CPAPtalk.com

Thank you, Guest. I think I'll make that call.

Guest wrote: This guest never said any of that.

Never said you did....we have no way to know one "guest" from another guest.

The information above from the "guest" above about Medicare requiring brand and model is incorrect for the bulk of the country...might be what he/she was told by the DME but it's not how Medicare works normally.
Medicare doesn't care about brand or model..all they care about is that HCPCS code.
Now a DME telling a patient that Medicare requires so and so...happens all the time but it isn't necessarily the truth.

Woody wrote: please don't turn me in to the cpcp pressure police !

they should be breaking down your door any morning now, (about 4am).

The declaration may come from a patient with restricted coverage,
like Medicare Advantage--which often works like an HMO. ("To hell with the patient")

Comfortably Numb wrote:

Hang Fire wrote:It seems uncomfortably numb that you are keeping secret the model of the machine you want from forum members who are trying to help you.

Not at all. Based upon my diagnosis, reading this forum, and my limited experience with cpap, I have selected the following:
Airsense 10 Autoset with Humidair heated humidifier
Amara View mask
Heated hose
My doctor may have other ideas. I'll find out on April 11th. I want to be prepared for him and the DME's which is why I'm doing my homework in advance.

I'd suggest the autoset for her, you might not like the extra mode it has, but it doesn't hurt to have it available.

Guest wrote:

Pugsy wrote:Guest gave you some information that isn't true for all areas of the country.

This guest never said any of that.

you all look alike.

Your Medicare supplement coverage won't care who you get your equipment from nor will they care what equipment you get.
They will just pay after Medicare pays.

Medicare allowed amount for the E0601 machine is going to be the same for each supplier in your area.
So as long as they are a participating Medicare provider the cost is the same and the supplement pays your co pay for you.
Now what the DME might bill out initially as the pie in the sky amount...might vary widely but the end result is they have to be happy with what Medicare says they will be happy with.

Medicare allowable amounts will vary across the country and in some states can vary a bit within a state. Medicare goes by regions. Areas where medical care costs tend to run higher will have slightly higher allowable fees for the same product.
But the suppliers local to you...will all be in the same region so the allowable amounts will be the same.
There is a way to find out what Medicare will allow in your region/area but it involves some really deep digging in the Medicare
DMEPOS fee schedules.
https://www.cms.gov/Medicare/Medicare-F ... edule.html
DMEs get a copy of the schedule that applies to them but they may not share it with who does the selling or dispensing of the machine. Meaning whomever you talk to at the DME office may not even be aware of the fee schedule because they don't deal with that part of the business.
Some DMEs simply have it already setup in the system to bill out whatever Medicare allows....some elect to initially bill out the pie in the sky amount and write off the difference.
The person you may talk to in the DME office may or may not have any idea what Medicare allowables are...so you trying to figure out if they are billing appropriately may hit a brick wall.

Understand that the blower part is usually billed out in the 13 month rent to own...the humidifier likely will be billed out separately even if the humidifier is built in and the humidifier fees might be a one time fee or they might elect to include it in the 13 month rent to own.
Everything gets broken down even if it is all in one package. It's just the way it is. Masks and filters and hoses...all are one time purchase billing. The only thing that is rent to own is the blower and maybe the humidifier.

If you want to dig into the DMEPOS fee schedule you will need the HCPCS billing codes to check for allowable amounts.
Here are the most commonly used billing codes.

Pugsy wrote:

Guest wrote: This guest never said any of that.

Never said you did....we have no way to know one "guest" from another guest.

The information above from the "guest" above about Medicare requiring brand and model is incorrect for the bulk of the country...might be what he/she was told by the DME but it's not how Medicare works normally.
Medicare doesn't care about brand or model..all they care about is that HCPCS code.
Now a DME telling a patient that Medicare requires so and so...happens all the time but it isn't necessarily the truth.

Until pugsy posted there was only 1 guest. But she doesn't like guests.

palerider wrote:

Guest wrote:

Pugsy wrote:Guest gave you some information that isn't true for all areas of the country. It might have been true for the DMEs in his area but it's not necessarily true for other areas. I think most likely his DME told him a story and blamed it on Medicare...wouldn't be the first time.
Medicare doesn't care about brand or model...all they care about is if your diagnosis supports the criteria for whatever billing code machine you get....single vs bilevel pressure.
Assuming your OSA is plain jane vanilla OSA and your pressure needs don't support the need for a bilevel...you will get an E0601 billing code machine.

This guest never said any of that.

you all look alike.

