Medicare CPAP supply requirements

[car54]

I am getting my cpap supplies through Medicare. I will be meeting with my doctor to try to switch to a Vpap machine which might be troublesome with all the Medicare rules. I have a used Vpap and if I use it my compliance reports will not be sent to my doctor because it is not registered to me.

So my question is, will I be able to continue to get the cpap supplies through Medicare?

Thanks, car54

[OpalRose]

My current VAuto is not registered through my DME because I bought it out of pocket.

I registered it with MyAir and give my Doctor print outs.  As long as the doctor is satisfied that you are using it, then insurance is happy.
My DME still sends supplies as needed every 60 days.

In your case, the used Vpap may or may not be registered to someone else.  You could try to register it through My Air and see if it's accepted.  Then let your Doctor and DME know.  The DME should still send supplies regardless of what machine you're using.

[car54]

question for OpalRose, 

Are on medicare?

I was able to register my used vpap on Myair and can get reports.

Went I went on medicare I tried to get a bipap because I have copd and asthma. My doctor initially approved of it but all I did is run into roadblocks and that is why I am on a cpap. 

My lungs are not getting better and I respond better to my craigslist Resmed Vpap. I had my yearly meeting with my pulmonologist, who also treats my sleep apnea and I showed him many graphs from OSCAR proving it. He agreed and sent an order to the DME to accept the serial # from my craigslist vpap so that I would be in compliance for medicare. They called and refused to do it because I did not buy it through them. Then they reprimanded me for changing my own pressure and they will inform the doctor of what I have done. I told them that the doctor is aware that I have changed the pressure.

The DME is affiliated with the local hospital chain and they seem to be hardnosed on everything.


So does any one have advice on this? I don't want to give in because of bureaucrats.

Thanks, car54

[SarcasticDave94]

If you use either OSCAR or sleepyhead, print a summary like a compliance report. Use that in conjunction with your doctor's patient notes of your ongoing treatment. This should be enough to prove medical necessity.

[car54]

That is what I did. I bought about 10 pages of Oscar results. Some on cpap and some on vpap. The doctor agreed and told the DME to accept the serial # of the used vpap. 

I am wondering if I change to a different DME if I would have the same problem.

[SarcasticDave94]

If that DME's that troublesome, certainly go elsewhere. Example, my required info to get PAP supplies with Lincare was answering "have you used the PAP regularly the past 90 days?". If yes you get supplies. No then you don't.

PS I'm not implying Lincare is great, but the one I use in Hanover, PA is good.

[OpalRose]

It's gotten pretty hard to get anything done when dealing with DME's, Doctor, and Insurance.

My pulmonologist wanted me to go for another sleep study. It had been 6 years.
I refused because of Covid. I still won't go... call me stubborn! He understood and wrote me a script for a BiLevel anyway. He even submitted it to Lincare and they refused to submit it to insurance without a sleep study. It's like dealing with a three ring circus.

A year ago, I decided to purchase a VAuto myself.

Here's the real kicker... Insurance finally agreed to pay for a replacement Apap without a new sleep study. I let them do it. Now I have a "For Her" model as a backup and a VAuto which I prefer.

Lincare seems more than ok with sending supplies every two months.

[car54]

I sent my doctor an email telling him what the DME said and asked for his help. I did not know if he would so.
 
Next would call my Medicare supplemental insurance company and talk to them about required compliance. After that I was going to contact other DME's and feel them out.

I never made it that far because I got a call from a rather serious sounding man, like a police officer calling to tell you about a car accident that your family was involved in. He was from the DME. In a very few words he told me that the doctor called and he was told to activate my used vpap machine. He did not sound happy about it.

So it seems that it has worked out. I can use my vpap and still get Medicare supplies. PRAISE GOD!

I will send the doctor a greatly appreciate thank you.

car54