DME hasn't been charging me for my AirSense 11

[beautifuldreamer]

Oct '22 I got a new AirSense 11 from my DME- and they charged medicare $100 in Oct, but no other charges (medicare claims) since October.

Over a month ago, I called the DME to inquire about not being charged for the Airsense 11, and the DME rep said according to their records I didn't owe anything/no outstanding bills.

A couple of weeks ago, I contacted DME Again re: no charges for AS 11, and then they said that according to their records I had returned the AS 11.

I explained that I did Not return the AS 11, BUT I did return the mask and was going through a different DME for my masks because they don't carry my mask of choice. (the returned mask issue took a couple of months to resolve).

Then DME representative said that someone would give me a call. *No phone call from the DME yet.

Since I am on traditional medicare with supplemental plan, there should be 13 months of charges, then it is considered mine and no further charges after OCT 2023.

*At the next Open Enrollment, I am changing to an Advantage plan.

I am Wondering - Hypothetically, what would happen if the DME doesn't resolve the problem before I change from my current supplemental plan to the advantage plan?

[ChicagoGranny]

I am Wondering - Hypothetically, what would happen if the DME doesn't resolve the problem before I change from my current supplemental plan to the advantage plan?

Medicare will not accept claims received after one year from the date of service. https://www.medicare.gov/claims-appeals ... ts%20share.

I would notify the DME one more time in an email. Keep a copy of the email. If the DME fails to file on time, tell them you are not paying and will sue them in small claims court if they ding your credit record.

[beautifuldreamer]

Medicare will not accept claims received after one year from the date of service. https://www.medicare.gov/claims-appeals ... ts%20share.

I would notify the DME one more time in an email. Keep a copy of the email. If the DME fails to file on time, tell them you are not paying and will sue them in small claims court if they ding your credit record.

Thank you Chicago Granny for the info re: Medicare! I will email the person from the DME who a couple of months ago, asked me to email a photo of the Serial # info on the bottom of my AirSense 11 -

[SleepGeek]

Oct '22 I got a new AirSense 11 from my DME- and they charged medicare $100 in Oct, but no other charges (medicare claims) since October.

iiwy - I would not speak to this DME again until I spoke with a Medicare Advocate. Reason is the DME will only give you advice that benefits them. Below I will link how to locate a Medicare Advocate near you.

I'm wondering who this DME is?
Some years back I had a problem with Apria. Not once did they contact me or attempt to see if I was having any trouble using their equipment but after the year was up attempted to bill me for the full price of the bipap. Well the reason they had no clue was I removed the modem before I ever powered it on.

After I contacted the SHIP she took it from there and represented me in this kangaroo type court setup in which the judge accepted my Oscar readout showing 100% compliance.

I think the DME gets more money when billing the patient directly than the negotiated price they have with insurance esp. Medicare.

https://www.shiphelp.org/

https://www.cms.gov/Center/Special-Topi ... or-You.pdf

*At the next Open Enrollment, I am changing to an Advantage plan.

Personally, I avoid any *Advantage* Plan - Reason is they often restrict which Dr.'s you can use, limit some meds (like the ones that work for you), and IF you travel restrict you to ER visits. But hey if that works for you so be it - they often end up costing more money than they save.

[SAG]

I am changing to an Advantage plan.

I would be sure to talk to the advocate about that. I know when I moved to a diff county my old advantage would not cover me and sent me a letter saying just that but iirc I was then able to sign back up with medicare.

[chunkyfrog]

Original Medicare without a part B supplement is possible--do the math.

[SAG]

Original Medicare without a part B supplement is possible--

Why would you want to do that?

[chunkyfrog]

Original Medicare without a part B supplement is possible--

Why would you want to do that?

I did the MATH.

[SleepGeek]

I did the MATH.

Show your work

[chunkyfrog]

I did the MATH.

Show your work

Everyone's situation will be different--so my math will not be relevant to your situation.
Briefly, do your own math--you may get different results--correct for you alone.

[beautifuldreamer]

my medicare supplement and or advantage plan is through my former employer- both the supplemental and advantage plans allow for my choice of doctors who accept medicare. and the advantage plan covers my preferred gym but the supplemental plan doesn’t cover my gym.

this is my first year on medicare. my supplemental shows me a running total of how much they’ve paid so far (they pay the 20% and i pay 0% and there is no deductible as they pay that as well. i should have a better idea of what works best for me after i have a year of advantage to compare to the year of my current plan.

[SleepGeek]

Original Medicare without a part B supplement is possible--

Why would you want to do that?

I did the MATH.