Step 2 in derailing threads by the tag team

Guest wrote: Until pugsy posted there was only 1 guest. But she doesn't like guests.

Never said I didn't like guests and I was actually fairly benign in my comments about what you said. I never said that you don't know what you are talking about....didn't make one derogatory statement about you. I had to use "guest" because I don't know you by any other name. You are just one of hundreds of "guests" ..you don't own the guest nomenclature at all.
I said that it might be true in your particular area for some reason or other but it wasn't necessarily the way it is for all other areas of the country and your DME might have been handing you a load of BS...it's not like they haven't been known to do that you know.

Oh...BTW when I first saw the "guest" post you initially made there were no names in parentheses below "guest" so I had no idea that the guest posting was probably the PITA guest I am familiar with. Now I see the names in parentheses which so often accommodate your posts. The names in parentheses are meaningless....doesn't tell me who you really are (not that I really care) . I saw one this morning that had my Pugsy in parentheses...it wasn't me.

When you choose to continue using guest...it just lumps you in with any and all of the other "guests" and I have no way to know if you are my usual PITA guest or simply another guest who doesn't elect to choose a screen ID for the forum.
If you don't want me making comments about what you say...hey, feel free to get a real name for forum usage and I will gladly put you on my Foe list and ignore you totally.

Again...for any other guest...I really don't care if you opt to use "guest" or take on a real name but when you do you run the risk of getting lumped in with other "guests" who might not have the most stellar reputation here on the forum.
It's your choice...do whatever you want to do I really don't care one way or the other.

For this current guest interaction...I don't wish to spar with you just for the sake of sparring which is what you want...so I won't be addressing you anymore. I don't have to have the Foe feature to ignore you...but it would make it so much easier but that's okay...I can still ignore you and for now I will do just that.

Guest wrote:

palerider wrote:

Guest wrote:

Pugsy wrote:Guest gave you some information that isn't true

This guest never said any of that.

you all look alike.

Step 2 in derailing threads by the tag team

step 3 gleefully contributed by .... something that obviously would rather just cause trouble.

Step 4. Conclusion: Forget about ripoffs and how Medicare billing is handled by the DME; make sure doctor Rx supports what I need and want; walk into the DME with my RX and specific equipment list; state that between Medicare and my supplemental insurance, I expect to get exactly what I want with 0 out of pocket; move on to another DME if necessary; go to cpap.com as a last resort and pay full price.

@Comfortable: you got it!

Guest wrote:

Pugsy wrote:

Guest wrote: This guest never said any of that.

Never said you did....we have no way to know one "guest" from another guest.

The information above from the "guest" above about Medicare requiring brand and model is incorrect for the bulk of the country...might be what he/she was told by the DME but it's not how Medicare works normally.
Medicare doesn't care about brand or model..all they care about is that HCPCS code.
Now a DME telling a patient that Medicare requires so and so...happens all the time but it isn't necessarily the truth.

Until pugsy posted there was only 1 guest. But she doesn't like guests.

Your actions show what you don't say. As mentioned before your undo credit there was only one guest post with no mention of what YOU said.

Give credit where credit is due, another registered member.

AirPump wrote:Hi -
I just went through this in the Seattle area. If your sleep doc has been taking Medicare patients, he'll know that he can't just write a "generic" prescription for you. For Medicare reimbursement, the prescription has to be specific brand and model of the CPAP unit and mask etc.

There you have it.

Comfortably Numb wrote:
"If you would list them here that will help tremendously on advising you. We don't know what you know or what is going thru your mind. Let me start by saying I would avoid any DME's that begin with A or L."
Here they are:
Beacon Respiratory Services of Georgia, Inc.
Lincare, Inc.
LIFEHME, Inc./Long Term Care, Inc.
AHP Alliance of _ _ _ _ _ _ _ _/American Homepatient, Inc.
SleepMed Therapies, Inc.
Medical Services of America/Medical Home Care, Inc.

You have already heard about Apria and Lincare prob two of the biggest Medicare providers and ripoffs - they know the rules and dodge them at every opportunity.

What I learned a couple weeks ago is that Lincare also owns AHP - such a nice sounding name "American Home Patient".
So avoid anything that begins with A or L and anything they own and operate.

The others I can't comment on cuz I have no personal experience with them.

btw - for anyone who has had a problem with any Medicare provider - by all means do file a complaint with Medicare as that is the only way they know. There were some changes last July when Medicare added some providers for the second round of bidding. So check directly with the cms dot gov site for changes and/or direct answers to any future questions.