Broken Machine [A10 Auto repair?]

[AtlBeardie]

My husband was diagnosed with severe sleep apnea in 2014 and received a ResMed AirSense 10 Autosense that was paid for by private insurance. He used the CPAP religiously since then, until it suddenly quit working 1-1/2 weeks ago. The machine is totally dead. Won't turn on at all. He went to his sleep doctor to obtain a replacement. First he was told that Medicare would require him to go through another sleep study. Crazy. But before he did that, thankfully, they called back with a “correction.” He was advised that because he is now on Medicare, and Medicare won't pay for replacing CPAPs that are less than 5 years old, he has to pay for the machine himself. 

What?!

I tried calling ResMed directly for help after I found this information on line indicating they would replace (or repair) the equipment free of charge in an incident like this:
(Google “helping patients replace their current CPAP machines” for PDF on Res Med web site; sorry  but your forum won't allow me to post a link because I am a new user)

The Res Med representative could not have been less helpful. She said the web page I referenced dated back to 2014, and was “not current.” She then said simply that my husband needed to take this up with the supplier of his equipment.

Can someone point me to the Medicare regulations covering replacement (or repair) of a CPAP, purchased originally by private insurance but less than 5years old? Armed with this, we can take matters up with the sleep doctor.

I've searched this forum and its wiki-facts and cannot find where this particular situation has been encountered before, so I apologize in advance if I missed this. Just point me in the right directions. Thanks very much!

[Gideon]

Welcome to the forum.  We will do our best to help you.

1.  Try to UNPLUG the machine for 5 minutes, then plug it back in and see if it works.  You may have tried this but if it works it is the quickest.

2.  IF you have it, Try a different power supply.  I have the capability of powering my machine from DC during a Power Outage.  
The above are quick fixes, and you not have the capability or have already tried this.

3.  You will need a DME to declare the machine DEAD in order to replace it or have ResMed repair it prior to 5 years of use.  
Who did you acquire the machine from originally?  Call them and ask for help.

Medicare Replacement when Less than 5 year expected life. per ResMed 
https://www.resmed.com/us/dam/documents/...achine.pdf

Less than five years The replacement of an item before its five-year life-time expires can only be done if the item is lost, is irreparably damaged, or the patient’s medical condition changes and the item no longer satisfies the medical needs of the patient.
• Loss or irreparable damage: – Irreparable damage is considered damage caused by a specific accident or natural disaster. – A physician’s order is needed to reaffirm the medical necessity of the item.
• If a PAP machine is replaced during the RUL because of loss, theft or irreparable damage due to a specific incident, there is no requirement for a new clinical evaluation, sleep test or trial period.
• The supplier must replace the equipment free of charge if it does not last the full five-year period (ie, is no longer serviceable or needs substantial repairs). If it is determined that the item is unable to last for the entire five-year RUL based upon accumulated repair costs (those repair costs exceeding 60% of the cost to replace), the supplier must replace the equipment with properly working equipment at no charge. Replacement equipment does not need to be new.

https://www.medicareinteractive.org/get-...ipment-dme

Replacing durable medical equipment (DME)

If you have a chronic condition and will need DME for a long period of time, it important to learn about Medicare’s rules for replacing your equipment. Replacement means substituting one item for an identical or nearly identical item. For example, Medicare will pay for you to switch from one manual wheelchair to another, but will not pay for you to upgrade to an electric wheelchair or a motorized scooter.
Medicare will pay to replace equipment that you rent or own at any time if it is lost, stolen, or damaged beyond repair in an accident or a natural disaster. Medicare should cover a new piece of equipment with proof of the damage or theft.
If your equipment is worn out, Medicare will only replace it if you have had the item in your possession for its whole lifetime. An item’s lifetime depends on the type of equipment. An item’s lifetime is never less than five years from the date that you began using the equipment in the context of DME replacement. Note that this five-year time frame differs from the three-year minimum lifetime requirement that most medical equipment and items must meet in order to fall under Medicare’s definition of DME. The item must also be so worn down from day-to-day use that it can no longer be fixed. Keep in mind that Medicare will repair worn out equipment up to the cost of replacement before the end of its lifetime.
Medicare will only cover replacement equipment if your doctor writes you a new order or prescription with an explanation of the medical need.
If you are affected by the competitive bidding demonstration, you must use a contract supplier to replace your equipment. If you are not affected by the competitive bidding demonstration, you can use any Medicare-approved supplier to replace your equipment. However, you will pay the least if you use suppliers who accept assignment.

