my PCP) about its uses and possibly medicare would cover the supplies for medicare even though I do not qualify for a cpap as medically necessary according to medicare? Keep in mind that my pulmonologist and PCP both know I have using a used machine.  Only out of pocket has been replacement masks and a couple of dollars for change of filter periodically.  And neither of them have ever said I could possibly get supplies covered.
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: Your thoughts on DME choice?
(03-09-2020, 02:36 PM)eajeff Wrote: So just to be sure:   are you saying the following:
1.   I should buy a new/used  autoset machine using the script I got last month  from my pulmonologist? 
2.  Then after using the new machine, I shold  have a discussion with him (or my PCP) about its uses and possibly medicare would cover the supplies for medicare even though I do not qualify for a cpap as medically necessary according to medicare? Keep in mind that my pulmonologist and PCP both know I have using a used machine.  Only out of pocket has been replacement masks and a couple of dollars for change of filter periodically.  And neither of them have ever said I could possibly get supplies covered.

I do remember your situation from an earlier thread.  Not to answer for Sleeprider, but I believe Medicare will not pay for supplies for something that they deem not to be medically necessary.  This is only a guess, but I think Medicare will require the same documentation for the supplies.  Otherwise anyone could get a prescription, go through Medicare, buy supplies, and sell them for a profit; which I imagine happens.  DME makes money and the patient makes money and the rest of us foot the bill.

In your position, you can use the prescription, buy whatever machine you want out of pocket from the an online source, and get supplies from them also.  You can also backdoor items through Craigslist or eBay.  I've done this and it is not a bad way to go.

The only downside is that you don't really exist as a CPAP patient and if things take a turn from your current sleep therapy, you may need to scramble if an expensive advanced machine is required.  It is somewhat of a weird feeling, after years of being proficient at therapy and making my own adjustments, to get that deer in the headlights look when you to go to the sleep lab and tell them that you were here almost 20 years ago and also 6 years ago... Who are you?

John
Post Reply Post Reply
#9
RE: Your thoughts on DME choice?
I’m falling behind and I’m on the mobile phone. I think a home sleep study will be of little value to you. Medicare is not likely to accept it and it has a higher risk of a false negative than a full sleep study. You clearly benefit from CPAP or you wouldn’t have continued use. Medicare is going to want a full PSG study in a clinic, ordered by a doctor that shows medical necessity for CPAP. That means AHI greater than 5 with Comorbid conditions or 15 events per hour for asymptomatic. Qualifying is strictly defined, and if want to avoid the bureaucracy, just get the script and find the Best deal.

The other alternative is to approach it as an existing patient. You are under the supervision of a doctor and he has to be willing to call your therapy medically necessary.

It seems to me it is easier for now to continue as before and if you want to migrate to Medicare coverage, the first step is a clinical Sleep study by PSG ordered by your doctor. That will be covered at 80% and supplemental may pay the rest. I can’t advise beyond the first step. We would need those results. If you qualify for CPAP, it seems your doctor will be easy to work with and you wil become a Medicare patient. If you don't qualify, you can continue as you do now. Being disqualified by Medicare does not mean you have to quit.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
Post Reply Post Reply
#10
RE: Your thoughts on DME choice?
Thanks for the reply.  Last month when I saw my pulmonologist he said to continue using the  used machine he gave me three years ago(( Phillips/Respironics System One which seems to continue to work fine despite its age).. However  I asked him to give me a script in case I wanted a newer machine.   After going round and round (in my head) on how to proceed over the last few weeks ,-- based on your guidance which I so appreciate-- I am simply going to buy a newer or slightly used  machine  soon or maybe I will continue to use the older machine for a little while longer.  And I will no longer pursue getting medicare involved because in my case I think you are right that I may going down a "rabbit hole" on Medicare..
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  Newly diagnosed and given choice of 4 treatments Artygal 8 259 03-25-2021, 01:01 PM
Last Post: DaveL
Question New CPAPer - Thoughts on OSCAR Report clayc 2 197 01-29-2021, 03:40 PM
Last Post: clayc
  New User, Apex XT Auto -- would welcome your thoughts scronch 7 312 01-23-2021, 08:06 AM
Last Post: OpalRose
  What are your thoughts on dental Daytime Nightime Appliances (DNA)? NoddingHacker 2 366 11-19-2020, 08:47 AM
Last Post: weiss27md
  Hoping for thoughts & advice Garfield 34 1,003 10-23-2020, 05:57 PM
Last Post: Garfield
  Any thoughts on problem with gap between teeth since using CPAP for a few years? green wings 17 730 10-21-2020, 12:23 PM
Last Post: Hydrangea
  CPAP choice Ghandi 22 1,074 07-16-2020, 03:47 PM
Last Post: Ghandi


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.