Medicare BC, need new supplier, am I limited to my city?

[Karn]

I need new company to get supplies. One that accepts Medicare Blue Cross without adding extra charges. Almost got caught just now. Wondered why she called within hour of order going out.
Can we use any online suppliers or only local?

[Pugsy]

It all depends if the online supplier will file your insurance and has a contract with your insurance.
Some online suppliers will and some won't.

But no, you aren't limited to local suppliers but you would have to find an online supplier that has a contract with your insurance company and will file insurance in lieu of a cash payment up front.

You would need to ask your insurance company to supply you with a list of suppliers they have a contract with.

[Karn]

I’m looking for companies that Medicare Assignment which is limited price they can charge. It’s bad enough they take $99 headset and charge for each part, but I want to know exactly what my cost is. Last year I called Blue Cross, called Medicare, called half dozen of the names they gave me and still got run around on how much each item would cost. They claimed I had to sign up and give them my order before they could price. As it’s set by Medicare that can not be true. I’ve ordered from Amazon as needed this year.
This should not be so difficult. I told dr office today I had to have company that accepted Medicare and people were happy with. I didn’t use the magic Medicare Assignment word and company woman on phone didn’t mention even after my stressing I needed supplies through Medicare. Then I found a new company on list and it ends up being the one I’m refusing to go back to after problems.

[LSAT]

Regardless of what the supplier charges, Medicare has a set price that they pay for each item. Charging for each piece of a mask is proper procedure. Once Medicare pays their part, your supplement should pay the balance. Usually Medicare will pay 80% of their set price and your supplement pays the remaining 20%.

[chunkyfrog]

Use the link in my signature to find local dealers approved by Medicare.
You can adjust the search radius if an occasional road trip is reasonable.
The green "M" indicates dealers who accept assignment, meaning they take
medicare allowable as full payment, and your share is only 20%.
Others are allowed to charge extra, but Medicare limits the percentage they can ask.
Some supplements cover that too, but not all.
Few dealers get the green "M".
Mine had it, but don't any more.

[Karn]

Thank you. The company I was sent to is not on the list. So talked to two people there. First had no idea what I was asking. The second understood, but is not actually telling me yes or no. They “accept” agreed upon prices with insurance companies. Do they accept what Medicare pays? Yes, but if not they will bill me first. What is the price they are going to charge? Well they can’t say until they bill my company. How are we supposed to be “good consumers” When can’t get a simple answer?

[chunkyfrog]

Just ask, point blank if they "accept Medicare assignment".
They know what it means--it only needs a yes or no answer.
If they cannot/will not tell you, head for the door.

[Pugsy]

When a DME accepts assignment from Medicare (or any other insurance) they get to bill out whatever they want....the pie in the sky amount but it doesn't matter because they HAVE to write off the difference from the Medicare/insurance approved amount and the pie in the sky amount.
Medicare's approved amount for various services vary with the region, city, county, etc.
Now there is a way go go digging deep into the Medicare fee schedules and look up the "approved" amount for any goods or services but it isn't easy.

Is your BCBS Medicare an Advantage plan or do you have regular Medicare and a BCBS supplement?

It is a common practice to bill each part out separately though....even if they all come in one package. Everyone does it and Medicare actually expects it. It's because each part is actually available separately as well as all in one package.

Each separate item gets billed out under a HCPCS billing code number. All insurance companies and Medicare go by this billing code.
This is Medicare's replacement allowance schedule and it has the HCPCS billing code for each item.
You could try asking the supplier how much Medicare allows for so and so HCPCS billing code but most likely the person won't have a clue because they aren't in on the billing side of things. That's probably done elsewhere by someone who isn't working up front but you never know till you ask.



Otherwise you have to dig deep into the DMEPOS fee schedule
https://www.cms.gov/Medicare/Medicare-F ... e-Schedule
for your area
It's not much fun and a lot of work. They are listed by the HCPCS billing code.