DME

[Mr. Smiley]

Well ive Been on my cpap machine for almost 100 days and I love it! Except for my dry mouth that is. Well I moved from Indianapolis to Columbus IN, so about 80 miles from my DME. We have a Lincare and a Apria here in town, both are almost on my door step. Well i called Lincare and told thim id like to have them as my DME supplier and they basically blew me off and said bring all your paperwork to us and we maybe able to help you out. And from all the bad stories about Apria i just dont even want to try them.

So I ended up calling my original Supplier (who i was having trouble with from day one) and said i want a Respironics Premium Chinstrap, a Hybrid mask and a Swift LT. And they siad no problem, they will get them out in the mail today. No fitting since all sizes are included. Thats service.

Mr. Smiley

[boston]

hope you asked about prices and co-pays ???

[Mr. Smiley]

hope you asked about prices and co-pays ???

Well with my sleep study that took care of my deductible im in the realm of 80 20.

Mr. Smiley

[zen]

Well you still might check the prices. My DME really price gouges when I order a full facial mask that should cost ~$200
they charge for each part of the mask so the total is about $500. So my 20% co pay ends up being about $100 for a $200
mask! I have been able to buy the same mask on Cpap Auction for less than my copay from my DME.

The same kind of applies to my cpap. I am on a Remstar M that has a retail price of ~$550 well being on medicare after
18 months rental I own the machine. I think I calculated that over those 18 months my 20% co-pays added up to ~ $720.
So I could have saved about $170 by just paying for one out of pocket.

I guess there are times you have to deal with a DME but by having a new mask, a used mask and a backup cpap I bet I
can put off dealing with my DME for a long time!

[Slinky]

Unless something has changed since the first of 2009 the Medicare capped rental is only for 13 months, not 18 months.

Have you checked your Medicare EOB?? The billed amount is NOT the amount that Medicare allows, nor is it the amount that your 20% copay is to be based on. Your 20% copay is to be based on the Medicare allowed amount.

For instance: 13 month CPAP capped rental in 2006
Supplier Billed: $135.00 - Medicare Allowed: $99.95 - Medicare Paid: $79.96 - CoPay: $19.99

Another instance: 13 month bi-level PAP capped rental in 2008
Supplier Billed: $239.92 - Medicare Allowed: $218.11 - Medicare Paid: $174.49 - CoPay: $43.62

In 2009 Medicare reimbursement dropped: 13 month capped bi-level PAP capped rental
Supplier Billed: $239.92 - Medicare Allowed: $148.04 - Medicare Paid: $118.43 - CoPay: $29.61

Here is the breakdown for a nasal cushion mask purchased in 2008
Supplier Billed: $199.40 - Medicare Allowed: $157.39 - Medicare Paid: $125.91 - CoPay: $31.48
This was broken down as
1 A7034 - Nasal Interface (Mask Or Cannula Type)
Supplier Billed: $129.40 - Medicare Allowed: $117.64 - CoPay: $23.53
2 A7035 - Headgear
Supplier Billed: $70.00 - Medicare Allowed: $39.75 - CoPay: $7.95

Medicare has broken the country down into 3-4 "districts" and there is some minor variation in Allowed Amounts between the districts. The above figures are from Michigan.

[Pugsy]

Hi Slinky,
How does the use of a humidifier factor into Medicare equation? Billed separately if a separate unit like with my Respironics M Series?
Thanks
Brenda

[Slinky]

Yes, the integrated humidifiers, and stand alone humidifiers too, are billed separately. They are paid up front items.

[Mr. Smiley]

When I went to get my firt 2 masks, a Quattro and a Liberty, I remember they charged the insurance about $600 for just the Liberty, i donr remember what it was for the Quattro. But my portion was $20. Filters are about $1 each. When i finely got them to bill me in full for my S8 Elite II they tried for a whopping $2000 and i only recieved a bill for $120. So this year im going to take full advantage.

Mr. Smiley