08-09-2012, 11:12 PM
Confusing call from sleep doc's office today
First some background: I had a sleep study in late March and was diagnosed with severe sleep apnea. The doc (very nice lady) wrote a prescription for a PRS1 with settings of 5-15 cm H2O and sent it to a local DME. I picked up the machine from the DME on April 3. I was assured by everyone that Medicare would pay for everything, minus my copay, and they have done so.
However, I muddied the insurance waters by purchasing my own PRS1 in late April on the local Craigslist for $300. Subsequently I returned the PRS1 to the DME. Since I did so without authorization from the doc they filled out an "AMA" form (against medical advice). I signed this form, else they would not have taken the machine back.
A few weeks later I went to the sleep doctor's office and obtained a copy of the prescription and results of the sleep study from her assistant. With prescription in hand I went to a different local DME and bought a Swift LT. Since it had not been three months I knew Medicare would not pay for the mask, so I just paid for it out of pocket.
The Swift LT was not satisfactory, so a couple weeks later I sent the prescription to Supplier #1 and bought a Mirage Vista from them. Again, it had not been three months, so I just paid for it out of pocket.
But a few weeks later the Pilairo finally became available and my new DME had them in stock. And now it was past three months, so theoretically Medicare would pay for it. I went to see the respiratory therapist at the new DME and ended up buying the Pilairo. They just charged me the Medicare copay ($22 and change) and assured me that according to my paperwork Medicare would pay for the rest. They also offered me a new hose and filters, all on Medicare's tab, but I declined them as I did not need them.
OK, now for the confusing phone call. I was in the back yard building a fence and suddenly my pocket started ringing. I quickly divined that it was the phone in my pocket that was ringing, not the pocket itself. I can figure these things out so much more quickly now that I am getting better sleep. I have the sleep doc in my contact list, so when I went to answer it I saw that it was from her office. It turned out to be a lovely sounding lady secretary calling me to tell me that I was past due for an appointment.
Trying to sound intelligent I responded "huh?" She explained further that if I did not let the doc see my data for compliance every 90 days Medicare would stop paying for the machine. I pointed out that I had my own machine, so to heck with Medicare. She insisted that Medicare still required an appointment every 90 days. We went back and forth for a bit until she finally concluded that if I had my own machine the 90 day compliance requirement was not necessary. We decided that she would leave a message for the doc explaining that my AHIs were under 5, that all was cool with me, and I didn't see the need for an appointment. If the doc thought that there was still some reason she needed to see me the secretary would call back.
What confuses me is whether the compliance information is necessary for Medicare to pay for supplies and new masks, which I do want them to do. And some day one of our manufacturers will come out with a new killer machine guaranteed to turn my body clock back to age 18. It will probably cost a lot, so I'll want Medicate to pick up the tab. I tried to read the Medicare information, but it was written in a mixture of two obscure dialects: Federalese and Medicalese, neither of which I ken. For that matter, as far as I know, the speakers of those dialects do not understand them either.
Does anyone think I ought to go see the doc, even though I don't need to? Any insights and observations welcome.
However, I muddied the insurance waters by purchasing my own PRS1 in late April on the local Craigslist for $300. Subsequently I returned the PRS1 to the DME. Since I did so without authorization from the doc they filled out an "AMA" form (against medical advice). I signed this form, else they would not have taken the machine back.
A few weeks later I went to the sleep doctor's office and obtained a copy of the prescription and results of the sleep study from her assistant. With prescription in hand I went to a different local DME and bought a Swift LT. Since it had not been three months I knew Medicare would not pay for the mask, so I just paid for it out of pocket.
The Swift LT was not satisfactory, so a couple weeks later I sent the prescription to Supplier #1 and bought a Mirage Vista from them. Again, it had not been three months, so I just paid for it out of pocket.
But a few weeks later the Pilairo finally became available and my new DME had them in stock. And now it was past three months, so theoretically Medicare would pay for it. I went to see the respiratory therapist at the new DME and ended up buying the Pilairo. They just charged me the Medicare copay ($22 and change) and assured me that according to my paperwork Medicare would pay for the rest. They also offered me a new hose and filters, all on Medicare's tab, but I declined them as I did not need them.
OK, now for the confusing phone call. I was in the back yard building a fence and suddenly my pocket started ringing. I quickly divined that it was the phone in my pocket that was ringing, not the pocket itself. I can figure these things out so much more quickly now that I am getting better sleep. I have the sleep doc in my contact list, so when I went to answer it I saw that it was from her office. It turned out to be a lovely sounding lady secretary calling me to tell me that I was past due for an appointment.
Trying to sound intelligent I responded "huh?" She explained further that if I did not let the doc see my data for compliance every 90 days Medicare would stop paying for the machine. I pointed out that I had my own machine, so to heck with Medicare. She insisted that Medicare still required an appointment every 90 days. We went back and forth for a bit until she finally concluded that if I had my own machine the 90 day compliance requirement was not necessary. We decided that she would leave a message for the doc explaining that my AHIs were under 5, that all was cool with me, and I didn't see the need for an appointment. If the doc thought that there was still some reason she needed to see me the secretary would call back.
What confuses me is whether the compliance information is necessary for Medicare to pay for supplies and new masks, which I do want them to do. And some day one of our manufacturers will come out with a new killer machine guaranteed to turn my body clock back to age 18. It will probably cost a lot, so I'll want Medicate to pick up the tab. I tried to read the Medicare information, but it was written in a mixture of two obscure dialects: Federalese and Medicalese, neither of which I ken. For that matter, as far as I know, the speakers of those dialects do not understand them either.
Does anyone think I ought to go see the doc, even though I don't need to? Any insights and observations welcome.
