My DME is charging double for my machine

My machine (Respironics BiPAP autoSV Advanced - System One) is a very expensive one. It is on cpapshop.com at special price for $3,145.00, with a regular price of $3,700.00. I don't know exactly what the DME is charging because it is through medicare, but it is around $7000. I'm curious, is this normal?

Rundgren wrote:My machine (Respironics BiPAP autoSV Advanced - System One) is a very expensive one. It is on cpapshop.com at special price for $3,145.00, with a regular price of $3,700.00. I don't know exactly what the DME is charging because it is through medicare, but it is around $7000. I'm curious, is this normal?

Pretty much. However, insurance providers and DMEs (typically) have "negotiated prices" which aren't really what the billed amount is. I have no real idea why they do it, but the stories about this have been told over the years.


Den

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The DME will always give the fantasy price.
Ask your insurance for the "allowable" figure for THAT machine.
Compare your cost to buying online, and ask the DME to price match.
The worst that can happen is they will say no, BUT!
You can say no, too.

Rundgren wrote:I don't know exactly what the DME is charging because it is through medicare, but it is around $7000. I'm curious, is this normal?

It's very normal especially when Medicare is the insurance. DMEs are going to want to get every dollar they can and if Medicare will pay for it then they will bill for it and with ASV machines...Medicare will pay.

What gets finally approved is what the final price will be and that depends on where you live and if you are in a competitive bidding area but your 20% copay is based of whatever Medicare allows and not always what is billed but in the case of ASV machines...the allowed amount is substantial. Not so much the case with the plain cpap/apap machines.
Typically a 13 month rental so the costs will be spread over 13 months and the allowed amount will be significantly lower.
The humidifier and mask and other accessories is usually considered a first time purchase and the 13 month rent to own is just for the machine.

How much Medicare will allow for the machine is going to depend on what area of the country you live in and are you in a competitive bidding area.

http://www.resmed.com/us/dam/documents/ ... F_RADs.pdf

So somewhere between 500 and approx 600 a month which over 13 months will add up to somewhere in that 7K price range.
It makes no difference what the price is online for that machine...Medicare doesn't look at that.
Those ASV machines (that's the E0471 coded machine) are something that in this situation Medicare allows a substantial amount per month and the price billed isn't nearly as much of a pie in the sky amount as it is with some of the other cpap machines or stuff..

This is Medicare...not necessarily reflective of how other insurances might handle ASV purchase but from what I have learned talking to a few others who got an actual approved amount quoted from their insurance...not that far off even with other insurance.

My Medicare Part B, plan F covers the entire 20% that is my share.
I can see getting that insurance before ordering your machine, if possible.

You should be receiving Medicare Summary Notices (MSN) by mail listing all charges by your DME to Medicare.

I started CPAP 6 months ago. Airsense10 Elite. DME charges Medicare $126.38 a month or $1,642.94 for the 13 month rental contract before the machine is mine. Medicare only approves $45.40 of that amount each month or about $590.20 a year. Medicare actually sends the DME $35.39 each month (the remaining $6.81 is paid by secondary insurance)...

Read those MSNs, you may be surprised what a provider charges and what Medicare pays.

Check those MSN's for services or supplies charged but you have not received (that is fraud)...

Dennis

We can't compare what Medicare allows for cpap/apap E0601 to what Medicare allows for the ASV E0471...apples and oranges...Medicare will allow a LOT more for the ASV.

I agree with ChunkyFrog...if you don't have a Medicare supplement that will pay the 20% copay that you will owe....get a supplement because your 20% is going to add up real quick with your machine.
I don't know supplement prices off hand but 20% of $500 is $100 and that's going to go a long way towards a supplement.
I think open enrollment is up to Dec 7 so there is still time to get a supplement if you don't have one already.

I would do two things--pay attention because time is short:

1. Get a good Medicare supplement plan that covers all of the 20% co-payment. Hurry, open enrollment ends DECEMBER 7!!! You can call your SHIP/HICAP for free assistance finding a good plan. The number is on the back of the Medicare and You book.


2. Wait until after January 1 to get the machine if you have to pay any deductibles. Otherwise you'll pay THREE deductibles. One for 2015, one for 2016, and possibly one for 2017, depending on the timing. December is a lousy time to get DME.

I will only have to pay the deductible once, I believe. I got my machine on Nov. 28, and my deductible is covered for 2015. So I will have to pay it in Jan. 2016. The rest of the months I will have to pay around $64. Thanks for the supplement info!

Pugsy wrote:...if you don't have a Medicare supplement that will pay the 20% copay that you will owe....get a supplement because your 20% is going to add up real quick with your machine.
I don't know supplement prices off hand but 20% of $500 is $100 and that's going to go a long way towards a supplement.
I think open enrollment is up to Dec 7 so there is still time to get a supplement if you don't have one already.

It will cost more for a Medicare supplement that covers the additional 20% copay, but in the long run, well worth it -- you can't put a price on peace of mind. I have heard of Advantage Care Plans that are pretty good though; it all depends on what you can afford. Call Medicare - they are really good about helping you make that decision, and suggesting where you might get more help. I also read that open enrollment is up to Dec. 7th.