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Machine replacement by Medicare
#1
Machine replacement by Medicare
My Resmed machine will be 5 years old this month. I understand Medicare will cover replacement after 5 years but am not sure what is required. I have a United Healthcare Advantage plan which follows Medicare guidelines. I phoned their customer service and was told a new machine will be covered but that Medicare requires a new sleep study to verify medical necessity. I pressed the rep a little about the sleep study requirement and it was clear she was unsure. My sleep study was in 2007 but I had no trouble getting my present machine in 2017 with this plan without a new sleep study. I'm wondering if Medicare requirements have changed. Has anyone had recent experience with this?
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#2
RE: Machine replacement by Medicare
I've dealt with UnitedHealthCare Community as they were my Medicaid coverage before Disability approval. Regardless, I'd be a bit suspicious of new tests to prove existing medical necessity to get a new machine. Now, when it comes to compliance, they may require that.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Machine replacement by Medicare
Since I've probably missed only 4 or 5 nights in the last 5 years I don't think compliance will be a problem.
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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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#4
RE: Machine replacement by Medicare
Just stating the obvious.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Machine replacement by Medicare
If you were changing from an Apap to a Bipap, then Medicare sometimes wants proof of medical necessity for that higher level machine via a Sleep Test.

But if you're replacing with another Apap, there shouldn't be a problem.  If you've been seeing a Sleep doctor or even your regular Doctor for your SA and they have documented your use, then the Doctor only has to send a Script to your DME for replacement.  

I would be surprised if this was an issue to get a new machine.
OpalRose
Apnea Board Administrator
www.apneaboard.com

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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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