Warning to all Medicare XPaP patients

MrRandom · Post by **MrRandom** » Thu Mar 27, 2008 12:21 pm

Slinky wrote:Ah, but you see, at least you had access to the sleep doctor even if difficult.

Wow, I had no idea it was so bad. My sleep doctor even wants to see me back in the office again in a few months to talk about everything. I did think it kinda outrageous that he charged my insurance nearly $1,000 to "read" the sleep studies, and that was in addition to the sleep lab charging over $5,000 them. It really seems like we are getting shafted on care, considering it costs $367 to get a sleep study in Thailand with the same techniques and equipment. Our health care system in the USA is quite obviously broken. Very broken.

The thing that gets me about this is they make access to care so difficult yet at the same time work pretty hard at preventing us from taking charge of our own care. Again all about the money. I wonder how much they charge to change the pressure on my machine? Good thing I found out how to do it on my own. Again, thank god for the internet. If Medicare and other insurers want to save money, they are really going about it the wrong way. There needs to be more regulation of these charges. It's out of control.

bap40 · Post by **bap40** » Thu Mar 27, 2008 12:28 pm

The name of the company is AGIO Medical Supplies. Only saw CPAP stuff there. It is a new place. Very small with one RT. They did the sleep study and that part was just fine. The tech for that was great. The doc is not onboard, in fact is in another state. So not available to his patients. His standard script is for straight CPAP for everyone. I think that they are related to Somna Sleep or something like that. I would not be surprised to hear that they are branching out all over the place. As I live in a fairly small town.

OldLincoln · Post by **OldLincoln** » Thu Mar 27, 2008 2:23 pm

This has convinced me to rush my new sleep study and get new equipment prior to turning 65 May 2nd. I thought I was doing a good thing and let my insurance company off the hook but they are so accommodating that I'm sure I'd get whatever the doc said.

By the way, when I pushed the point of getting an APAP for my agrothing she finally admitted they get the same payment regardless of machine and don't like to hand those out. She also told me Medicare will only buy me 1 machine for life so be sure of what I'm getting.

For my second machine I told the doc I wanted an APAP and he said he couldn't justify it with my study. However, if I paid the $250 difference between the CPAP and APAP I could have one. This time I'm going to insist on it and live with the consequences.

OldLincoln

jomac30 · Post by **jomac30** » Thu Mar 27, 2008 8:43 pm

I always have to drive to my DME which is about 30 miles each way. I was told today that I can only get the white disposable filters every 3 months, but I thought Medicare allowed 2 per MONTH.
Has Medicare changed the frequency of giving out supplies?
I know the hoses changed from one a month to one every three months, but I was unaware the filters changed.
Anyone have a list of Medicare's current frequency of replacing items?

6PtStar · Post by **6PtStar** » Thu Mar 27, 2008 9:33 pm

What Medicare Allows
Medicare provides guidelines for beneficiary receipt of CPAP and Sleep Apnea related equipment. This means that you can be regularly provided you with brand new CPAP equipment. Here is a quick reference chart of supplies and their allowed rates of re-order:

HCPCS Code Description Allowed Replacement Frequency
A7030NU Full Face Mask 1 every 90 days
A7031NU Full Face Cushion 1 every 30 days
A7034NU Mask 1 every 90 days
A7045 Exhalation Port with or without Whisper Swivel Span Not Yet Released By Medicare
A7032NU Mask Cushion 2 every 30 days
A7044NU Oracle 1 every 90 days
A7033NU Nasal Pillows 2 pairs every 30 days
A7035NU Headgear 1 every 180 days
A7036NU Chinstrap 1 every 180 days
A7037NU Tubing 1 every 90 days
A7039NU Non-Disposable Filters 1 every 180 days
A7038NU Disposable Filters 2 every 30 days
A7046 Humidifer Chamber 1 every 180 days
E0601NU CPAP Varies Greatly - Call For More Information
E0470NU BiPAP Varies Greatly - Call For More Information
E0562NU Heated Humidifier Varies Greatly - Call For More Information
E0561NU Passover Humidifier Varies Greatly - Call For More Information

The problem with the filters is that they generally come in a package of 6. A lot of DME's won't break a package so one package every 3 months. I ran into this with my DME. Of course in the next breath they told me I really did not need to use the white filters.

Jerry

jomac30 · Post by **jomac30** » Thu Mar 27, 2008 9:35 pm

My white disposable filters come in a two-pack(respironics) If we're allowed 2 every 30 days, why aren't they supplied by the DME? My DME has a 6 month kit which has only two filters and I think it should be 12 if its 2 per
month.
What is a mask cushion? I didn't know any part of the mask was replaceable.

6PtStar · Post by **6PtStar** » Thu Mar 27, 2008 9:59 pm

jomac30 wrote: What is a mask cushion? I didn't know any part of the mask was replaceable.

It is the (generally) silicone part that seals to your face, especally on Full Face Masks. It is replacable on many masks but not all of them.

Jerry