Medicare issue paying for BIPAP vs ASV
My doctor diagnosed me with Central Sleep Apnea and recommended an ASV machine. Currently using a Phillips BIPAP ST. Upon ordering a ResMed Aircurve 10 ASV, I was informed that Medicare would not pay for the machine because my current machine and the ASV machine have the same accounting code EO471. According to their definitions, the machines are alike/similar.
My doctor tells me that the machine have entirely different functions. Medicare won't pay. The alternatives are to pay full price or search for a rebuilt ResMed S9 Series machine.
A group of experts submitted recommendations on this subject and others in 2021. Medicare responded that they were not going to evaluate the recommendations based on time and priorities.
Has anyone experienced this problem and / or found a solution?
Thanks
Ugh, this sounds frustrating; I'm sorry that you have to go through this. 😔
I started with a new insurance company this year and will try to get a new machine through them. I'm also on Medicare and use the ASV-type of device. It's been very helpful; however, mine has been recalled. Most insurance companies make us wait five years until paying for a new one.
If you haven't already done so, I might suggest contacting the billing department with your insurance company and see if you could appeal the decision.
Please keep us posted,
Warmly, — Matt G. (sleepapnea.sleep-disorders.net) Team MemberThe equipment supplier knew that payment would be rejected so they did not enter a claim thus I don’t have paper trail for an appeal. I plan on writing letters to my elected officials. I may also have the equipment supplier submit a claim.
ThanksHi
, I think contacting your "elected official" is a really great idea; thank you for sharing. 🙂
Cheers, — Matt G. (sleepapnea.sleep-disorders.net) Team Member
