Cpap vet getting Medicare coverage and a "new patient" exam - need advice please!

[Sleeprider]

My physician is not a sleep specialist, but manages my therapy needs by incorporating a discussion of "how is your bipap therapy going" into each exam. That is documented as a physician contact and is available to the DME if needed. He wrote my last prescription based on my requested settings for the Vauto, and I got my last machine several years before starting Medicare. I suspect I will need to document some additional things for Medicare, but since I have been under continuous care since receiving my last machine, and my 2008 diagnostic study is on record, I should be able to fill future Medicare prescriptions...I hope. Anyway, Medicare is paying for my supplies now along with the BCBS Advanage Plan, so when a new machine is needed I hope everything will be in place. I guess the bottom line is, you don't need a specialist if your doctor is willing to discuss your therapy at routine visits and you are confident in managing your own care under his supervision.

[Feedsack]

Surprisingly I just went through the very thing that you are experiencing. When I was diagnosed with AFIB i knew something was wrong. At that time with help from a friend I self diagnosed my sleep apnea since I had no time for a sleep study! (foolish thing). I got a Repironics auto bipap set it on auto and with time and help from this forum got AHI numbers at times close to 1 and never so high as six. I then went to medicare and was forced to see a pulmonary specials and did sleep studies and titration and ended up with a free to me RESMED aircurve vauto. Im using this now.Yesterday was the first time. So far im not out anything and supposedly they will send me stuff every month as supplies.

[SheitlQueen]

I am new to both Medicare and Sleep Apnea. Was referred to a sleep specialist before I went on Medicare who recommended a home sleep study. Since I was still on my old high deductible insurance, I opted to wait a couple of months until Medicare kicked in. I have found the process efficient and I love that everything has been covered. Had the at home sleep study, went in to the sleep lab for the titration study, went to the DME place and got set up with a bipap and a mask. Went back to the doctor for a compliance visit which went well. He said come back in a year. No problems, no issues, and best of all no out of pocket expense. Even managed to order cpap supplies at the end of December so I don't have to order them after the new year when the medicare deductible resets.

[FormerFed]

Oh, but I can keep it.  I learned through a handy guide BC/BS Federal Employee Program sent me some months before my b'day, "Medicare and Blue - 2019" … if you are already under Federal retiree BC/BS coverage you can keep that as your secondary, it is no longer your primary unless you refuse Medicare.  I recall something that BC/BS rules or coverage changes if you refuse Medicare, but I don't remember what that was as I didn't look into that option, didn't think refusing Medicare was a good idea.  You can bet the farm I double checked with a live body to be sure I was comprehending what I thought I was reading!  It isn't the cheapest way to go, but the guide indicated, with the very pessimistic crystal ball I made up to forecast  what might happen to me this coming year, it selected my current option as the way to go.  I'm liking, also, going thru my 1st "Medicare" year with as much unchanged from previous years as possible, and then start meddling around with it next year during open season if this year's combination of coverage was overkill or too expensive.

[EmilySleeps]

Medicare can be a bit tricky.  Yes, you've been successful and compliant with your treatment, but they don't know that, since you haven't been back to a doctor.  What they will want is documentation or proof that you've been compliant.  

I have the same issue with my regular family doctor, as he doesn't want to treat or write scripts for anything Sleep Apnea.  So, I show up once a year to my Sleep Doctor/Pulmonologist and he documents everything.  You have to "play" Medicare's game if you want continued coverage.  

Start printing out reports from ResMed and OSCAR software to show you've been using the machine and for how long.  Bring all that with you to your appointment.  Possibly bring a copy of your SD card along too.  

Good Luck!

I'm also having trouble getting Medicare to cover my CPAP expenses. I've been using my CPAP for years and have a copy of my original test results and prescription, although my original prescriber is no longer in practice. I've been told that Medicare insists on a new sleep study, which I definitely don't want to do given the Covid situation. Does anyone have any suggestions for working with Medicare?  I've been paying for all my CPAP expenses out of pocket and it's expensive.

Also, you suggested "Start printing out reports from ResMed and OSCAR software to show you've been using the machine and for how long." How do you print out such reports??  Many thanks!!!