Show your work

Everyone's situation will be different--so my math will not be relevant to your situation.
Briefly, do your own math--you may get different results--correct for you alone.

Parts of Medicare
Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Sounds like end of life to me.
Anyone here using Part A?

afaik - Part B is what pays for your sleep studies, Dr's office visits, cpap supplies among other medical needs so Part A won't be needed so soon anyway.

This is where Advantage plans can force you to use supplies you aren't used to or brands that don't work for you.

Part B (Medical Insurance): Helps cover:

Services from doctors and other health care providers
Outpatient care
Home health care
Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

[Janknitz]

On Sirius XM radio "Doctor Radio" there is a call-in show for Medicare and health insurance questions. They often suggest not getting a supplemental plan for Medicare parts A & B because the out of pocket costs without it are often less than you pay out in premiums and co-pays. You really have to do the math for each particular Medicare Plan and costs for the supplements and what they cover to see what makes the most sense.

The radio people are very anti-Advantage plan, but they are in New York and have no idea of the level of saturation of Advantage plans in some locales. In my area, Kaiser swallowed up nearly all of the Medicare Market. Last year, Sutter and Providence which comprised the rest switched all of their Medicare practices to Advantage programs too. it's nearly impossible to find coverage in this area which isn't an Advantage plan.

You also need to look carefully at Part D supplement plans EVERY year, because the formularies are constantly changing, and it's really the drug costs that will bite you in the butt.

SHIP is a great resource for analyzing potential costs. In California it's called HICAP but it's the same program as SHIP. It is printed on the back of your Medicare and You booklet that comes every year, and it's available on the Medicare.gov website, too. Totally free and they do NOT sell supplemental plans so you can get unbiased info.

[beautifuldreamer]

On Sirius XM radio "Doctor Radio" there is a call-in show for Medicare and health insurance questions. They often suggest not getting a supplemental plan for Medicare parts A & B because the out of pocket costs without it are often less than you pay out in premiums and co-pays. You really have to do the math for each particular Medicare Plan and costs for the supplements and what they cover to see what makes the most sense.

The radio people are very anti-Advantage plan, but they are in New York and have no idea of the level of saturation of Advantage plans in some locales. In my area, Kaiser swallowed up nearly all of the Medicare Market. Last year, Sutter and Providence which comprised the rest switched all of their Medicare practices to Advantage programs too. it's nearly impossible to find coverage in this area which isn't an Advantage plan.

You also need to look carefully at Part D supplement plans EVERY year, because the formularies are constantly changing, and it's really the drug costs that will bite you in the butt.

SHIP is a great resource for analyzing potential costs. In California it's called HICAP but it's the same program as SHIP. It is printed on the back of your Medicare and You booklet that comes every year, and it's available on the Medicare.gov website, too. Totally free and they do NOT sell supplemental plans so you can get unbiased info.

Thanks for your feedback Jan= it is a challenge to determine the best choice/math for me - I don't take any meds/drugs and the former county I retired in pays a percentage of my supplemental plan - if i leave the group where I am selecting my supplemental and or advantage plan from = I can Never get it back and so I am testing things out for now. . . and I choose that it isn't the best for me I will have to check that out= I had a lot of cost (that medicare covered last fall, as I had a sleep study, new cpap machine, physical therapy etc). this year is more toned down is actual cost, where what I have spent so far is way less than adding up the monthly cost of my supplemental plan (but a bit skewed since the DME isn't charging me for the monhly rental fee yet). Albeit, I do like the fact that there is no deductible to meet and also the full 20% that medicare doesn't pay for I don't have to pay anything . . .

[SleepGeek]

Costs for Part B (Medical Insurance)
Part B costs:

What you pay 2023:

Premium

$164.90 each month (or higher depending on your income). The amount can change each year. You’ll pay the premium each month, even if you don’t get any Part B-covered services.
Who pays a higher premium because of income?
How do I pay my Part B premiums?

You might pay a penalty if you don’t sign up for Part B when you’re first eligible for Medicare (usually when you turn 65). Check when I should sign up for Part B.

How much is the Part B late enrollment penalty?

You’ll pay an extra 10% for each year you could have signed up for Part B, but didn’t.
This penalty is added to your monthly Part B premium. (You may also pay a higher premium depending on your income.)
It’s not a one-time late fee — you’ll pay the penalty for as long as you have Part B.
Generally, you won’t have to pay a penalty if you qualify for a Special Enrollment Period. To qualify, you (or your spouse) must still be working and you must have health coverage based on that job.
Example of the Part B penalty.

Original Medicare is available anywhere an Advantage plan is - even better just go online.
AND is taken by any US Hospital - that is except the VA Hospital - go figure.