Medicare Question - Replacement Machine
I requested a replacement machine from my DME, Verus Healthcare (an Adapt Company), and they said they would contact my doctor for "documentation" which they refused to explain.
Does anyone know what documentation Medicare actually requires? From the questions they were asking, it sounded like what they say when I order supplies.
Thanks,
Steve
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
RE: Medicare Question - Replacement Machine
They have to receive an order from a doctor for CPAP therapy. May also need the results of a sleep study so they can set the machine up. My DME wouldn't even talk to me until they received the order and study results! DMEs tend to be a pain to work with. Fortunately I discovered apneaBoard and OSCAR around the time I was to receive a new machine and didn't need the DME once the equipment arrived.
RE: Medicare Question - Replacement Machine
@ withtao
Thanks. I sent my last sleep study (done in 2016) to the DME along with the original Rx at the time of my request.
I sent the last 90 days of therapy in the ResMed ResScan format to my doctor with a note about the machine I wanted and the settings I am using.
I guess I will now play the waiting game.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
RE: Medicare Question - Replacement Machine
My first sleep study was 2015, my PCP ordered a new on for 9/1/2022 in anticipation of the DME demanding a more recent one. That helped in my getting the Air Sense 11 on 9/28 after the PCP sent the order to the DME. The insurance provider and insurance regulations are behind a lot of this.
Went thru similar hassle getting an O2 concentrator when I discovered I had very low O2 while sleeping using an oximeter I purchased. I was able to use the results from my oximeter and OSCAR to convince my PCP, which in turn convinced the Medicare Advantage insurance provider.
You're in the right place at aneaboard and using OSCAR.
RE: Medicare Question - Replacement Machine
It sounds like the DME is requiring a (LMN) from your doctor.
http://www.apneaboard.com/wiki/index.php...sity_(LMN)
RE: Medicare Question - Replacement Machine
Is this the first machine you are getting under medicare? When I was in that situation I had 2 things going on. Upgrading from APAP to BiLevel. Doc ordered a split test but the diagnostic study didn't go as planned, I only got 1 hr and 59 minutes of sleep of the required 2 hrs. The tech fudged it in. Anyway the study was needed by medicare since my previous was over 10 yrs old.
04-22-2023, 06:16 PM
(This post was last modified: 04-22-2023, 06:19 PM by srlevine1.)
RE: Medicare Question - Replacement Machine
@ Gideon -- no, this is a replacement.
@OpalRose -- thanks. Now I know what to ask for when I talk with the Doctor's office on Monday.
Is there a time limit on Sleep Studies? My last one was in 2016, and not much has changed. I am under 1 most of the time with a rare 2+.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
RE: Medicare Question - Replacement Machine
Is this the first machine you are getting under medicare? When I was in that situation I had 2 things going on. Upgrading from APAP to BiLevel. Doc ordered a split test but the diagnostic study didn't go as planned, I only got 1 hr and 59 minutes of sleep of the required 2 hrs. The tech fudged it in. Anyway the study was needed by medicare since my previous was over 10 yrs old.
