"please keep me updated about oximeters "
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MEDICARE COVERAGE
DOES ANYONE KNOW IF MEDICARE WILL REPLACE A MACHINE THAT IS OLDER
THAN 5 YEARS WITHOUT IT BEING BROKEN, LOST OR STOLEN?
THAN 5 YEARS WITHOUT IT BEING BROKEN, LOST OR STOLEN?
Views: 91
Replies to This Discussion
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Permalink Reply by Judy on
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Most likely you will be required to have a new in-lab PSG. There are so many changes being made that I hesitate to say one way or the other.
Was your first CPAP purchased by Medicare? Has Medicare been purchasing your supplies? Are you just recently starting on Medicare?
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THANKS JUDY ...MY SUPPLIES ARE BEING PAID FOR BY MEDICARE AND THEY
PAID FOR MY CURRENT BIPAP. I HAVE RECENTLY HAD ANOTHER SLEEP STUDY ...TWO PERSONS AT MEDICARE SAID THAT THE 5 YEAR REPLACEMENT RULE WOULD GOVERN AND THEY WOULD PAY...BUT OTHERS HAVE SAID THAT IS NOT CORRECT...THAT MEDICARE WILL ONLY PAY IF A MACHINE IS BROKEN, LOST OR STOLEN. I HAVE BEEN LOOKING FOR CURRENT MEDICARE REGS THAT WOULD EXPLAIN BUT HAVE NOT BEEN ABLE TO LOCATE THEM.
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Permalink Reply by 99 on
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did you get the names of the ones who said the 5 year rule applies then use that as leverage
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My guess would be that most likely it will all depend on who at Medicare receives and processes the claim - and the mood they are in that day. Especially when you are talking a bi-level. But this "ain't" gospel, its just my pessimistic side cropping up.
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All insurance companies will pay for a new PAP every 5 years. your DME supplier will get prior approval from the insurance (even Medicare). This does not guarantee payment but this rule of 5 years allows for change in technology and breakdown.
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Welcome to the forum,Tom. Am always DELIGHTED to see a sleep professional who uses a Resmed!!! *wicked grin*
I have to say that I've unfortunately read more than once of someone whose insurance refused to replace an xPAP older than 5 years that was still working. Of course, one of those was someone on Medicare whose LOCAL DME PROVIDER was the one to tell them that Medicare would NOT buy them a new xPAP as long as their older than 5 years xPAP was working - and we all know that there are those local DME providers who are either less than truthful or dumber than a rock.
By the way, we are MUCH NICER to sleep professionals in this forum than those in at least one of the other apnea support forums on the web so you will find that you really are welcome here.
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great suggestion....but of course i forgot and didnt get the names of the persons i spoke with.i will do so in the future. thanks.
99 said:did you get the names of the ones who said the 5 year rule applies then use that as leverage
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i can certainly related to your pessimistic side at this point. another issue that cropped up is whether i set up a purchase arrangement with the supplier and medicare at the outset of obtaining the machine or whether i checked the rental box...
if i did the latter than the supplier owns the machine. if the supplier owns the machine, i am told, then replacement
becomes a greater issue. whereas if i agreed to purchase the machine and thereby agreed to pay for all repairs in the future...the replacement procedure is simplified somehow because i own the machine....all seems murky at this point without clear rules and regs to read..
Judy said:My guess would be that most likely it will all depend on who at Medicare receives and processes the claim - and the mood they are in that day. Especially when you are talking a bi-level. But this "ain't" gospel, its just my pessimistic side cropping up.
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thanks...but my local dme supplier has told me that i am not qualified to obtain a replacement machine even tho i had a recent new sleep study..one reason ...the billing coding would be the same and not acceptable which i have discovered is not correct. my machine is over 7 years old and i have a res med auto 25 loaner temporarily but have also been told
that there is insufficient clinical data supporting the use of the auto feature on a regular basis...all totally unclear but this confusion has led me to start researching these questions in the hope that medicare will replace my old respironics.
Tom said:All insurance companies will pay for a new PAP every 5 years. your DME supplier will get prior approval from the insurance (even Medicare). This does not guarantee payment but this rule of 5 years allows for change in technology and breakdown.
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Claudette, since you are past the Medicare purchase period for your current bi-level you are not "stuck" w/this local DME provider any longer. If you also have secondary insurance coverage of your xPAP equipment, call your secondary insurance and ask what local DME CPAP providers they are contracted with and then "shop" those suppliers and see if any are willing to help you w/this issue. If you don't have secondary insurance then you have the option of almost every local DME xPAP provider since most all of them accept Medicare.
Good luck and God bless!!!
claudette paluch said:thanks...but my local dme supplier has told me that i am not qualified to obtain a replacement machine even tho i had a recent new sleep study..
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JUDY....ITS GOING TO BE AN INTERESTING RIDE....(which i wish i didnt have to take) thanks so much for your input..
Judy said:Claudette, since you are past the Medicare purchase period for your current bi-level you are not "stuck" w/this local DME provider any longer. If you also have secondary insurance coverage of your xPAP equipment, call your secondary insurance and ask what local DME CPAP providers they are contracted with and then "shop" those suppliers and see if any are willing to help you w/this issue. If you don't have secondary insurance then you have the option of almost every local DME xPAP provider since most all of them accept Medicare.
Good luck and God bless!!!
claudette paluch said:thanks...but my local dme supplier has told me that i am not qualified to obtain a replacement machine even tho i had a recent new sleep study..
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When billing to insurance or medicare you only have 3 code for a machine E0601 CPAP SYSTEM (reg or auto) , E0470 BiLevel System (reg or auto) , and forgot the code for Bilevel ST. Most DME companies will not want to give you an auto machine as this costs them more but only reimburses at the E0601 price.
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