End of the Saga

[PollCat]

Subtitle: Medicare, Insurance, Supplier #1 & I

As some of you may recall, I tried two RemStars during January of this year, sending both of them back to the online DME (Supplier #1) because they were excessively noisy. In February the DME credited the last noisy machine to my purchase of the S9. Since that time I've been "working with" Medicare and my insurance company to get reimbursed for a portion of the costs incurred.

Medicare rejected my purchase (for failing to buy the machine thru an approved Medicare DME) back in June. I then filed a claim, with all the pertinent paperwork, with my insurer - which promptly lost it. I re-filed the claim in late September, by faxing everything directly to the insurer, per their request.

Today, I received several letters from the insurer. Besides the usual stuff about the Medicare open-season, I got a letter requesting an original copy of Medicare's payment for the purchased machine and another one with a check for the full price of the original RemStar purchase. Given that the RemStar was slightly more than half the price of the S9, I'm going to "settle" for that amount and forget about trying to pry another 25% out of the insurance company.

Moral of this saga: if you have Medicare, make sure you buy your machine from an "approved DME" even though their price may be higher than your regular online DME - unless you have 'deep pockets' and can absorb the cost yourself. A lesson I'll probably have forgotten when I next need a new machine, in 5-6 years.

[zonk]

Moral of this saga: if you have Medicare, make sure you buy your machine from an "approved DME"

Good advice

[SuperSleeper]

Well, all-in-all, it could have been worse for sure. Glad that you recovered some of your cost, at least.

Education is sometimes expensive, unfortunately.

Thanks for passing on your experience so others can learn from it, Bob.

[renatae]

Hi, I'm new to the forum - and so thankful to have such a place to come to! Love the advice I've read here! My husband was dx about 5 years ago, but he is one of those "Does it work? Good. I don't need to know how and I don't want to read about it or talk about it" types. I'm the exact opposite. He has a RemStar Pro - nice enough machine, he's happy with it, he uses it, but boy, it's noisy after it ramps up. And he seems to be fighting to exhale at points and blows air out of his mouth, sounding like he's blowing raspberries. "P-P-P-P-P-P-P-" This is only occasional, though.

I was recently diagnosed, new to Medicare, and have had my titration study. Thursday they called telling me they were ready to get me set up. Having read assiduously here, I had my heart set on an s9 autoset for her. However, the sleep center said they don't carry ResMed, but would be happy to set me up with another DME. I asked if they would write the set of my dreams on the script and first she said, "You definitely will be getting an auto" and then said she'd be happy to write up the s9 auto. Next day, a supplier called, said they'd come to the home to set me up (I thought I read somewhere Medicare does not allow this but can't find it now.) She explaine Medicare would pay 80% for 13 months and my Medigap would pay the other 20%, which I knew. I'm on clould 9 for about a day, until I look up the supplier on the Medicare site, and find they are listed, but without the green P that denotes a Participating Supplier. But if they are not a Participating Supplier, they can't bill Medicare in the first place, right? Or do you think they will pull a fast one on me and try to get me to sign papers at the last minute consenting to an upcharge? Or, as I have read elsewhere, could the supplier list be outdated and the company really a Participating Supplier?

Of course, this all occurred to me Friday night after 5 pm and I'm going nuts, LOL.

Thanks for any help you can give!

[PaulaO2]

No clue. Check the page out and see when it was last updated. Some things are done on a quarterly basis vs monthly.

And it sounds like your husband is due for another sleep study. Is his machine an auto? Is it data capable?

Before I forget, ask for a copy of the prescription as well as a copy of the sleep study. All medical records such as this is a good thing to have.

[renatae]

I was looking for a date on the page, but found none.

I do intend to ask for the titration report, but I don't think I'll really have to - my doctor is very informative and gave me copies of my first test in the waiting room as I waited for my appointment so I could review them before we spoke. She went over them in detail with me.

My hubby is due, unfortunately, for more than another study. I think his last mask/hose any replacement was at least a year and a half ago. He won't go back. "They don't do anything. They gave me my old mask and hose as a backup. I don't need anything. I'll go back when I get on Medicare." The current insurance is a massive deductible which still hasn't been met. We just had this discussion again today. When I said he didn't want to talk about it, I meant it, LOL. Wondering if I really needed Climate Line, since we rarely have the windows open around here and maintain a constant temperature, I asked him about his hose and if he ever had condensation. "Of course, there is cold air going through them all the time." Exasperated sigh. Goes back to watching TV. Well, at least he has a washable filter. I try to cover his mask during the day so it doesn't get dusty, give him baggies, he dumps them in the bottom of the basket I put beside the bed for his equipment and dumps the mask on the floor.

Have no idea what type of machine he has. No idea where the instructions are - he's one of those who never reads instructions. By the pictures on the site, it looks like an M series, and it's labeled RemStar Pro. Has three buttons somewhat centrally located which are backlit in blue. He has Central Apnea.