Clarifying what I need to get cpap

[Pokey49]

I am having trouble with a DME that I think doesnt fully understand the basic requirements for providing cpap to someone, in this case me. I will try to be brief. I recetnly did a level 3 study, home sleep study with FDA approved equipment. Ive tried 3 in lab studies that were bust. I can't sleep in a damn lab. Im dont with sleep labs. 

The test results came back saying I had an AHI of 16.7, RDI 17.6, ODI 5.1. The doctor who reviewed the study is a board certified sleep specialist and an Medicare approved provider. The DME is a Medicare provider. I need Medicare to pickup its 80% for the cpap. The DME kept insisting I needed some sort of case notes from my PCP saying I needed cpap to which I responded " well he wouldn't know that until I got tested, which I did and the test says I need cpap. As far as I can tell I have what I need: a test result, a prescription and a DME provider that takes Medicare.

What am I missing??
Pokey

[Big Guy]

Way back (June 2018), our PCP referred me to a Sleep Study Clinic that was local. I had an in-lab two night study performed. 

The Sleep Lab doctor prescribed a CPAP machine for me. They contacted a local DME supplier and an appt. was set up for me. I went in and they had a Resmed AirSense AutoSet 10 waiting for me. 

After a sort tutorial, they sent me on my way. We have Medicare and my out-of-pocket cost was something like $68.00 or so. 

You might find less resistance if you see your PCP and have them write you a script.

[OpalRose]

All DME's operate differently, but they most likely want a LMN, as required by Medicare.

Besides the actual prescription, they probably need the Letter of medical necessity (LMN) from your doctor, or known as the Doctor's Notes.

[Pokey49]

Problem is I can’t into my pcp until late March I have a script from a sleep medicine MD. I guess I don’t understand the reticence by the DME to move forward. The bases are covered.

[SarcasticDave94]

I would call these doctors and tell them you'll need a letter of medical necessity to go with the script. Ask if they can send it to the DME of your choice.

Also be ready to use a different DME if this current one fails to help further.

You're going to want to request a ResMed machine as it is the gold choice.

[Pokey49]

LMN  is a term I’ve not heard until know. I guess I can message my PCP or my PA and see if I can get such a thing. Thing is they hav  Ed nrr try known cpap is a medical necessity until I had the home sleep study done. ? seems a bit backwards to me but then lots of such “bureaucratic” stuff isn’t necessarily logical

[Big Guy]

Problem is I can’t into my pcp until late March  I have a script from a sleep medicine MD. I guess I don’t understand the reticence by the DME to move forward. The bases are covered.

I would think that the script from your sleep medicine doctor would be sufficient. That's ultimately what was needed for my CPAP machine. 

Try calling another DME, run the situation past them, and see what happens. 

[Deborah K.]

Yes, request a ResMed Airsense 10 or ResMed AirCurve 10 Vauto if you need a bilevel.  But don't get a ResMed Elite or any brand other than ResMed.  They are the best.

[Pokey49]

Yes I definitely want a ResMed. My Rx just says auto pap. Is Airsense 10 AirCurve 10 auto pap?? What do you know about the ResMed 11??

[Deborah K.]

The ResMed Airsense 10 is the Autopap.