Seeing Sleep Doc next week

[Peter_C]

Let's see?? (am bad on dates), I bet it's been 5-6 years since I've seen my sleep Doc. He's a practical guy that has specialized in this field for many, many years and unlike many of the horror stories others have posted, I've been very happy with him since the beginning of my OSA treatment.

With him, it's all about the results. He says you're a big boy, you know when you need to see me (Law says he must see me yearly to get new scripts for anything, but otherwise there is no need unless I need him). So I am suddenly on 'Medicaid' til July, then will be on 'Medicare' - so I called yesterday to leave him a message, and they called back within 90 minutes with an appt for next week.

My expectation is to go in, show him a few recent reports, bring him up to speed on my med list, talk about Pain MGNT vs OSA - and (hopefully) get a script for a new machine (S9 Autoset - correct?).

Am hoping to just fax the new script to Supplier #1 and let them deal with Medicaid? Does anyone have experience with both Supplier #1 and will they handle the whole Medicaid bit, or must I get a local DME to do it? I've dealt with Supplier #1 in the past on a cash-only basis, so have no idea if they bill Medicaid/Medicare or not?

Anything I'm missing here? Will be the first sleep Doc visit in years but am not expecting any issues, mainly chasing a new machine. Wish to upgrade to a nicer/newer model.

[trish6hundred]

Hi Peter_C,
If I'm not mistaken, the online companies, (such as Supplier #1 on the list,) either send you a link to a form on their site, or a pdf of the form, via e-mail regarding how to deal with your insurance, I don't think they deal with that directly.
Hang in there for others who know better about this.
Good luck to you at your Dr. apointment. Hopefuly, you will get a prescription for a newer machine.

[retired_guy]

Anything I'm missing here? Will be the first sleep Doc visit in years but am not expecting any issues, mainly chasing a new machine. Wish to upgrade to a nicer/newer model.

Try to get one with four doors and a sunroof.

Also, call the online suppliers and ask them how the medicare thing works.

[jaycee]

I don't do anything with billing at my company, but if I understand correctly, to get your supplies billed to Medicare/Medicaid all you would need would be:

1) An RX from your doctor (it doesn't actually need to be a sleep doctor, it can be any doctor, or with some insurances a PA or NP).
2) A copy of your PSG (sleep study without PAP) showing that you do infact have sleep apnea.
3) Medicare will need a copy of office notes from your doctor that mentions CPAP and that you are benefiting from it.

[Peter_C]

I may well just let my sleep doc's office handle (like they did before) it. They have everything, as they've done my entire work-up and all my various studies, etc. Why try to save medicaid $$$ - as long as I get a *new* machine (check the total hours).

So I don't goof? The correct Model I want is??? "S9 AutoSet"?

[robertbuckley]

You have to be careful with Medicaid/care. Depending on where you are located they will only cover when equipment is ordered through an approved supplier that is on their list, having gone through a bidding process.

[PaytonA]

If you want the newer version of your current model I would get the S9 VPAP Auto. The Autoset does not give you bilevel and I notice that you are using a PS of 7 which is more than the 3 you can get with the EPR on the Autoset. It is my understanding from the reading that I have done that the S9 VPAP Auto uses the same algorithm that was developed for the Autoset. Someone please jump in here if I am wrong

Best Regards,

PaytonA.

[Peter_C]

Yup - the models confuse the heck out of me. I do want/need to stay with a bi-level machine, so the "S9 VPAP Auto" is the current model for me, unless the sleep doc decides to pursue ASV issues. Thanks~!