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How to qualify for medicare- what I have learned - Printable Version

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How to qualify for medicare- what I have learned - eajeff - 02-13-2020

Back in 2016 I did a sleep study overnight recommended by my pulmonologist.   I hardly slept and am suspect that the results were sufficient although....it appeared I had sufficient sleep apnea that I needed a cpap which would be covered by medicare.  After having the machine sent out and using it for 3 weeks, the pulmonologist office calls and says medicare must have changed rules and although I should still use cpap, medicare won't cover after all.  So machine was picked up; my pulmonologist gave me a loaner; has worked fine for past 3+ years but not a current machine and not covered by medicare. So recently I met socially a  guy who is a sleep doctor in another state and he told me that I should be able to go online and find a company who will send me a home sleep apnea sleep test.  In fact, he tried to go online in my presence and find a company that would provide the home study test locally where I lived (I have homes in Fl and NY)  and pick  up the test..  He was short on time and could not fine one in my cities (Tampa nor NYC). Said he would look around and get back to me but has not.  He also told me to make sure I got myself very very tired before taking this home test, sleep at least four hours and imagined I might qualify for medicare  after all.  Any recommendations on who to use.?  I just went online and a quick search brought up a company  but  one you send away and mail back to get results.  Any other companies to recommend?


RE: How to qualify for medicare- what I have learned - Crimson Nape - 02-13-2020

Hi eajeff! - Welcome

Checkout Supplier #10 and  Supplier #30 in our Supplier list.  For Supplier #30, Look under Customer Support for the test.


RE: How to qualify for medicare- what I have learned - OpalRose - 02-13-2020

Hi eajeff,
Welcome to Apnea Board!

Just curious, if you don't mind me asking... what was the reason given by Medicare for denying coverage?


RE: How to qualify for medicare- what I have learned - eajeff - 02-13-2020

I will do my best to answer.  Supposedly,after my overnight sleep student   the doctor/pulmonologist initially said I was covered   He contacted a local vendor to send me out a machine, which was demonstrated to me and I used it for about 3 weeks.  Then I got a surprise call  from the physician's office; she told me that as best as she knew medicare changed the criterion and since my apnea was mild, medicare would not cover it.  I tried to look at the rules and could never find anything definitive.  (Maybe I should have called medicare but I did not?) I figured the doctor knew what he was talking about; but frankly I  was surprised and upset especially after sending me the machine to use for 3 weeks.  I went back to see my pulmonologist who said the same thing  (medicare must have changed their rules) and he gave me a loaner.


RE: How to qualify for medicare- what I have learned - Nightynite - 02-13-2020

My primary doctor filled out a short form and faxEd it to a company that sent me my home sleep test equipment by mail. ( your pcp should be able to do this also) I tested at home for 2 nights and the machine transmitted my info automatically with the built in cellular back to there in-house sleep technician. The tech sent my results along with my RX requirements to my PCP. Done.

Since I was on Medicare, I just looked up on there site to see which DME accepted Medicare assignments in my area. There was only one. Apria.


RE: How to qualify for medicare- what I have learned - eajeff - 02-13-2020

Thanks for the reply.  What company did your testing?


RE: How to qualify for medicare- what I have learned - Nightynite - 02-13-2020

(02-13-2020, 03:01 PM)eajeff Wrote: Thanks for the reply.  What company did your testing?

Novasom sleep study.     I also live in NY.  And Medicare payed for everything.  If you go it alone it will be costly.


RE: How to qualify for medicare- what I have learned - Nightynite - 02-13-2020

I believe your pulmonologist was confused. He probably didn’t understand or know that only appointed DME’s are accepted to do this. I believe the word is assignment. The DME has to provide you equipment under Medicare guide lines. So they are approved.

Your pulmonologist may have called a local DME who was not approved and was told Medicare does not cover that. Because they were not approved.


RE: How to qualify for medicare- what I have learned - lacro - 02-13-2020

(02-13-2020, 02:55 PM)eajeff Wrote:  I tried to look at the rules and could never find anything definitive.  (Maybe I should have called medicare but I did not?) 



RE: How to qualify for medicare- what I have learned - harrywr2 - 02-14-2020

Medicare Rules for CPAP coverage

Short version - AHI of 15 and above or 5 and above with a related co-morbidity(stroke , heart problems, high blood pressure etc) - read article for complete list