Be careful and track how long you pay medicare copay

[wilsonintexas]

I recently noticed that i was still paying for my cpap, after a long time.

I had auto payment set up, and did not notice.

So i turned it iff.

It turns out that when i switched medicare plans they started the counter over.
It tool a while, but eventually i got a refund for the overpayments. It took 5 emails, 6 phone calls, and tracked mail.

I proved that i had made 13 payments.

Then i kept getting bills.

When i dug further they said it was because they had not collected from the insurance. Per law that is their problem, they had preaproval, in fact it is their responsibility to file the appeals.

Eventually, after quoting the medicare guideline that said it was their responsability

They said, we will fix it.

More bills.

More calls.

It took 6 more emails and 4 more phone calls and waiting for 2 supervisors…to get them to fix it .

I tried to report it as medicare fraud, medicare said since it was an advantage plan, take it up with them. They did not care.


My point is
Track your payments
Then know your rights.
You are only responsible for 13 payments, no matter what they say. Even if it is under 2 plans.

If they did not collect, that is their problem, even if they have you sign some small print, federal law trumps it.


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[GrandmaA]

Thanks for the heads up. I have a Medicare Advantage plan. I've only made one payment, right after I got the machine this January, I got a paper bill for the copay. Since then I have not gotten any bills. I did get one text telling me to call a number to pay for my recent shipment of masks or something. I did not call and haven't heard from them since.

Ironically right before I read your post I got an email from Medicare about scams. Now I'm thinking, was that text really from my DME or some phishing scam sending out mass texts about "equipment" and hoping to catch people who happened to have received some kind of equipment? I don't think it specified masks, I think it just said, "shipment of equipment"?

Anyway I'm glad I didn't respond to the text. I thought it was weird they texted me after I had gotten a paper bill in the mail the first time.

In the middle of typing this I decided to go look in my records to figure out why I have not received a bill since January. I discovered that my payment in January went through twice! I paid online and maybe hit the button twice. Then I looked at my insurance statements and have small copays which I never got bills for, so I called them on the phone and sure enough, they credited my account for the double payment and I still have $12 credit and do I want them to mail me a check for $12? I told them no, just keep applying it to my account.

Then they asked if I would like to turn ON autopay and I said NO!!! After that remaining $12 runs out, send me bills!

So thank you for this post, it made me go sort out my stuff and figure out why I haven't been getting bills.

So by Medicare rules, you pay rent for 13 months and after that you own the machine? I will stay on top of it!

[Janknitz]

You may be surprised to learn that Advantage plans are NOT limited to the 13 month capped rental original Medicare does for CPAP. They can require perpetual rental for the life of the equipment. And from what I have observed, most do impose perpetual rental, because they can. Why not? Medicare allows this and it's good for the Advantage plan's revenue.

So this may not be a case of fraud. You can check your plan by reading your Evidence of Coverage (EOC). The EOC is NOT the same as an Explanation of Benefits (EOB). The EOC is the actual contract between you and your Advantage plan--even if you never saw it before. It may be posted o line or your will have to ask for it. Under the section about Durable Medical Equipment, it will say if the rental period for Durable Medical Equipment is capped at 13 months or not.

Federal law. Ain't it fun.

[GrandmaA]

You may be surprised to learn that Advantage plans are NOT limited to the 13 month capped rental original Medicare does for CPAP. They can require perpetual rental for the life of the equipment. And from what I have observed, most do impose perpetual rental, because they can. Why not? Medicare allows this and it's good for the Advantage plan's revenue.

So this may not be a case of fraud. You can check your plan by reading your Evidence of Coverage (EOC). The EOC is NOT the same as an Explanation of Benefits (EOB). The EOC is the actual contract between you and your Advantage plan--even if you never saw it before. It may be posted o line or your will have to ask for it. Under the section about Durable Medical Equipment, it will say if the rental period for Durable Medical Equipment is capped at 13 months or not.

Federal law. Ain't it fun.

I did not know that, I will check my plan.