Average Joe tries to save Medicare money; Medicare says 'no thanks'

 - 
11/19/2009

Few people know about senseless government waste more than HME providers. But it seems beneficiaries might be taking notice as well.

A recent opinion piece on the sunnews.com asks "What is wrong with Medicare"? Written by a man name Joe, who turned 65 this year, it outlines his introduction to Medicare rules and regs regarding CPAP machines and supplies. Joe was diagnosed with a sleep study in 2006 and has been using CPAP ever since.

My sleep study was conducted at a sleep lab chosen by my insurance company, and the exam determined that I indeed suffered from sleep apnea after only 109 minutes of testing. However, despite being officially diagnosed with sleep apnea, Medicare rules require a sleep study lasting at least 120 minutes. Therefore, since I was 11 minutes short of their requirement, I must undergo another sleep study exam in order to qualify for the CPAP supplies that I have been receiving regularly for the past three years. The exam costs over $1,000, but I was told that I would not be billed for the sleep study because Medicare will incur all charges.

So, while Joe, the new Medicare beneficiary, has successfully gotten himself diagnosed and treated for three years, your government would like to shell out another $1,000 for him to retake the sleep study to recoup that extra 11 minutes. Meanwhile, we hear daily about soaring health care costs, soaring Medicare costs and millions of uninsured Americans. Undeterred, Joe attempted to reason with Medicare.

I called Medicare directly to advise them of this absurdity and spoke to two different customer service representatives in the hopes of convincing them that this was a unique situation that warranted an exception to the rule. However, I was told was that I needed to retake the sleep study or they would deny any CPAP supply claims.

The problem, of course, is that a bureaucracy offers no flexibility. It isn't, shall we say, nimble. Which should scare the beejesus out of everyone as all these unwieldy trillion dollar health care reform plans (although I haven't seen too much actual reform included) wend their way through Congress.

Why are Medicare costs so out of control? I think the problem starts with Medicare itself.

Theresa Flaherty

Comments

I have seen this many times through the years. Although we have patients complaining about the money Medicare is spending, sometimes we can only agree with the patient. Patients come to us over the years with their cpap supplies and oxygen only to find out that when they receive Medicare benifits they must go back to the doctor and requalify at the cost of their time and Medicare's money. The HME companies and doctors are held at fault, when in fact we have nothing to do with it.

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