Purchase new machine, send bill to Medicare

[SewTired]

Your first mistake....believing what the DME told you without verifying with Medicare what they told you.
First of all...even without the recall thing Medicare is no longer automatically paying for new machines after 5 year mark.
They (Medicare) now require the machine to be broken or not fixable or cost more to fix it than it is worth.

This seems to depend on the DME. I got mine after 5 years last year and I only had 13,000 hours on it. They only needed evidence that I used it nightly. I had to wait for several months due to delay on Resmed for Her not in stock. So it's worth checking with the DME.

[Pugsy]

Your first mistake....believing what the DME told you without verifying with Medicare what they told you.
First of all...even without the recall thing Medicare is no longer automatically paying for new machines after 5 year mark.
They (Medicare) now require the machine to be broken or not fixable or cost more to fix it than it is worth.

This seems to depend on the DME. I got mine after 5 years last year. They only needed evidence that I used it nightly. I had to wait due to delay on Resmed for Her not in stock. So it's worth checking with the DME.

Of course it depends on the DME and you have no idea what your DME told Medicare when they sent in the request for the new machine at the 5 yr mark besides the fact that you were using the machine nightly.

What I was told by a couple of suppliers who told me that Medicare now wants the machine to be broken beyond repair was that all it takes is a note about excessive noise or some sort of issue with the machine because most of the time it always costs more to repair a machine after the 5 year mark.

Are there good honest DMEs out there? Sure there are but there are also a sizable chunk of crooked DMEs or DMEs who tell people that their own in house rules are Medicare rules and that's simply not the case. Everything gets blamed on Medicare when it is in fact nothing more than an in house rule.

People should always verify anything they expect their insurance to pay for or do with their insurance carrier directly and not rely on the service provider.
Some years ago I had some physical therapy and the PT office assured me that my insurance said they would pay for it. I trusted them and didn't verify. Come to find out they were out of network for my insurance....I had a 2500 out of network deductible and then it paid 50 %. I got a real ugly surprise with that bill.

[SewTired]

Your first mistake....believing what the DME told you without verifying with Medicare what they told you.
First of all...even without the recall thing Medicare is no longer automatically paying for new machines after 5 year mark.
They (Medicare) now require the machine to be broken or not fixable or cost more to fix it than it is worth.

This seems to depend on the DME. I got mine after 5 years last year. They only needed evidence that I used it nightly. I had to wait due to delay on Resmed for Her not in stock. So it's worth checking with the DME.

Of course it depends on the DME and you have no idea what your DME told Medicare when they sent in the request for the new machine at the 5 yr mark besides the fact that you were using the machine nightly.

What I was told by a couple of suppliers who told me that Medicare now wants the machine to be broken beyond repair was that all it takes is a note about excessive noise or some sort of issue with the machine because most of the time it always costs more to repair a machine after the 5 year mark.

Such a good point! Thanks!

[chunkyfrog]

"Broken beyond repair" need not mean completely nonfunctional..
It can/should include "too noisy to sleep", as it cannot be used if you can't sleep.
Obviously, dangerous components should be grounds for immediate action.