Medicare "Smart Card" monitoring

[Tired Ma]

Today Hubby & I had appointment to pick up CPAP machines with a provider of our primary insurance carrier. Medicare is our secondary insurance carrier. The provider totally ignored the primary insurance company & only was only interested in talking about Medicare. The sales person proudly mentioned the "smart card" which recorded data & sent it to Medicare so our usage could be monitored. When I asked about this procedure, we were told since Medicare is paying & even though Medicare is our secondary insurance carrier they had to monitor our usage of the CPAP machines & we had to return the "smart card" to the provider company within a 30+ day period of time. They then said if we didn't use the machines/no usage monitored, Medicare would not pay & we would be required to pay the amount Medicare would pay. When we seemed totally confused, they brought us a document for us to sign with an amount filled in as amount we would agree to pay if Medicare refused to pay [document not signed]. As the session progressed & our confusion increased, we decided to delay getting our machines. The provider company insists that if we had Medicare [even if secondary] we would have to be monitored by Medicare. Totally confused, but doing our online research hoping to understand this "monitoring" by "Big Brother".

[junie]

I have Medicare can't get a secondary insurance because of my health, where I got my cpap
it took me like 3 months before they sent me my card I keep bugging them to send it to me,
they never told me about sending the card to Medicare not at all, I live in Delaware. I'm going to give them a call on Monday and ask them.

[jules]

Most insurance requires some report of compliance before they pay for the CPAP. Medicare has attempted to spell it all out in new regulations for their patients recently.

This is a post by a RT who works for an Alaska based DME.

viewtopic.php?p=311368#p311368

[mindy]

Thanks for the link, Jules. The way I read that policy, one doesn't have to send Medicare the Smartcard - it sounds to me like it's a requirement for the sleep doc to have a record of compliance (from the Smartcard) in the medical record in case Medicare ever decides to do an audit.

Mindy

[jules]

I expect what is and isn't required will vary by region and will become clearer as this new policy gets instituted.

I know 3 year ago when I got my machine, Medicaid patients had to have cards read and compliance sent in by the DME. My private insurance needed just a letter from the doctor for compliance. I have no idea what Medicare required back then and hope to never know actually.

Big Brother has been watching us for a long time. This really isn't anything new except of course they are making it more public in this case.

[Slinky]

Most all local DME suppliers accept Medicare, so call your primary insurance and ask them what local DME CPAP suppliers they are contracted with. Hopefully you will have the option of more than this one.

I know some of the Medicare regulations are due to change but .... I don't think it will be necessary to submit your data card every 30 days to prove compliance. This supplier sounds more concerned about their being paid than anything else. I believe I read that the supplier must be able to prove patient compliance IF such is requested. Up until now, Medicare and most insurances have accepted a form letter the DME supplier sends to you after 3 months of use that you must fill out and sign stating you are using your CPAP, how many nights a week and how many hours a night. But I do remember reading discussion that better proof in the form of device data will need to be available from the DME supplier so I don't think this DME supplier is totally misleading you. Talking to a few other local DME suppliers should clear the air about this.

[Debjax]

Today Hubby & I had appointment to pick up CPAP machines with a provider of our primary insurance carrier. Medicare is our secondary insurance carrier. The provider totally ignored the primary insurance company & only was only interested in talking about Medicare.

I am a bit confused, perhaps I have misunderstood. If Medicare is your secondary provider, why isn't the DME looking at your primary first? My husband and I have Tricare Prime, technically a government backed health care provider. IF we had another insurer, especially if it was a primary, IT would have to pay first, then Tricare could be billed. Wouldn't Medicare be the same? You may want to check beyond the Medicare paymets to see if they will require your primary to be billed first.

[GumbyCT]

I suspect this DME has had problems getting paid in the past, likely bc of shady practices and/or poor service. I am certain Medicare doesn't want to see the smartcard for any reason. It's a scare tactic. Compliance would have to be certified by the DME.

I think you should turn and run away from this DME before you have more trouble. Sounds way to shady for me.

[FoxNewsFan]

Hi Tired Ma,

I got my machine 7 months ago, (Medicare-primary, Empire Plan-secondary), and no one has asked me to show them any data of any kind.

When I went on Medicare, my primary, Empire Plan, AUTOMATICALLY, became my secondary. Could this be true in your case also?