[SideSleeper]

For EmilySleeps: Call Medicare if you haven't and get the correct information. I would think they would at least cover a home study. Your secondary insurance program, if you are enrolled, should pay the 20% that Medicare doesn't cover. You should be able to get a new machine if yours is 5 years old.

[EmilySleeps]

For EmilySleeps:  Call Medicare if you haven't and get the correct information.  I would think they would at least cover a home study.  Your secondary insurance program, if you are enrolled, should pay the 20% that Medicare doesn't cover.  You should be able to get a new machine if  yours is 5 years old.

Thanks for your reply, SideSleeper!  I've tried to reach Medicare, but it's not easy to get to talk with someone who is knowledgable.  I'll try to call them again tomorrow!  Also, I didn't realize that you can get a new machine after 5 years - I've had mine since 2014!

[plakky]

I was already on Medicare when my CPAP experience began less than a year ago during Covid, and Medicare plus my supplemental insurance has paid for everything. (Be sure to look up the Medicare resupply schedule online for machines, masks, cushions, hoses, etc., etc.)

My experience was that after one Afib event, the cardiologist referred me for an extremely basic home sleep study, which was analyzed by a pulmonologist who confirmed OSA. I have never met him in person - have only had Zoom appointments; the purpose is clearly just to document my compliance for Medicare coverage. All my DME transactions have been over the phone; there is no physical office in my area. Again, Medicare has paid for everything.

Basically I needed the sleep study, a doctor to acknowledge the results, and periodic doctor follow-ups for compliance for the first year or so. Luckily we have this forum to learn the nuts and bolts about how to fine-tune and use our equipment.

As long as their (basic and clearly set out) rules are followed, Medicare is absolutely wonderful regarding OSA/CPAP.

[EmilySleeps]

I was already on Medicare when my CPAP experience began less than a year ago during Covid, and Medicare plus my supplemental insurance has paid for everything.  (Be sure to look up the Medicare resupply schedule online for machines, masks, cushions, hoses, etc., etc.)

My experience was that after one Afib event, the cardiologist referred me for an extremely basic home sleep study, which was analyzed by a pulmonologist who confirmed OSA.  I have never met him in person - have only had Zoom appointments; the purpose is clearly just to document my compliance for Medicare coverage.  All my DME transactions have been over the phone; there is no physical office in my area.  Again, Medicare has paid for everything.

Basically I needed the sleep study, a doctor to acknowledge the results, and periodic doctor follow-ups for compliance for the first year or so.  Luckily we have this forum to learn the nuts and bolts about how to fine-tune and use our equipment.

As long as their (basic and clearly set out) rules are followed, Medicare is absolutely wonderful regarding OSA/CPAP.

Thanks for your message, plakky.  Unfortunately, I just spent hours on the phone with Medicare and multiple durable medical equipment supply firms. (Medicare said I needed to contact a supply firm directly and they gave me a list to call). More than half on the list said they no longer work with Medicare, and with the others I left messages. CVS was on the list, so I called and was told I needed to call their Minute Clinic number, but they didn't seem to understand what I was talking about. I contacted Medicare again as I thought this information would be helpful to them in updating their referral list but the woman I spoke with said she can't do anything about it. AAAARGH - such a frustrating waste of time.  Maybe I should try asking a cardiologist for help.

Best regards,
Emily

[plakky]

In my relatively recent and very medically-distant-due-to-Covid CPAP experience, my doctors aside from my cardiologist have not done anything medically since my one Afib episode, but are only currently involved to assure Medicare compliance to allow me to receive the equipment I need. The cardiologist referred me to a pulmonologist who referred me to a sleep study place which mailed me a do-it-yourself kit for a home sleep study.

After receiving the at-home sleep study results, the pulmonologist sent a prescription for a CPAP machine and mask to a DME, who mailed me the equipment. All interactions were done virtually or by phone.

Bottom line, you just need a doctor who will write prescriptions for you; in my case a pulmonologist. They don't need to be your favorite MD and you don't need much of a relationship. And you can change DME's when you want, and many accept Medicare. Good luck!