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CPAP and Medicare and yearly Rx renewal - silverchief2 - 04-05-2024
I posted before on a related subject and recently followed through on this.
I had a sleep study done long ago and have had my airsense 10 for long time, before medicare.
I get my consumables from a local DME that deals with Medicare.
My last Rx renewal was over a year go.
The DME refuses to resupply the consumables saying medicare requires yearly renewal.
I checked with medicare and they said that is not required.
I just call other DMEs and they all say medicare (and other insurance) required yearly renewals.
One said if the number 99 was present in the Rx it did not require yearly renewals????
Someone here said medicare does not require yearly Rx renewal.
I would appreciate definitive answer.
If someone here gets consumables for CPAP through medicare w/o yearly renewal what is your source?
RE: CPAP and Medicare and yearly Rx renewal - OpalRose - 04-05-2024
My script from 2014 states " Lifetime". No one has ever asked me to get a renewal...yet?
My DME sends needed supplies every 90 days.
I also buy from online suppliers when I see a good deal, but I'm not reimbursed for that.
RE: CPAP and Medicare and yearly Rx renewal - SarcasticDave94 - 04-05-2024
Rx renewal requirements have been mentioned here on the Board by others. However, it very likely points to either a doctor or DME money grab. It is not required as long as your script date/description covers it. Lifetime or 99 years would suffice. Medicare does not require yearly testing or script renewals. Scam, fraud, money grab comes to mind.
Take a look at the CMS Medicare website HERE.
And this was answered definitely in another thread by Sleeprider. Yearly Rx isn't required, a party other than Medicare is requiring this of you.
RE: CPAP and Medicare and yearly Rx renewal - cps22 - 04-07-2024
I ran into this issue when I had my compliance visit with my sleep doctor. Although I would normally use my local DME in order to get equipment covered by Medicare, I asked the doctor for a prescription so I could purchase masks online out-of-pocket that my DME doesn't carry, or that I'm not eligible for yet. He printed it out for me, and I uploaded it to Supplier #1. They contacted me and said they could not send me the complete mask system because the Rx said "no refills", and they could not know whether I'd already had it filled elsewhere, but they could send me the separate parts instead ($5 more than purchasing the entire system). After I responded to them that I'd gotten that from the doctor when I'd asked about purchasing online, and they could see that I uploaded it the same day as the Rx date, they went ahead and filled it but said that they couldn't fill it again from the same Rx, and that normally it should say "99".
Since I haven't needed to purchase another entire mask system out-of-pocket again yet, I didn't bother pursuing that issue with my doctor, so I don't know whether or not he would issue the prescription with an unlimited date. But I'm eligible for another full mask system this month, and I'm hoping that my DME has the F40. If not, I'm not sure whether I'll have them give me the F30i I've been using and try to purchase the F40 online (either as parts or contact the Dr for a new Rx), or see if the DME thinks they'll get the F40 soon and just wait for it. I hate to keep having to buy supplies out-of-pocket when I have Medicare plus a supplement so I have no co-pay for anything I get from the DME.
RE: CPAP and Medicare and yearly Rx renewal - Sleeprider - 04-07-2024
This section of the Dealing with a DME discusses this issue https://www.apneaboard.com/wiki/index.php?title=Dealing_with_a_DME#DME_or_Sleep_Specialist_Says_I_Need_a_New_Sleep_Test If you have a copy of your original sleep test, it is still good and you don't need another. You should discuss your therapy annually with your primary physician. No need for a specialist. Your doctor can continue to renew Rx for supplies and device as needed, and can even upgrade your device if he feels you will benefit from bilevel. Don't be bullied by a DME. They have to obtain insurance approvals, but it's not their job to tell you your study is not adequate. Tell them to submit the claim, or do what I did in your case. My DME suspended my supplies, so I changed DMEs, provided them with a copy of my test and referred them to my doctor for a prescription.
RE: CPAP and Medicare and yearly Rx renewal - silverchief2 - 04-07-2024
Thank you so much. My sleep study was over 10 years ago. I imagine my sleep specialist RN has a copy but she is difficult to deal with.
I will try this week. I recall something weird. I had my sleep study and a consult with a sleep MN who set me up with a DME who provided me with the CPAP and supplies. Later I needed to replace CPAP when mine electrically fried itself. I was told I did not have an Rx only the sleep study (never got an Rx?) and need an Rx which I got.
Do you know of any CPAP places that deal with medicare and ship and do not require an annual Rx?
Perhaps the trick is to have the MD say it good for 99 years or never expires?
I meant sleep MD not sleep MN Also the first CPAP was with insurance not Medicare the I had an HMO.
RE: CPAP and Medicare and yearly Rx renewal - Sleeprider - 04-07-2024
My last sleep study was in 2008. I have retained a copy for my records. The DME does have to keep a current Rx to be reimbursed for Medicare, but as I said before, this does not require a specialist. Don't you have a doctor you see every year? Even with a 99 year CPAP expectation, the doctor only has to determine you're benefiting from your therapy and it is medically necessary to continue.
RE: CPAP and Medicare and yearly Rx renewal - Homerec130 - 04-08-2024
My DME says they need an updated script once a year from my sleep doc. So, I see him every 6 months, so each time I see him, he sends a script to the DME. He asks me what I want and fills it that way. BTW, I usually get a 10' hose as it works best for my setup. DME only says we have the update script. My wife's doc does the same (we both have the same DME). It has been more than 5 years since my last study, and my doc says we'll do another if we need it. It appears my DME doesn't care.
RE: CPAP and Medicare and yearly Rx renewal - SarcasticDave94 - 04-08-2024
It appears pretty clearly that your DME is the one causing the request for yearly renewal issue. Something needs to change if you want different results. If the issue is caused by the DME, replacing them solves the issue. I have not read about Medicare requiring yearly script renewals. For one supposedly following Medicare rules, they aren't getting it right, from what I'm hearing.
RE: CPAP and Medicare and yearly Rx renewal - clancynet - 07-11-2024
This industry is riddled by fraud. The DME's (mine is currently CARE Medical/Athens,GA) doesn't provide an invoice and insists on adding "filters" to every order. Salami technique. It's only a few dollars but we all know you can buy 100 of those filters online for next to nothing. They charge about the same for 6 filters. Scam.
The doctor wants you to see him twice a year and colludes with the DME supplier to run up his cut.
Is there any DME supplier out there that lets you order what you actually NEED and let your insurance pay for most of it? (my UHC medicare advantage plan covers 80%, leaving me a 20% share.)
As taxpayers and consumers we are being ripped off.
Agitated in Atlanta. :-)