So...can't wait till Friday

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Barb (Seattle)
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Re: So...can't wait till Friday

Post by Barb (Seattle) » Sat Apr 14, 2018 12:43 pm

I might call Monday and ask...she seemed pretty adamant it would be a pain in the patooty.

this particular DME that's associated with the sleep center does not take medicare. I would have to switch back to the one I used before these sleep studies.

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chunkyfrog
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Re: So...can't wait till Friday

Post by chunkyfrog » Sat Apr 14, 2018 1:07 pm

Barb (Seattle) wrote:
Sat Apr 14, 2018 12:43 pm
. . .DME . . . does not take medicare. . . .
It is not their choice.
Actually, Medicare will not deal with a DME who is connected to a sleep lab,
because of conflict of interest. I was told it is the law.
Funny, BCBS has no problem with spurious connections . . .

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Rubyslipperss
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Re: So...can't wait till Friday

Post by Rubyslipperss » Sat Apr 14, 2018 9:31 pm

chunkyfrog wrote:
Sat Apr 14, 2018 1:07 pm
Barb (Seattle) wrote:
Sat Apr 14, 2018 12:43 pm
. . .DME . . . does not take medicare. . . .
It is not their choice.
Actually, Medicare will not deal with a DME who is connected to a sleep lab,
because of conflict of interest. I was told it is the law.
Funny, BCBS has no problem with spurious connections . . .
Aha! So that is why the sleep lab I used when I had regular health insurance (now I have Medicare and a supplemental policy) couldn’t get me a new machine! I had to have my Primary Care MD do It!

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Pugsy
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Re: So...can't wait till Friday

Post by Pugsy » Sat Apr 14, 2018 9:42 pm

Medicare doesn't allow the DME equipment to be supplied by a facility that the doctor doing the sleep study stuff has any personal financial interest in....the restrictions also include a DME that is run or owned by the doctor's family member.
Too much chance for conflict of interest to happen.
I may have to RISE but I refuse to SHINE.

prodigyplace
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Re: So...can't wait till Friday

Post by prodigyplace » Sun Apr 15, 2018 4:16 am

Pugsy wrote:
Sat Apr 14, 2018 9:42 pm
Medicare doesn't allow the DME equipment to be supplied by a facility that the doctor doing the sleep study stuff has any personal financial interest in....the restrictions also include a DME that is run or owned by the doctor's family member.
Too much chance for conflict of interest to happen.
Since Medicare is a federal program why are there not more voting recusals in the federal government to avoid conflicts of interest?

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D.H.
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Re: So...can't wait till Friday

Post by D.H. » Sun Apr 15, 2018 9:02 am

Barb (Seattle) wrote:
Sat Apr 14, 2018 12:43 pm
I might call Monday and ask...she seemed pretty adamant it would be a pain in the patooty.

this particular DME that's associated with the sleep center does not take medicare. I would have to switch back to the one I used before these sleep studies.
You should be able to use a DME provider on your plan without switching sleep docs. The only thing is that you might need to take the SD card when you visit the doc, as he probably won't be able to get stats directly from a DME with which he is not associated.

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Pugsy
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Re: So...can't wait till Friday

Post by Pugsy » Sun Apr 15, 2018 9:10 am

When switching to Medicare and getting Medicare to pay for the ASV it's going to take more than the SD card contents and the doctor saying "you need ASV".
Medicare is going to want some additional documentation...like the recent sleep study with the centrals and documented need, etc.
along with the sleep study has to meet Medicare requirements as to how it was done. Which standards for diagnosis was used kind of thing.
An in lab sleep study most likely won't be a problem but the documentation of that still needs to be met.
I may have to RISE but I refuse to SHINE.

Jas_williams
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Re: So...can't wait till Friday

Post by Jas_williams » Mon Apr 16, 2018 3:49 am

Pugsy wrote:
Sun Apr 15, 2018 9:10 am
When switching to Medicare and getting Medicare to pay for the ASV it's going to take more than the SD card contents and the doctor saying "you need ASV".
Medicare is going to want some additional documentation...like the recent sleep study with the centrals and documented need, etc.
along with the sleep study has to meet Medicare requirements as to how it was done. Which standards for diagnosis was used kind of thing.
An in lab sleep study most likely won't be a problem but the documentation of that still needs to be met.
Barb/Pugsy


I have just bought one of these it was a risk as a spare machine took just over a week to get it as I had to have it Reshipped to the UK. The one I received was not a 36037 but the older 30037 but the good news was it only has 124hrs use it comes as just the machine I got a non branded PSU from Amazon but a complete backup ASV machine for under $200


I thought it may be useful ? A PSU and humidifier would be needed.


