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Medicare Requirements - Printable Version

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Medicare Requirements - TomKriek - 06-29-2020

I was diagnosed with sleep apnea about 20 years ago after an in-center study. Six years ago a repeat in-home study for Medicare showed I didn’t meet criteria. So I have been buying my own equipment/supplies. A recent in-center study showed AHI of 2.4 and RDI of 8.8. I have at least two of the Medicare risk factors. My PA doesn’t think I meet Medicare criteria, but from what I see, I do. What are your thoughts. Would be nice to have my stuff covered again.

RE: Medicare Requirements - Sleeprider - 06-29-2020

It's interesting to see your clinical AHI/RDI is so mild, yet you find therapy important enough to self-fund. I can't explain why a PSG sleep study would only find a RDI of 8.8, but with comorbidities, that should be sufficient. It's not coming out of your PA's pocket, so I have no idea why you are not getting an order for the treatment you need. The only questions that needs to be satisfied when you are already using therapy are; is therapy medically necessary, do you benefit from the therapy, and do you use the therapy? While I understand the role of a PA in the medical system today, why are you tolerating this? Go through your regular physician. Sleep apnea does not require a specialist, which your PA clearly is not.

RE: Medicare Requirements - TomKriek - 06-29-2020

No question I sleep better with CPAP than without and am 100% compliant. I see my pulmonologist’s PA to discuss next week. My pulmonologist should go for it if she balks. Just wanted to make sure I’m reading the Medicare guidelines correctly? Already reached out to two providers to make sure they are comfortable with my numbers.