Getting new machine Tuesday - Medicare

[mirkee]

First of all, I have been on CPAP for 30 years.  Always compliant.  I don't think I have missed a night of using my CPAP since I started.  I nap very seldom, but when I do, I use my CPAP.

Two questions:

1.  I have a Resmed auto S-9 now.  I told the Dr. that I wanted a new Resmed 10, also auto, and he said OK.  This was after they had written the report saying that I needed a Resmed A10 with no specification for auto sense.  When I saw him for the sleep study follow up he said he would change it to auto but it's not in the original order.  If this is a problem, will I still get the machine I want?  I think he will change the order and make it good but I want to ask in advance.  I have Medicare parts A and B with a supplemental Blue Shield Medicare Basic (PDC), not Medicare advantage, HMO type.

2.  The girl from the pharmacy providing the CPAP machine told me that one of the advantages of the newer machines is that they could monitor my use at all times.  Since I have been compliant every day for 30+ years, compliance should not be an issue.  I just don't like the idea of constant monitoring.  Is there another way to satisfy Medicare's compliance requirments that does not include remote monitoring?

By the way, my sleep study indicates AHI index of 76.2/hr and low SpO2 of 85%, mean of 91.9 Post CPAP AHI is 0 per hour, SpO2 above 93%.

Thanks in advance.

[OpalRose]

Hi mirkee,
I wouldn't worry too much about Medicare.  All they care about is that you meet their compliance rules.  It doesn't look to me like you would have a problem with that.  

You should however double check with your doctor and be sure that he wrote your  prescription for an Auto Cpap.  

Good luck and keep us posted.

[trish6hundred]

Hi mirkee,
WELCOME! to the forum.!
Call your doc and make sure he/she has changed your prescription to the Resmed AirScense10 AutoSet.
Good luck as you continue CPAP therapy.

[Gideon]

I'm in a similar situation to you. I am going on Medicare, correction, I just went on Medicare with a similar plan, United Healthcare aka AARP vs bcbs.  Plan G.

Call your DME and ask 2 questions.  What machine are they going to provide after stating ResMed Autoset or AutoSet for her. And do they accept Medicare Assignment.  Think of it as being in network for Medicare.

[Mosquitobait]

1. Just call the DME and confirm that the doctor upgraded the order to an auto. Call before you go that they indeed have an auto there waiting for you. Shouldn't be a problem. My BC/BS basic supplemental doesn't cover cpap machine or supplies AT ALL, but it may vary by state. Medicare still covers the 20%. Be aware that the DME will list the humidifier separate because there is no code for an integrated unit.

2. Every time you get a new machine from Medicare, you have to go through compliance. Once you've completed 90 days plus the follow-up doc appointment, compliance is no longer necessary. Ask your DME what they do after the compliance period is complete. Lincare, for example, does absolutely nothing unless they receive a doctor's order after the compliance is complete. They don't track anything because it costs them personnel time to do so and they don't get reimbursed for that.

[sbf1943]

25+ year cpap/apap user. Recently got a resmed A-10 apap covered by Medicare-BC/BS, though the BC/BS is traditional not HMO.

Like mirkee I was concerned about compliance monitoring. I asked about it and told that since this was the second machine paid for by Medicare there was no compliance monitoring required.

I don't know if this is mirklee's second machine but for those who get a second machine from Medicare monitoring is probably not required. This is insurance and government, obviously everything is subject to change, so its always best to check your own situation.

First post, good site, helped me make an informed decision about my new Resmed apap. I'll try not to lurk too much!!

[mirkee]

Indeed this is my first machine through Medicare, hence the required monitoring.

[Sleeprider]

It's a good idea to call the supplier and see what machine is being dispensed before you go in or have it dropped off. If it is not the Airsense 10 Autoset, then simply decline it until it is. Do NOT take delivery. Machines have been able to track compliance since at least 2006, and now provide you with full efficacy data. That means you can see information that is like a sleep study every night, that will let you optimize treatment. As far as transmitting data, the machine can be put into airplane mode to prevent wireless transmission, but the information sent is mainly date, time of use and summary leak and AHI. You can prevent transmittal if you choose, but it's not much of a problem, and in many cases no one is listening anyway.

[mirkee]

Went to pick up my machine.  DME tech told me the Auto is the only one they get anymore, so I'm happy.  At least I knew what to ask for thanks to this forum.