Medicare payment for BIPAP?

[alcaldeellen]

Sorry, I don't quite understand how to find an existing thread, so if there already is information existing in the forum, please let me know how to access it and I'll start there.

My partner is trying to get a BIPAP. Everything I've read and researched says starting this therapy earlier rather than later is better. His FVC, however, was at 69 percent a few months ago, and, apparently, Medicare will not pay for this until the FVC is less than 50. Has anyone had success in getting Medicare to pay for a BIPAP when you don't meet the precise criteria?

 

[scaredwifetx]

My Husband was approved at 67%. His doctor called in the orders and we were contacted by a home health care. He is on the Trilogy. Contact his doctor and get them to put in the order.

 

[GregK]

Sorry, I don't quite understand how to find an existing thread

At the top of each page there are a series of links.
Search is one of them along with New Posts and Quick Links.

Try it. 8^)

 

[KimT]

I'm still waiting to see if they will ACTUALLY pay. The company, with my doctors orders, say they approved it. My FVC is higher than 50.

 

[alcaldeellen]

Thank you. How did I miss that?

 

[alcaldeellen]

It seems to be a very confusing issue. But I appreciate all the advice! Thank you.

 

[alcaldeellen]

At the top of each page there are a series of links.
Search is one of them along with New Posts and Quick Links.

Try it. 8^)

How'd I miss it?

 

[GregK]

How'd I miss it?

No worries!

 

[alcaldeellen]

No worries!

Thanks very much. I am pretty computer savvy, but I have very little experience with these kind of forums, so I'll be more careful.

 

[lgelb]

Keep in mind, if need be, with a script that any doc can write, you can buy a new or used BiPAP yourself (I recommend Second Wind and see machines w/ humidifiers there currently for $649 up, which probably compares favorably w/ what you will otherwise pay as a copay) and get an Astral or Trilogy for going out, later, under Medicare. Many masks are available with return insurance on places like cpap.com so you can see what works and have a larger selection than most DMEs offer.

Are we talking traditional Medicare w/ no secondary plan, or a Medicare Advantage plan, or??

 

[patrick123]

My FVC was at 68 when I went on the BiPap. You will need a prescription from your pulmonalagist and a sleep study. Before Medicare will pay.
Patrick

 

[alcaldeellen]

Keep in mind, if need be, with a script that any doc can write, you can buy a new or used BiPAP yourself (I recommend Second Wind and see machines w/ humidifiers there currently for $649 up, which probably compares favorably w/ what you will otherwise pay as a copay) and get an Astral or Trilogy for going out, later, under Medicare. Many masks are available with return insurance on places like cpap.com so you can see what works and have a larger selection than most DMEs offer.

Are we talking traditional Medicare w/ no secondary plan, or a Medicare Advantage plan, or??

Thanks so much for this information. It appears clear that you are a really amazing contributor to this forum! We had looked into buying a BIPAP directly, but various medical providers said it would be hard to get it serviced or maintained, and were very discouraging... He has a good supplemental policy with the Medicare. It looks like things are now in limbo since he didn't meet the FVC requirement, but the last test was several months ago and his breathing has worsened, so now we're trying to get an FVC test, which shouldn't be that hard, but is (at least here in New Mexico)... I wish pressure could be brought to bear on Medicare to change the rule, since I've read so much that indicates getting a BIPAP at diagnosis or shortly thereafter is a good thing.

 

[FamilialALS?]

My mom was prescribed hers shortly after diagnosis with Medicare and a supplemental. No sleep study was required. Her coinsurance was costly at about $250 per month. I'm not certain of her fvc at the time. The change to a trilogy was a challenge to get covered, but it did come together. And once she transitioned to hospice coverage there was zero out of pocket cost for anything.

 

[lgelb]

The regs for NIVs (which the Trilogy or Astral is considered to be, but not a BiPAP S/T) changed recently and will be changing more in the future. DMEs are sometimes scared to deal.