Reply to Insurance Denied Coverage for Medical Equipment

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[quote=Anonymous]If you mom has a Medicare Advantage plan instead of Regular Medicare, they still should be covering a CPAP machine. Or a BiPap machine if she tried the CPAP machine and failed.

But they could make it more difficult. You may need to jump through more hoops, get more prior authorizations, etc. Medicare Advantage plans stink.

https://www.medicare.gov/publications/11045-medicare-coverage-of-dme-and-other-devices.pdf

[quote]What if I need DME, and I’m in a Medicare Advantage Plan?

Medicare Advantage Plans must cover the same medically necessary categories of
DME items as Original Medicare (Part A and Part B). However, the suppliers you get
your DME from and your specific costs will depend on which Medicare Advantage
Plan you belong to.

If you’re in a Medicare Advantage Plan and you need DME, contact your plan to find
out if it will cover the DME. If your Medicare Advantage Plan won’t cover a DME item
or service that you believe you need, you can appeal your Medicare Advantage Plan’s
denial of coverage and get an independent review of your request for coverage.
You can also find a description of your Medicare Advantage Plan cost-sharing for all
Medicare covered services, including supplemental benefits offered by your Medicare
Advantage Plan, in its “Evidence of Coverage” document[/quote][/quote]

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