Medicare rejected my replacement Cpap after 4.5 years

[DoctorOctopus]

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

[staceyburke]

What was the reason to deny the claim? I think I would resubmit it again with a Dr. note.

[mesenteria]

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.

[StratCat48]

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) .