Transition of Treatment from Private Insurance

Transition of treatment from private insurance to Medicare/Medicaid

These are the steps in the order they should be completed:

  1. Face-to-Face Visit with your Provider or Sleep Specialist.

    • This visit has to be Face-to-Face. It cannot be done over the phone. The visit has to have everything listed in the Face-to-Face Checklist for Continuation of Supplies in the Provider’s report at the time of the visit. CMS will not accept addendums.

    • Download must be completed from your current machine

      • The download of the machine must show compliance of use. CMS states that compliance is ≥ 4 hours per night 70% of the time within a current 30 day period.

    • A copy of the sleep study that diagnosed you with Sleep Apnea and the physician’s note from that time frame stating your diagnosis and need for treatment.

      • **Medicare/Medicaid has different rules about scoring of a sleep study versus private insurance. If your sleep study was not scored by these rules, you will have to start the process over again.  See Initial start to investigate a sleep disorder.**

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