Not Apnea

[Rowdy1]

I was prescribed a CPAP machine not for apnea but because I was diagnosed with a partially paralyzed diaphragm Medicare won't pay for the machine because of this diagnosed. Does anyone have experience with getting reimbursed by Medicare or their secondarily insurance? I have Bs/BS.

[robysue]

I think your best bet is to start by asking the doctor who prescribed the CPAP to send a letter of medical necessity to the appropriate insurance companies.  You should also contact your insurance company and ask to speak to a case manager to find out about the process for appealing a decision to deny coverage.  Typically the appeals process will require some paperwork, much of which has to be completed by the prescribing doctor.

Good luck.

[trish6hundred]

Hi Rowdy1,
WELCOME! to the forum.!
Good luck to you as you deal with insurance and also with CPAP therapy.

[Beej]

I'm wondering why the doc didn't want a ventilator of some sort, given the partially paralyzed diaphragm. Maybe ask?

[Mosquitobait]

You need to file an appeal with Medicare.  They will cover this. My brother has a similar problem and has a bipap because of it.  He had to first fail the cpap before Medicare would give the bipap.

I technically would not have qualified for a cpap with Medicare because my AHI is too low (only occurs during REM and near REM) although the RDI was 36.  Medicare only cares about AHI without additional paperwork so they fudged it because my oxygen level is very low without cpap.

[Rowdy1]

Thanks for the advice and welcome!