Medicare - United Healthcare

[Dotneck]

Hi y'all. Newbie to the forum but I've been on CPAP for about 20 years. Can't imagine trying to sleep without it.

I've been reading the board for a few days and I'm surprised to see what folks say about their doctors and DMEs. I've seen a doctor twice about sleep apnea. One sleep study when I was first diagnosed and once about seven years ago for a second sleep study because my CPAP machine died. I've been given a machine and sent on my way. I've never had any follow-up on therapy other than compliance check ups so insurance would pay for the machines. Every year or two I order some masks on-line.

My Resmed S9 is now showing the end of life message about my motor (after 23,000 hours of use). Also I am now on Medicare (after about a year) with the supplemental from United Healthcare. I've asked my PCP for a prescription so I could buy a new machine and wonder if I submit my receipt to UH if they will reimburse my expense. My last sleep study was about seven years ago (or 23,000 hours). I'll probably pursue the ResMed Airsense 10

Any suggestions?

[OpalRose]

It depends on your coverage. Call your insurance and ask about your coverage. Often times, Medicare will reimburse much less if you choose an out of network provider (DME), so it's best to get a list of providers from them. If you have a high deductible, you might want to consider self paying.

Also, if you go through Medicare, your Doctor will have to document a once a year visit in order to get supplies covered. Best to do your research, so there are no surprises.

[SarcasticDave94]

It would also depend on which segment of United Healthcare you have. I'm thinking there's a regular paid version and then there's the United Healthcare Community plan AKA Medicaid. I had the latter until I started on Medicare May 1 this year. UHC emulates Medicare more or less exactly, excepting they do not reimburse at all. Either the item is approved via pre-authorization and goes through all the proper authorization steps or you buy it.

[Big Guy]

My sleep doctor told me that I need to see him twice a year to satisfy any Medicare requirements.

[GuyScharf]

If you now have traditional Medicare, you need to fill the Rx for a machine through a DME that is a "medicare provider." Medicare will then cover 80% of the cost, automatically submit the bill for the remaining to UHC, and they will cover the rest (depending on your supplemental plan). I have supplemental plan F, so my out-of-pocket expense for a CPAP machine was zero.

Generally, you cannot purchase and submit a receipt. Medicare doesn't work that way.

[Dotneck]

Thanks everybody for the input. Called my old sleep clinic and they have closed their doors during the pandemic. Found a new provider at a neurology clinic so I made an appointment as a new patient. I hope they don't want a new sleep study...I really don't want to do one during this pandemic.

[SarcasticDave94]

Ask the new facility to provide you with a medical release form and get them to transfer all patient files from old to new.

[SideSleeper]

Medicare does pay 80% of the cost, but basically they are paying the DME to rent the machine for a year. After that you own it. I had to go see the DME monthly to prove compliance for that year.