Insurance payment for replacement CPAP

[dougwur]

How often will insurance/Medicare pay their % for a replacement machine?
Sorry if this has been asked, but I did a search and got no results.

[Melman]

I believe it's 5 years.

[staceyburke]

It is 5 years BUT the supplier will not replace if it is only to get an upgrade or newer machine.  I tried and so did my wife (mine 5yo wife 7yo) and were told both times if the machine was working we could not have a replacement.  They mentioned they could replace it if it had water damage or had been dropped or not working right.  So I bought one got a RX from the doctor with the name and model of the machine and turned it into the insurance for durable equipment.  I was paid for it from my regular insurance.

[becker44a]

Hi Doug,
In the last year, I requested a replacement for my (working) Resmed S9 Autoset, with about 16,000 run hours (about 6.5 years).  My Primary Care Dr. wrote the Rx, and the S9 was replaced with an Airsense 10 Auto unit.  From the DME, I understand that this is on a 13-month rent-to-own program thru Medicare, and my supplemental insurance is paying the rest of the cost..  I have read posts where others have said that the machine to be replaced must be broken, but this was not my experience.  I have retired the S9 to backup duty.  It is comforting to have a spare if something happens to my main machine.

[staceyburke]

I wish that was my case, my wife’s has 24,000+ hours and she was just last week denied through Medicare our regular insurance oked it but Medicare has denied it.

[SideSleeper]

I had a 5 year old Respironics 560 with high hours--100% compliance on it except for 10 in the hospital during that time on their machine. Had been doing well then started having problems with my AHI going up. Tried everything I had read here and nothing helped. Went to my sleep doctor and aid it's almost like it isn't working right. He agreed and I had my new Resmed Airsense 10 almost exactly 5 years from the date I got my old machine. No problems with a new DME getting the OK from Medicare. This was September 2020. My AHI is down below 1.0 now most every night.

[Gideon]

Stacy, is it getting louder, are you hearing a little bit of bearing screeching? I don't know but this commonly happens to older machines.

[staceyburke]

Neither were having pro. I wanted to go from a dreamstation to a VAUTO 5 yo. I just paid for it out of pocket and my insurance reimbursement was given for durable equipment. (I purchased from Supplier #2 on the suppliers list - used)

My wife has a brick (machine with no data) 7 years old - nothing wrong - it was denied by Medicare. I did not want to lie about having problems so when they asked IF there was a problem I told them no but we wanted an up to date machine with data. Rejected by Medicare.

[greatunclebill]

your doctor's nurse should be able to care of it. the doctor needs to know how to write a convincing prescription, and the nurse should have a good relationship with the dme to put it thru. if you don't have this you should find a new doctor and/or dme.

[staceyburke]

WELL I just got a call from my provider and they resubmitted my wife’s request again and she gets her machine Thursday. I don’t kno what was it they did differently but we were denied now we are ok. It was a 7 year old machine and had no data. She was prescribed a 10s autoset for her. Now we will see what we get.