New sleep test because of Medicare

I got my last machine a ResMed S9 Vpap Auto in November of 2012. It is very high hrs now. I have been trying to get through the hoops on getting a new machine for about 2 yrs. My old sleep Dr. retired and I am with a new Sleep clinic and Dr. Medicare has said I need a new sleep test. I have Myasthenia Gravis and when I was 1st diagnosed in 2008 I was put on a Respironics M series BiPapAuto right from the start. I am curious if they will make me "fail" cpap in order to get another Vpap Auto or will the fact that I am already using a Vpap Auto be taken into consideration. Any ideas on how this will; work? I have only been on Medicar for 2 years so I am not a Medicare pro by any means. Thanks,
Dale

I got my machine through Medicare a little about four and a half years ago. My original prescription called for a Resmed bilevel machine with a set pressure range. My prescription contained a statement that simply said "Patient did not tolerate CPAP". I had no problem at all getting my machine. I did have to do a split study and a bilevel titration study.

I will keep that "Patient did not tolerate CPAP" phrase in mind.
Thanks

If you have not spoken to Medicare directly, please do so.
The additional study may not be "officially" required, and your new doctor has other rea$on$.
Your MG may also be a factor, and Medicare may allow the extra study-for your health.
If Medicare does not require the study, then the two years on an old machine
might be considered a delaying tactic, putting your health at risk.
Be sure to bring your MG specialist into the loop.
He might be able to light a fire where necessary.

I already talked to medicare and the person i talked to could barely read the boilerplate that said I need a new sleep study. My sleep center has been trying to avoid making me take a new study. I guess if they want to waste the money they will waste the money. At least a sleep tech gets paid.

deerhound wrote: ↑

Thu Oct 31, 2019 12:02 pm

I already talked to medicare and the person i talked to could barely read the boilerplate that said I need a new sleep study. My sleep center has been trying to avoid making me take a new study. I guess if they want to waste the money they will waste the money. At least a sleep tech gets paid.

When speaking to Medicare, it is OK to ask to speak to a more knowledgeable person.
Don't settle for the first idiot they give you. (They have DOZENS of half wits.)
And point out that further delays will be documented for possible legal recourse.
Record the call, and tell them you are doing so.

My husband needs to have his cpap replaced. He is on Medicare. The provider says Medicare requires a new sleep study. The sleep apt is in Dec. during his busy season at work. I was able to have the sleep study changed to him sleeping with a smart watch "sleep study". He did Thursday. Medicare said they were asking for his compliance with cpap. He has been using cpap since 1998. He is also worried they will say he doesn't need cpap. I can be a witness that he needs cpap. I think Medicare doesn't want to pay for a sleep apnea machine for someone who will just turn around and sell it on the web.
Good Luck.

gingerdos wrote: ↑

Sat Nov 02, 2019 10:36 pm

. . . The provider says . . .

You need to call Medicare.
They are the final authority--not the provider.

I have used Cpap 8 years. After 5 years my machine became very ineffective due to lots of hours.
I went to my pulmonologist which I do once Year she sent new RX to DME and I had new machine in 5 days. No new sleep test required
I never talked to Medicare

If you can prove compliance, Medicare will not require a new sleep test. Some people may consider it overkill, but my wife and I see the nurse practitioner st the sleep clinic every six months. If we ever need a new machine, proving compliance will not be a problem. We consider this as just one of the many things we do on a recurring basis in an attempt to stay as healthy as we can.

Thanks to all the above advice. I went to a different sleep center on Dec, 4, They put in an order to Major Medical/Rotech and today I picked up a brand new 0 hour ResMed Vpap Auto 10. No sleep test. No BS. Finally someone decided to do their jobs. Thank you everyone.
Dale

My former know nothing Dr. was just sure I would need a new study to replace my 7 year old machine.
And believe it or not I got the DME to give him a call and explain that because I had had regular follow ups
medicare would't require new study. I soon found a much better Dr.

deerhound wrote: ↑

Thu Dec 19, 2019 2:25 pm

Thanks to all the above advice. I went to a different sleep center on Dec, 4, They put in an order to Major Medical/Rotech and today I picked up a brand new 0 hour ResMed Vpap Auto 10. No sleep test. No BS. Finally someone decided to do their jobs. Thank you everyone.
Dale

Sounds like an early Christmas present to me good job

deerhound wrote: ↑

Thu Dec 19, 2019 2:25 pm

Thanks to all the above advice. I went to a different sleep center on Dec, 4, They put in an order to Major Medical/Rotech and today I picked up a brand new 0 hour ResMed Vpap Auto 10. No sleep test. No BS. Finally someone decided to do their jobs. Thank you everyone.
Dale

Glad to hear you were proactive on this!! Merry Christmas!