Purchase new machine, send bill to Medicare

[Thumper1947]

My Dreamstation is 5.5 years old and I qualify for a new machine from Medicare. Does anyone know if I purchase a machine directly from an online retailor, can I then submit the bill to Medicare for reimbursement. I have always purchased through DME in the past and they took care of billing Medicare and I don't know Medicare rules. Thanks.
Thumper

[LSAT]

The DME must be an approved Medicare Provider. I don't think they will accept and reimburse for private purchases.

[Pugsy]

Medicare doesn't normally pay or reimburse for services filed by the patient.
It's a long complicated process even if you buy from a Medicare approved and participating provider/DME.
Medicare doesn't want patients filing their own claims. They make it very difficult but they do list a way to do it on their website.
I have seen it but don't have the link handy and I don't remember all the specifics.
You might google something like (will Medicare pay me if I submit a claim) and start reading.
Might modify the wording of the search if you don't find the answer. I forgot how I got to the Medicare website where I saw that answer and I don't have time right now to go look again.

[packitin]

I was told by my DME that I'll have to wait until January 2022 to get a new machine. I have my prescription in hand, but I have to wait for the end of the 5 yrs, which occurs then.
But what am I going to do for the next 7 months? I'm in sort of a quandary, with only able to use my own wits, I guess. My old machine is just not going a good job, and my AhI has doubled.

I suppose I could get a cheaper Resmed with maybe 1200 hrs or so, and there should be a lot of those around.

Does anyone know anything about company Dotmed? They have a few Resmeds at good prices and low hours. Its my understanding the machines came from health clinics. However, if a seller would not agree to state in writing that the machine has been used by a non-smoker and the user has not had any communicable health issues, such as covid, tb, or others, then I would shy away from that.

Thoughts?

[Thumper1947]

Thanks for the info on Medicare. I did do some googling and came up with what Pugsy said. I also looked over the form to fill out and send to Medicare. Bottom line, you might get some reimbursement, maybe, but don't hold your breath. I have ordered a new machine from my DME, but they say the delay will likely be months. It's a quandry for sure.
Thumper

[Pugsy]

I was told by my DME that I'll have to wait until January 2022 to get a new machine. I have my prescription in hand, but I have to wait for the end of the 5 yrs, which occurs then.

But what am I going to do for the next 7 months?

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.

Call up Medicare yourself and get the information directly as to what they will or won't do right now as well as when the 5 year thing rolls around.

I am sure that by now Medicare is aware of the recall but I haven't yet seen any official documentation as to what they are willing to do...if anything.

I have heard of dot.med but I don't have any personal experience to draw upon.
You would need to contact the individual seller (dot.med is more like a collection of individual sellers be it a DME or private person) to see if you can find one that meets your own specifications.
Secondwindcpap.com is an option as well...all their used machines are less than 2K hours...and they won't accept any machines that have been used by smokers. Your other requirements are a bit unrealistic though. There is no way to know about past medical history of any prior user. Since it is apparently critical to you I suggest you maybe look at secondwindcpap.com new open box specials.

[packitin]

Thanks, that's good advice. I found the number for the Virginia Medicare, and have already asked the question by email. I hope to get answer in the morning. Or I may call back as soon as possible.

If I may ask, since I haven't used a Resmed, (and I'm reading the prescription as I type this) the doctor has written: "Please provide Resmed Curve 10 in Bipap mode with pressure setting IPAP 10.5 and EPAP 8.5cm's H20 plus heated humidity." Then he writes a couple other things related tubing and masks.

Is there one model in particular which fits this description, and if there's more than one, which should I ask for?

Thank you for being willing to share your knowledge.

[Cecioboe]

There are lots of DME's out there. Maybe try a different one who might have it in stock? Best wishes.

[chunkyfrog]

This is most definitely an emergency situation; calling for action from high up.
Respironics should be forced to immediately buy their defective machines back,
enabling their VICTIMS to buy safe machines from whoever can provide them.
No one should be forced to accept the new BRICKS from Respironics.

[packitin]

I couldn't agree with you more.

[greatunclebill]

if you do not want a straight pressure bpap, make sure the prescription says autoset.

[Okie bipap]

My prescription specified a ResMed bi-level machine with a range of EPAP values (20-25) and IPAP values (15-20). My wife's prescription is essentially the same thing. We both have Air Curve 10 VAUTO machines.

[packitin]

Guess what dear friends!!.
The 5-year rule DOES NOT apply when there is a recall! I just got off the phone with medicare.

It been 3 weeks since my sleep doc gave me a prescription, and I still have not gotten my new machine.

I went to FOUR DME suppliers to try to fulfill my prescription, and I got all sorts of answers - from getting a new sleep study to I'm not eligible because of the 5 year rule.

Well, they were all wrong!!

Do not believe what DMEs say. There may be some good ones, but they apparently don't know the Medicare rules.

Thanks to everyone who tried to help me. You may have saved my life because I was going to keep my old machine (A Respironics which is not very good)
thanks, again all, and for this forum with folks who want to help.

Jay

[Pugsy]

The 5-year rule DOES NOT apply when there is a recall! I just got off the phone with medicare.

Do not believe what DMEs say.

You know the DMEs that gave you the run around...sorry DMEs for sure. They are in the business to sell machines and make money and they should have immediately contacted Medicare when the recall happened to find out just what Medicare would or wouldn't do but they were too lazy. I am fairly sure that if Medicare is going to pay for a new machine it will be just like all the Medicare machines are...the 13 month rent to own thing. They could be making tons of money with their Medicare patients selling them a new machine.
All they needed to do was call up Medicare and find all this out on their own and start the process and rake in the dollars.
If I owned a DME...that's the first thing I would have done.
At least call and find out what Medicare was going to do.

They lie...and they are lazy and really don't give a crap about their patients.
The place that you have been waiting 3 weeks for a machine...call them up and light a fire under their ass...tell them you have talked to Medicare and this shouldn't be taking so long and if they can't furnish you with a machine you will find someone who will.

You might call Medicare back and confirm if the new machine reverts back to the compliance requirements that usually come with a Medicare supplied machine. The standard compliance requirements of 70% of the nights within 30 consecutive nights sometimes or other within the first 90 days and the face to face with doctor requirement. They may or may not waive some of these requirements since this is a recall thing.
Always best to go directly to Medicare though...you already learned that they lie and are lazy.
Also find out if you are responsible for any co pays...etc.

[packitin]

thank you, and I'll do that.

(this whole thing has blown my mind)