Medicare DME self pay

[Lancaster]

I will be retiring soon. I do not need an new asv machine at this time.

However, in planning my retirement I discovered that my MD may not have done all the required documentation when
my initial sleep studies were done to comply with Medicare rules when I eventually need a new machine.

I just found a post written a while ago that said that the DME can't let a Medicare patient self pay a new machine.

I was counting on being able to buy it myself if need be in the future because I am not going to go without my machine.

I would appreciate any input anyone can offer me so I have more knowledge. My machine was brand new and now has 8000 hours on it. So I have a ways to go.

Is Kaiser less strict than Medicare at paying for these machines?

[LSAT]

Your DME or Medicare have no way of knowing when you buy a machine on your own.....They don't even care...why would they?

[Lancaster]

I would want to buy it directly from the DME to get the warranty and have them set it up with the prescribed settings etc.
I can see buying a cpap machine from an online vendor but not an ASV machine.

[Okie bipap]

If your machine has an SD card in it, it has a record of your usage which proves compliance.

[Julie]

Secondwindcpap.com, from which many of us buy equipment, used and new, warranties everything and is terrific about honoring them. You should have no trouble at all dealing with them (and no, I have no personal connection ).

[greatunclebill]

you don't want to self pay at a dme.$$$ machines all have warranties. set up is easy to do and you can get help from the experts on this forum. the dme and the on-line stores will all require a prescription. there are ways to buy without prescription and huge discounts from forum members that sell machines.

[SewTired]

You are not required to fail any other machine since you had a diagnosis and machine before you started with Medicare, but you do need the copies of your original study - the report and the raw data. You need a copy of the doctor's notes at the time you need a new machine. As mentioned, your SD card shows compliance. Make certain you have backup of that data in case your card fails or at least print out reports that your doc can keep on file.

I don't use an ASV machine and haven't followed the particulars of it, but I would TRY to get it through Medicare first. These machines are quite a bit more costly.

[palerider]

I can see buying a cpap machine from an online vendor but not an ASV machine.

You'd be wrong about that being an issue.

Now, an VAPS machine... that'd be complicated.
ASVs aren't.

[CPAPforever]

You can buy a new machine from anyone with a doctor's Rx for cash. Medicare would love that because they won't have to pay for any of your supplies.

Get your new machine with Medicare so you won't have to pay for all your replacement masks, etc. If that means you have to have a new sleep study because your doctor doesn't have proper documentation, do it. Depending on how long its been since your previous sleep study was done, a new sleep study may be beneficial. New settings may be needed for optimum treatment. You won't know that without new study.

[LSAT]

If your machine has an SD card in it, it has a record of your usage which proves compliance.

If he self pays, there is no compliance requirement.

[Janknitz]

https://www.bf-law.com/faqs-patients-paying-cash-dme/

Q: May a contracted CB supplier sell covered items for cash to Medicare patients?
A: No, unless the item is not medically-necessary. CB contract suppliers must accept assignment on all items under their contracts. DMEPOS Competitive Bidding Program Contract Supplier Obligations, Palmetto GBA, Jan. 2011

CB= Competitive Bidding.

So if you live in a CB area and the DME is a contracted CB supplier, they may not sell you the CPAP for cash. If you go out of your CB area or are working with a non-contracted supplier, you can pay cash if they give you notice that Medicare may not cover the item.

And yes, CPAP's are considered "medically necessary"-- see

Participation and Assignment Q&A:

Q: For a medically necessary capped rental item (eg cpap, portable oxygen concentrator), does Medicare allow suppliers to collect the full purchase price upfront from the patient when billing non-assigned claims?

[chunkyfrog]

Since you are PLANNING your retirement, schedule a consultation with your state's senior health insurance information provider (SHIIP, in some states).
They should give you all the details, and hoops you will need to jump through.
And when! Best not to wait too long.

[ChicagoGranny]

However, in planning my retirement I discovered that my MD may not have done all the required documentation when
my initial sleep studies were done to comply with Medicare rules when I eventually need a new machine.

What did he fail to do? Or, what did he do wrong? Who told you something is missing or not correct? Once you are eligible for Medicare, why can't he complete whatever required documentation you think is missing?

I do not need an new asv machine at this time.

Go ahead and get one as soon as you are eligible for Medicare. A backup machine is always recommended here by users who were without one when their machine suddenly failed. Even most of us who have never experienced this unfortunate event recommend and keep a backup machine.

I'm afraid you are giving up too easily on getting Medicare to pay for a machine.

[SewTired]

I just found a post written a while ago that said that the DME can't let a Medicare patient self pay a new machine.

I was counting on being able to buy it myself if need be in the future because I am not going to go without my machine.

Many DMEs have contracts that limit them to dealing only with patients who are paying via insurance or Medicare contracts. I buy a lot of medical supplies for sick family members and have run into this multiple times. Your best bet is to get recommendations here for the best deal you might be able to make in your state. My DME will actually work with a self-pay patient for the specialty machines (i.e. ASV, COPD).

Also, as mentioned, don't give up on Medicare either. If your concern is the doctor's notes, that can be worked on. Clearly, you can't have a sleep study without a doctor's order, so if there is nothing in the notes, your current doc can file an appeal.