Take care,

Ed

[Tired & Sleepy]

Thanks to everyone for sharing your thoughts about Medicare monitoring [so says provider]. I have used CPAP for aprx. 10 yrs myself, & Hubby recently diagnosed. We both had sleep studies in Nov at a well-known Houston TX hospital's suburban branch. Afer numerous inquiries, we finally were called by a major DME provider of CPAP equipment for an appointment to pick up machines & asked if we had Medicare. We thought that strange as they seemed uninterested in our primary insurance, Aetna. At the appointment, we were never asked for insurance cards. We mentioned numerous times our primary insurance was Aetna, but they were only interested in Medicare. After explaining the "smart card", I asked what the purpose of a smart card as my present CPAP has no card. The salesperson said that as we had Medicare, we had to have a machine with a smart card so "Big Brother" could track us to make sure we used the machine. We emphasized Aetna would be paying, but we were told that as long as Medicare was in anyway involved, a smart card for monitoring was required. From our understanding, we would be required to bring in the smart card at about the 36th day for the DME provider to record the information. At this point, we called Aetna & were told Aetna would pay 100%. The salesperson asked us to sign stating Medicare was not to be used in this transaction & we, personally, would be responsible for any co-pay Aetna did not cover [we did not sign]. At this point, we decided we needed time to give more thought & research before getting CPAP machines. It was interesting to find [either on this forum or another] that DMA providers make more $ with Medicare paying [as compared to other insurance or private pay] as they actually "lease" the machines for a period of time to make sure the equipment is actually used by the insured. From my math, seems the profit from the lease/purchase transaction was several hundred dollars profit for the DME provider. Oh, yes, we also wanted to try on the masks offered, but were quickly told that was not possible. There were probably @ 12 styles available. From experience, I know the feel of masks can make a big difference. I miss the Gold Seal masks [discontinued I'm told]. Now I'm reading that we will possibly be "under contract" with a DME provider. This is a bit toooo much. As a CPAP user for 10 yrs without DME contracts & Medicare monitoring, how did I survive or is this just more ways to make a buck? Also, the salesperson let us try on one of the demos & the chemical/plastic smell was very strong, not something I'd want to breathe all night. From our experience with the sleep apnea indusgtry in the last 2 months, I'm feeling like it's comparable to the recent sub-prime lending bubble.

[Slinky]

Since Aetna has said they will pay 100% just call them back and ask what local DME suppliers they are contracted with. Hopefully you will have the option of more than just this one.

MANY insurances have some type of "rent to own" or capped rental purchase method. W/so many new patients NOT staying compliant w/CPAP therapy, most insurances require AT LEAST 30 days before they will make the purchase.

Be rest assurred any of the local DME suppliers will be billing considerably more for the xPAP than they will receive from your insurance (Aetna). Aetna has contracted w/them at a set price. It may be that this particular supplier is interested in your Medicare secondary as a way to get more of the difference between the contracted price w/Aetna and the allowed amount by Medicare. AND Aetna's contracted price "might" well be so low the local DME supplier will be particularly adamant about providng ONLY a bare bone, compliance data only CPAP w/o that "extra" from Medicare.

[jules]

Some of us have gone "out of pocket" to get what we want and not have to deal with insurance headaches (I was spending 2 hours a month on the phone being insulted left and right trying to straighten out a DME bill). I realize that in your case insurance paying 100 % is a big reason to not go OOP.

Medicare does do a long rental contract - Medicare has recently made changes in how they handle compliance. It would be nice to get feedback on people who have dealt with the new regulations on both sides.

I hope when I reach that magic age and am put on Medicare primary based NOT on my own work (I am retired state employee) but on my spouse's history to continue to pay OOP. I was told that we would never be forced to take Medicare if we put in our 20 years (which I did), but of course that isn't the case and not only are we forced to take Medicare if we are eligible, it becomes primary and what insurance I had before becomes secondary.

[Guest]

Medicare changed their regulations FOR NEW patients using CPAP machines effective Nov. 1st 2008
This is why the DME is overly concerned. There are many ways for your doctor and the DME to confirm you are using your CPAP - and a 'smart card' provides documented data they can put in their files should/when Medicare audits them.
The new rules require, for new patients, that during the first 90 days - and after at least 30 days - that you meet with your doctor and that he/she can document you have used your cpap at least 70% of the time for a 30 day consecutive period. If you have not, Medicare will stop paying for the device.

If your hubby has been on CPAP since before Nov 1, 2008 - this regulation (to my understanding) should not apply.

[tom@]

Medicare changed their regulations FOR NEW patients using CPAP machines

When I picked up my machine yesterday my DME provider mentioned the Medicare requirement for smartcard monitoring, and I don't even have Medicare.

He also said he expected more insurance companies to start doing this over the next 2 years, so I shouldn't misplace my smartcard that came with the machine..

BTW, I did ask him if I could have a copy of the software for my device, and he said they don't provide that for patients.

[boston]

I have aetna insurance, and the only reason I stay with my piece of $%#& DME is they only took $150 dollars copay and said that is all i would have to pay until i start getting replacement masks, hoses, etc. He is a newer DME only selling cpap equipment. Told me his plan is to make less money on the machine, and make it up on the replacement parts. (hes still getting like 7 times what cpap.com will sell the unit for) He just doesn't know I plan on getting all my replacments from cpap.com when I start needing them.