Abandoned by Sleep Doctor

[KTinTexas]

I recently retired from my job and went on Medicare plus a supplement. My sleep doctor's office stopped contacting me to set up follow up appointments. I called them but they didn't return my call. I notice that for compliance under Medicare I have to use my CPAP at least 4 hours a night. I've never managed to do that consistently. Do you think the doctor's office just abandoned me because their visits aren't going to be covered? You'd think they would at least tell me that.

[LSAT]

Medicare compliance applies when you get a new machine paid by Medicare. The Compliance requires that you use the new machine a minimum of 4 hours a night, 70% of the time during a consecutive 30 day period (21 nights). This must be accomplished during the first 90 days following receipt fv the machine. After that you must have an annual visit to a doctor that will confirm that you are getting benefit from your machine.

[Grumpy48]

I never had a 'sleep doc' that I consulted with, everything was through my regular PCP including a face to face compliance visit to meet the Medicare and insurance requirements. I would presume your own PCP could do the same. My DME had also sent me a reminder of the compliance visit via email (below). If I recall correctly my PCP forwarded the compliance notes to my DME.

Compliance Requirements
Most insurance companies require that you use the machine for 21/30 consecutive days within the first 90 days for 4 hours or more. This comes out to 70% of the time. Most insurances require these 21/30 to be between day 60-90.
Failure to meet compliance requirements may result in having to go for ANOTHER sleep study, privately pay or return of equipment.
We will be following up with you periodically within the first 90 days, but urge you to call us if you have any questions or concerns.
Many insurance companies require that you have a face-to-face, follow-up visit with your doctor after 30 days and before the 90th day of CPAP use (between the 2nd and 3rd month). It is your responsibility to schedule this appointment if it is not already scheduled. The notes from this appointment can be faxed to (xxx) xxx-xxxx or email to support@xxxxxxxxxxx.com

I was not aware of an annual visit to the doc to confirm benefit from the machine. The 13 months has lapsed and it's no longer a rental (I own it), so do they really care other than supplies I get from the DME?

[SleepGeek]

I recently retired from my job and went on Medicare plus a supplement. My sleep doctor's office stopped contacting me to set up follow up appointments. I called them but they didn't return my call. I notice that for compliance under Medicare I have to use my CPAP at least 4 hours a night. I've never managed to do that consistently. Do you think the doctor's office just abandoned me because their visits aren't going to be covered? You'd think they would at least tell me that.

Time to find another sleep doc - end of story.

Unless, of course, you are experienced enuff to set your own pressures and know what you are looking for?
I have had PCP's who refused to do anything for my sleep and all I wanted/needed was the supplies.
He told me to have the DME do it, nah.

IMO he just didn't know what to do and wasn't interested in learning.

Find yourself a pulmonologist who specializes in sleep but try to get recommendations from someone you know.

[zonker]

I recently retired from my job and went on Medicare plus a supplement. My sleep doctor's office stopped contacting me to set up follow up appointments. I called them but they didn't return my call. I notice that for compliance under Medicare I have to use my CPAP at least 4 hours a night. I've never managed to do that consistently. Do you think the doctor's office just abandoned me because their visits aren't going to be covered? You'd think they would at least tell me that.

not being a wise@ss, genuinely curious as to why you feel the need to see a sleep doctor after at least four years on cpap therapy?

[KTinTexas]

I recently retired from my job and went on Medicare plus a supplement. My sleep doctor's office stopped contacting me to set up follow up appointments. I called them but they didn't return my call. I notice that for compliance under Medicare I have to use my CPAP at least 4 hours a night. I've never managed to do that consistently. Do you think the doctor's office just abandoned me because their visits aren't going to be covered? You'd think they would at least tell me that.

not being a wise@ss, genuinely curious as to why you feel the need to see a sleep doctor after at least four years on cpap therapy?

It hasn't been continuous for 4 years. I had insurance changes. I've only been with this sleep doctor for 2 years. In that time, I've had a lot of problems. They were adjusting my pressure and giving me suggestions. The last thing was they wanted me to take Horizant, but my prescription coverage will not cover it.

[zonker]

It hasn't been continuous for 4 years. I had insurance changes. I've only been with this sleep doctor for 2 years. In that time, I've had a lot of problems. They were adjusting my pressure and giving me suggestions. The last thing was they wanted me to take Horizant, but my prescription coverage will not cover it.

i see. thanks for that.

good luck with your search!

[chunkyfrog]

. . .
I have to use my CPAP at least 4 hours a night. I've never managed to do that consistently. Do you think the doctor's office just abandoned me because their visits aren't going to be covered? You'd think they would at least tell me that.

You might be correct.
Why do you think they should have told you?
That is for insurance/Medicare to say--but you have to ASK.
Unless you have a personal assistant, it is nobody's responsibility but yours.

[Cecioboe]

If you are in the Dallas area, send me a message and I'll give you the name of the doctors I see. They accept Medicare.

[Popozeto]

If you are in the temple/killeen/waco area send me a message i can recommend my sleep doctor which are great, most of the time i just send an email and they will respond for any kind of issue i have.
btw they take medicare.

[chunkyfrog]

Did you ever get the deviated septum fixed?

[KTinTexas]

Did you ever get the deviated septum fixed?

No.

[KTinTexas]

. . .
I have to use my CPAP at least 4 hours a night. I've never managed to do that consistently. Do you think the doctor's office just abandoned me because their visits aren't going to be covered? You'd think they would at least tell me that.

You might be correct.
Why do you think they should have told you?
That is for insurance/Medicare to say--but you have to ASK.
Unless you have a personal assistant, it is nobody's responsibility but yours.

Kinda' funny. I understand. I left them a message that was never returned.

[chunkyfrog]

Some doctors do not want to take Medicare patients,
or will only take a limited number, because of . . . Money.
Many state that on their web page, or on signs in their office.
It is understandable, because private insurance pays so much better.
Medicare pays a fraction of that--often not enough for office expenses, etc.
You might consider getting the septum fixed--
Medicare should cover it if it impedes your breathing.
You might actually have a better time using cpap,
good enough to get Medicare to cover it.