https://www.medicareinteractive.org/get-...for-oxygen

Durable medical equipment (DME) repairs, maintenance, and replacement (except for oxygen)



If you need DME, your equipment may need regular maintenance and repairs from your supplier. Repairs by a supplier involve fixing equipment that is worn or damaged. Maintenance means checking, cleaning and servicing your equipment. If possible, you are expected to do regular maintenance yourself using the owner’s manual. However, a supplier should do maintenance if it is more complicated and requires a professional. Medicare coverage of repairs and maintenance that is more specialized depends on whether the supplier owns the equipment or you do.
If you need oxygen equipment, Medicare pays for repairs and maintenance differently.
As long as you are paying a monthly rental fee for your equipment, your supplier must perform all needed repairs and maintenance that require the work of a professional. The supplier cannot charge you for this work.
On the other hand, Medicare will pay a separate amount to the supplier for repairs and maintenance if you buy your equipment or if you now own your equipment after first renting it. The repairs and maintenance must require a professional and must not be covered by warranty. Medicare will pay 80% of the Medicare approved amount and you will be responsible for the 20% balance. 
You can save money by going to a supplier who takes assignment. If you live in a competitive bidding area and you own equipment that is on the list of items you must get from a contract supplier, it is best to get repairs done by contract suppliers. Although Medicare will cover maintenance (and replacement parts needed for the repair) from any Medicare-recognized supplier, contract suppliers must accept assignment for the repair. 

Sorry for the delay.
Most of this will appear in a Wiki Article.

1. You will need your Doctor to state that CPAP is still a medical necessity to you.
   
2. Contact your DME (Original and Medicare)
   
3. Have Repair attempted or be declared non-repairable
   
4. Acquire a replacement machine.
   

Fred

[greatunclebill]

medicare has no record of your cpap or how old it is. have your doctor write a prescription for a new machine. period. say nothing about old machine. this will be your first medicare machine. your original sleep study should be good enough for them. if the dme is causing unnecessary trouble, change dme's

[Sleeprider]

The Medicare funded CPAP machine should be replaced if it is found unrepairable, regardless of age. The original DME is on the hook for backing up the machine as described in Bonjour's post.

You can obtain a Resmed Airsense 10 Autoset for $570 with prime shipping, without prescription, within two days if you get tired of the bureaucracy.

The most common cause of breakdown is the AC adapter. Your DME should be able to plug your machine into a known good adapter to see if that fixes it.

[trish6hundred]

Hi AtlBeardie,
WELCOME! to the forum.!
I hope you get your Durable Medical Equipment, )DME,)machine and insurance problems resolved, soon.

Good luck to your husband with getting his CPAP therapy back on track.

[peace]

I would recommend having the machine checked out.  They are usually indestructable.  likely some dust got in there and got something stuck or burned out but can usually be repaired by an authorized dealer.  worth checking out, and most stores will do repairs for a deal or even free if you become their customer for supplies.

[AtlBeardie]

Thank you everyone for your replies and advice. 

We checked the adapter on the old machine and it tests out fine, so the problem appears to be with the machine itself. Unfortunately, if Medicare didn't pay for the machine, ResMed says their warranty is only one year; consequently, any repair cost would be out of our pocket. The insurance company that paid for the machine originally is different from the insuror that my husband presently has Part B coverage with under Medicare. The present insuror doesn't have a dog in this fight, so to speak. We might investigate the cost to repair this machine, just so we have a “back up” just in case this ever happens again.

After a little haggling with the doctor's office, the doctor has written a new prescription for a CPAP, documented that he recently saw my husband, provided the results of his sleep study done several years ago, and “other documentation.” This has all been provided to a DME supplier, and we are supposed to hear back from them next week re: actually getting a new CPAP paid for by Medicare. Fingers crossed my husband won't have to repeat the sleep study (or studies, actually - it took them two tries to get him to a “therapeutic level of correction”). It would be a serious waste of taxpayer money to require another sleep study, but sometimes the government gets wrapped up in its own red tape.

Anyway, again thank you everyone for your comments and advice. It was all very helpful.
C.

[Sleeprider]

If you are buying without insurance, I told you before, a new Airsense 10 Autoset can be had on Amazon for $548, free shipping, no prescription, no hassle. There are other deals out there that will probably beat your DME by a factor of 50%. Seriously, if you want a machine in 2-days for less money, just buy online. Hope you get one paid for by Medicare. You really should since the old one will be deemed unrepairable.