Jason

https://www.dotmed.com/listing/cpap/res ... pt/2648878

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Pugsy
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Re: So...can't wait till Friday

Post by Pugsy » Mon Apr 16, 2018 6:56 am

Thanks Jason...that listing got me confused..talked about the Adapt and then started talking about including the Elite console.

At any rate...I have located a loaner S9 Adapt 36037 for Barb...it's a loaner but no time limit frame on the loan.
What we want to do is make damn sure it works first and then we can look deeper into her options but Medicare will pay for these machines provided the paperwork hurdles are jumped over.

So the plan right now is......get a loaner S9 Adapt 36037 to Barb...let her give it a try and see how she does with it. I don't know how much the recent titration results would help us with starting settings...it all depends IF they even tried ASV and where they got to IF they did and IF we can get a copy of those results to review. If not...we can wing it and work it out. Not ideal but it's not the first time we have faced not ideal and it won't be the last.

Then the rest of the plan is going to be based on the results with the Adapt. We will keep an eye out for a suitable private purchase because even with Medicare these puppies ain't cheap with the deductibles and co pays. Unless she has a good supplement to pick up the co pays it still might be more cost effective to buy privately. Not to mention have to deal having the Medicare big brother watching over the shoulder for 13 months.

But in the meantime with the loaner she can see if it works..how she does with it and take her time with deciding what to do about getting one of her own....and it's not going to cost a huge cash out lay at this time....and she can plan ahead and not be rushed about it.
I may have to RISE but I refuse to SHINE.

Jas_williams
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Re: So...can't wait till Friday

Post by Jas_williams » Mon Apr 16, 2018 7:07 am

Yes an absolutely rubbish listing so confusing the Elite Console (Seems to be the SD Card)??? they seem to have 37 of these things, seems like a DME or hospital clear out. What I received as I said was a used 30037 & SD card. Bear the link in mind if someone is desperate for a cheap ASV it’s no worse a chance than CraigsList. If they knew what they were selling the cost may be more.


I’m glad you have a plan for Barb I’m sure we will be kept updated, being in the UK I can’t help with much other than information and support :D



Jason

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Barb (Seattle)
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Re: So...can't wait till Friday

Post by Barb (Seattle) » Mon Apr 16, 2018 7:56 am

Pugsy wrote:
Sat Apr 14, 2018 9:42 pm
Medicare doesn't allow the DME equipment to be supplied by a facility that the doctor doing the sleep study stuff has any personal financial interest in....the restrictions also include a DME that is run or owned by the doctor's family member.
Too much chance for conflict of interest to happen.
Had no idea! No wonder my insurance wouldn't work with her! They knew she was connected to a center. They simply tried to stonewall her by saying there's no coverage.

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gwc2795
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Re: So...can't wait till Friday

Post by gwc2795 » Mon Apr 16, 2018 8:06 am

Is the machine Jas_williams purchased for $150 an AVS machine? The reason I ask is -- I continue to have CA events and it is my understanding that an avs machine can treat them.

Please forgive me for hijacking barbs tread.

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Barb (Seattle)
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Re: So...can't wait till Friday

Post by Barb (Seattle) » Mon Apr 16, 2018 8:08 am

so, also, they did say that during this recent sleep study I "qualified under Medicare guidelines" (had to desat 4%) they ran it both for my insurance
and to meet the Medicare criteria. so...maybe I won't have too many hoops to jump through. The sleep center IS covered by
Medicare...just not the DME next door.

IF i eventually decide to go Medicare. It might be just as easy to bypass them and get these machines every 5 years or so....IF I can find them for a reasonable price it sounds wonderful. Hope this works out :) :)

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Barb (Seattle)
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Re: So...can't wait till Friday

Post by Barb (Seattle) » Mon Apr 16, 2018 8:09 am

.

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Barb (Seattle)
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Re: So...can't wait till Friday

Post by Barb (Seattle) » Mon Apr 16, 2018 8:32 am

Question pugsy. the s9 you have...it will force me to breathe if I have a central..right?

still learning about these machines....:D

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