Medicare requires repeated new split study? After 15 years of cpap use.

[Gen99]

So as long as you are a Kaiser Senior Advantage member--possibly for the rest of your life--you will have to pay a monthly 20% rental co-pay for CPAP and an O2 concentrator.

To my surprise Kaiser does not charge me for rent on a CPAP - senior advantage plan. New machine ordered last Dec, it was a one time purchase amount and the price was reasonable (well under $1000 for new airsense 11), I paid my copay and no payments since.

[Gen99]

OZIJ, As I said, the sleep Dr was refusing to do any study other than a split study, didn’t matter what I was asking for he insisted, adamantly and repeatedly, that a split study was needed.

[Gen99]

Shoot lost the post I did.

Update - short story:
I fought back and forth with the sleep Dr. being adamant about the CMS stating what I said (oximeter with Cpap showing less than 10 ahi). I said show me the CMS that says differently and adamant about a cardiologist sign off.
All while waiting for the new Pulminary Dr appointment scheduled 2 days before the sleep lab appointment.

Sleep Dr finally said ok I changed it to a titration study but Medicare won’t give you an o2 concentrator because it was not a split study. Since the lab said they only did what the Dr ordered and I had a botched titration many years before at a different lab, I had no confidence they would do the requirements for an O2 concentrator

Pulmonologist appt - they did a lung test, passed just fine.
Showed him Oscar report showing low AHI 28 days out of last 30. Showed him my oximeter results.
He ordered an oximeter at home test and even did it for 2 days when I asked for that. That has been done and they got oximeter back a couple days ago. Phone visit today to review results but I wore my oximeter one day so I expect theirs to show O2 is needed.
Hopefully we get a purchase outright on the O2 concentrator but maybe not without a track record showing it is needed long term.

[Gen99]

Because someone asked and this is not so easy to find…

To find the Medicare advocates in your state,
Go to www.medicare.com.
Scroll down until you see

Get free personalized health insurance counseling
State Health Insurance Assistance Programs (SHIPs) help people with Medicare and their families make informed healthcare decisions.

Chose the “find my local shop”
And you get the organization for your state.

[Janknitz]

So as long as you are a Kaiser Senior Advantage member--possibly for the rest of your life--you will have to pay a monthly 20% rental co-pay for CPAP and an O2 concentrator.

To my surprise Kaiser does not charge me for rent on a CPAP - senior advantage plan. New machine ordered last Dec, it was a one time purchase amount and the price was reasonable (well under $1000 for new airsense 11), I paid my copay and no payments since.

Very surprised as EVERY Evidence of Coverage for Kaiser Sr. Advantage I've looked at has said the following:

In Original Medicare, people who rent certain types of DME own the equipment after paying
copayments for the item for 13 months. As a member of our plan, however, you will not acquire
ownership of rented DME items no matter how many copayments you make for the item while a
member of our plan, even if you made up to 12 consecutive payments for the DME item under
Original Medicare before you joined our plan

What region are you in? Do you have additional coverage--i.e. an employer group health plan?

[Gen99]

Janknitz
We are in OR so kaiser NW.

I have heard that if you change Medicare plans the rental clock starts over.

No other insurances
Had Medicare, another advantage plan prior to here.
Got the new cpap machine a month after moving here.

First CPAP was 2008, I don’t know or how long it has been used is an issue.