Does Medicare only cover rentals of machines?

[CheBella]

It's time to get a new BiPap machine.
For my last one, I just followed my doc's suggestion & used a DME that rented the machine.
They were terrible, really awful.
This time, I realized that I could buy 100% out-of-pocket a machine from the internet for less than the total of my monthly 20% copayment (*after* Medicare has already paid their 80%.
(Don't make me do the math again; when I did, it took days for me to stop walking around in circles with my mouth open.)

Medicare tells me that all these nice places that sell machines are not approved suppliers.
Approved suppliers say "Your 20% is only $158 a month + your firstborn child. You get no choice of machine. You are not guaranteed a new machine. You want I should put you down for this or not, cause I gotta go on my break now."

Is there anyplace that sells bi-level machines (not just masks & supplies) that IS covered by Medicare?
(I only have Medicare, no private insurance at this time.)

BTW< I'm leaning toward the DeVilbiss intellipap Bilevel S (DV55D-HH); it seems to have everything I need & costs $1025.
--or-- the auto-adjusting model, which is $200 more...can't decide.

I'm sorry if this has been covered (bad pun); I did look, but this is my very 1st post, & I'm sometimes amazingly stoopid.

Thanks for any help!
Donna

[LSAT]

Normally Medicare is rent to own. You are renting for 13 month and then you own the unit. The humidifier is an up-front purchase. There are some changes this year, but I don't think it affects the CPAP purchase.

[Pugsy]

I am confused as to what you are asking...are you wanting an online supplier of machines that will accept Medicare payment plus your 20% for payment so you aren't out of pocket the whole amount?

Or are you just wanting to find a good deal on a machine on the internet?

Or are you thinking that just because on online seller is not an "approved provider" that you should not buy from them even if the total amount paid is less than you would have paid if you went through a local DME and Medicare. Are they insinuating inferior products because the seller isn't "approved" if so, that's hogwash.

If you are paying you own money and not wanting to bill Medicare...they shouldn't care one whit where you buy it or how much it costs...they aren't paying for it.

[katandmah]

I have Medicare and after two 6-month compliance checks, the machine is mine. Also the DME calls me every 6 months or whenever its time for new stuff, to ask me if I need new hoses, humidifer chamber or anything else. I did not have to pay for anything. I do have a supplement Medicare, but I dont believe they were billed anything. I would try calling again.

[CheBella]

[quote="LSAT"]Normally Medicare is rent to own. You are renting for 13 month and then you own the unit. The humidifier is an up-front purchase.

Yes, I understand that. It's just that the rental provider charges ~$150/month rental for my 20%, which x 13 months = $1800, which is ~$800 more than I can buy a machine online 100% out-of-pocket.
Which also means that Medicare is being charged $10,000 for their 80%.

The 20% I would pay for a humidifier is $158.

Pugsy,
Yes, I am wanting an online supplier of machines that will accept Medicare payment plus your 20% for payment so you aren't out of pocket the whole amount?

--- and so that I won't be a part of this atrocity of Medicare charges.

I will still pay 100% out-of-pocket (& choose my own machine & have no one except my doc checking my compliance) if that is the only way.

[Pugsy]

There are a few online sellers who will be a participating provider and bill Medicare and your supplement insurance but I think that you will find that what they settle for is going to be what Medicare ends up allowing per month is going to be pretty much the same as your previous experience.

This was last years allowable amounts. There might be a few minor variations depending on locality but this is pretty close.

http://www.resmed.com/us/documents/1013 ... ilevel.pdf

E0601 is what all brands of cpap/apaps will be billed at. From the most basic brick to the APAPs.
Monthly allowable varies a little with more the first 3 months and drops a little for the remaining 10 months.
E0470 would be the bilevel machine code with the ASV bilevels being E0471

It doesn't matter what the DME bills if they participate and take assignment....they have to be happy with what Medicare says they are going to get.

http://www.libertymedical.com/cpap/products/
I believe Liberty Medical will accept Medicare assignment.
As well as American Home Patient
http://www.ahom.com/
There are some others but I don't remember their names.

So it really doesn't matter who you buy it from if they take assignment with Medicare...they are all going to get paid the same and it doesn't matter what pie in the sky amount they bill out to start with. It gets adjusted off down to the allowable amount.

[herefishy]

Looks like medicare is rembursing about $100 a month or so, for it's 80% - how could the patient be having to pay $158 for his 20%?

[Pachyderm's Nose]

Looks like medicare is rembursing about $100 a month or so, for it's 80% - how could the patient be having to pay $158 for his 20%?

There does seem to be something fishy (no offence) there. When my insurance determines what they will pay for something and adjusts the bill I am then only liable for my portion of the adjusted bill, not my portion of the original bill. Maybe it has something to do with medicare being unable to negotiate prices?

[LSAT]

Chebella is looking for a BIPAP...not CPAP/APAP

[Pugsy]

Medicare allowable for last year for the Bilevel was $238 to 201.
20% of that would be $40 to $47 .
Historically allowable amounts have come down over the past few years so I suppose a few years ago the patient portion could have been $58.

[Pachyderm's Nose]

Medicare allowable for last year for the Bilevel was $238 to 201.
20% of that would be $40 to $47 .
Historically allowable amounts have come down over the past few years so I suppose a few years ago the patient portion could have been $58.

I think your numbers are good but OP stated their 20% was $158/month which would be outrageous.

[Pugsy]

I think your numbers are good but OP stated their 20% was $158/month which would be outrageous.

Yeah, and I don't know how they came up with that amount. Even the was E0471 bilevel with backup rate (ASV)
http://www.resmed.com/us/documents/1013 ... et_rad.pdf
$595 to 505 roughly.
$112 co pay which likely would have been higher in the past when Medicare allowed more.

There's something weird going on here and without seeing the billing and the codes...we don't know what actually happened.
There may have been an ABN signed for all we know.
It doesn't compute by normal standards for sure.

[Pachyderm's Nose]

This is one area where private insurance trumps medicare. If my DME tried to bill me above the allowable rate established by my insurance I could call the insurance and they would hammer them back in line or remove them from the provider list.

[akcpapguy]

This is one area where private insurance trumps medicare. If my DME tried to bill me above the allowable rate established by my insurance I could call the insurance and they would hammer them back in line or remove them from the provider list.

You have this same ability through Medicare, if they are a Medicare Provider they can not bill the patient more than 20% of the allowable. If this happens it's a quick call to the Medicare fraud hotline.

[Christine L]

Approved suppliers say "Your 20% is only $158 a month

Sorry for stating the obvious, but that is nearly $2000 per year for just the 20%.

How expensive are BiPAPs?