Better to use Medicare for new apap, or buy used/new?

[PopIsGettingGrumpy]

My father was just diagnosed with severe obstructive sleep apnea with 54 events per hour. We have been prescribed a Resmed Auto CPAP with Heated Humidifier, but are trying to decide how we'd prefer to acquire one (dme/medicare, new or used out of pocket). I'm hoping for some advice to help us decide how to proceed:

- He has medicare a & b, but I'm very worried about the many poor reviews I see for our local DME's. I don't want trouble with unexpected charges or recurring billing/supply issues. Is it possible to really protect ourselves from those kinds of issues with DME's, or is it better to purchase the machine ourselves? The ones in our town (Medford, OR) state that we have to give them a card on file, although I see many cpap users stating never to do that. What is the best way to protect ourselves from shady DME practices?

- If we purchase our own new or used machine without using medicare, will we still be able to have medicare cover the supplies at 80/20%? If used, will we be able to set it ourselves to our sleep doctor's prescribed rx and settings, and set it up for our doctor to access remotely? I tried asking our sleep doc, but was told that we would likely have to take any used machine to a DME supplier to set it up correctly. Is that true?

At this point, we're really trying to weigh the pros and cons of going through medicare/local DME, or buying a new or used machine ourselves -- while still being able to set it up per our doc and give our doctor remote access.

[Pugsy]

If we purchase our own new or used machine without using medicare, will we still be able to have medicare cover the supplies at 80/20%? If used, will we be able to set it ourselves to our sleep doctor's prescribed rx and settings, and set it up for our doctor to access remotely? I tried asking our sleep doc, but was told that we would likely have to take any used machine to a DME supplier to set it up correctly. Is that true?

Setting up a machine is easy. People do it all the time. No need to have a DME do it unless you just want them to.

You can still have Medicare cover masks and other accessories even if Medicare hasn't paid for a machine.
I have Medicare...Medicare has never bought me a machine though...I always bought private and used because it ended up costing me actually less than my co pay if I had used my Medicare. So since 2009 I have been using a DME only for masks or a hose or water chamber every now and then as needed.
In fact the DME I use actually told me if I had trouble with my private purchase machine they would help me with it....that's what a good DME does. Most won't though.

Your dad has Medicare part A and B....cpap stuff all comes under the Part B coverage. Does he have a Medicare supplement as well. Medicare supplements will pay the co pay that Part B doesn't cover. Medicare pays 80% of the allowable part B service and the patient is responsible for the remaining 20%....medicare supplements pay that 20%.

Medicare does a yearly deductible on Part B charges...so in January there will be another deductible.
This year that deductible was $203...next year it will be probably a little more. I can't find how much exactly right now but probably around $5 or so. It goes up a little each year.
Depending on which Medicare Supplement a person has it may pay the patient's part of the deductible or it may not.
If he doesn't have a supplement he might be better off buying a used/new machine privately due to his potential out of pocket costs.

Medicare does a capped rental system and pays by the month and after 13 months the machine is paid for.
Unfortunately this will likely mean another deductible in January along with the 20% copay each month and it might add up in total to more than it would cost to just buy your own. You have to do the math and the math depends on if he has a supplement or not and what it covers.

As for DMEs often wanting a "card on file"....just tell them you don't use credit cards....or maybe get a prepaid card with maybe 25 bucks on it and give them that card number.
If he has a supplement they won't or shouldn't ever need to bill him because the supplement should pick up the difference (assuming deductible has already been covered).

I don't know about setting up remote access where your doctor can access things for a used machine that might have already had the serial number assigned to someone else but setting up a new machine isn't difficult.
You register with MyAir website and provide serial number and then you give that serial number to the doctor and he can go in and see the results at the doctor version of MyAir (I forget the name).
Or a SD card can be used for results like we did for years and doctors used ResScan.

If he has Medicare AND a traditional supplement....it will probably be cheaper to use Medicare and go through a DME and do the monthly capped rental thing.
If he doesn't have a supplement we would just need to do the math and get an idea what he will be paying over 13 months for his 20% co pay and any part B deductible and compare it to what you would pay online for a new machine or privately for a used machine.

[Pugsy]

Oh I forgot...humidifier costs...it's billed out as full purchase the first month ...even if it is built into the machine like it is with the AirSense 10 AutoSet. It's always been that way because most of the time humidifiers are separate purchase and not returnable. Only the blower unit is returnable.
So the monthly capped rental thing is just for the blower.
First month charge is always larger because of the humidifier one time full purchase.
With Medicare (and most other insurances) everything always gets billed out separately even if they are technically part of one package. They do it with masks as well.

[SAG]

Unless and until you know the answers to your questions and know how to set up this equipment I think you are better off using a DME. The docs I know don't setup any equipment the write the order for the DME to follow.

Don't give them a credit card esp. Apria and check the reviews of the DMEs.

Once you feel comfy doing all of those things you can turn in the equipment and buy your own.

[ChicagoGranny]

I'm hoping for some advice

Just remember that reviews are mostly written by people who have had bad experiences. The people who have good experiences don't bother to write reviews.

My DME is excellent. I've procured two machines and all my masks through them using a Medicare Advantage plan. This is cheaper than purchasing from an internet supplier. They are also good about having masks in stock that are used for doing fittings. If you take any mask from them and it doesn't work out, you can switch it to another mask within 30 days. They also promised me a loaner machine the same day (M-F) if my machine ever fails. (I do keep my own backup machine.) They file my insurance and never bill me until they see what the insurance pays. They keep up with my compliance and answer any insurance inquiries about my compliance.

So there are good B&M DMEs and there are advantages to using them.

Avoid Apria.

[chunkyfrog]

Go into Medicare>>providers>>cpap, etc.
Enter your zip code, and you will see all Medicare providers.
If you are lucky, some will have a green "M", (preferred providers),
which indicates they accept Medicare allowable as full payment
If no local dealer is satisfactory, you may increase the search radius.
Even a non-preferred provider is limited to how much upcharge they are allowed.
Your share is 20%, plus that upcharge, if assessed--
a supplement should pick that up, but premiums often exceed benefits.
I noticed that most doctor and hospital charges are way more than the allowables.
[[[Think, "pie in the sky"--they almost never get that much.]]]
Medicare "allowable" is weird--maybe half of a doctor's charges,
give or take half of hospital, but about full price on cpap supplies,
except filters. (Medicare pays way over retail for filters--go figure)

[PopIsGettingGrumpy]

Thanks to everyone for such detailed info. My father does not have a supplemental plan, but he has met his deductible for this year. For the first DME company that I prefer to avoid, we were told that the initial charge would be $78 for the equipment/setup. The rental fee was quoted at $11/month this year, and would go up to $48/month next year until his deductible was met. Initially that sounded fine, but they have a large number of reviews for charging more than quoted, autoshipping/charging for supplies that were not wanted and sending people to collections over their billing discrepancies. When I pressed for assurance in writing that we would not be autobilled for any unexpected charges or supplies they kept dodging the question, and I opted not to use that company due to that.



While I believe my father will pay less with medicare, I am hesitant to get stuck in a billing battle with our local DME's. I will look into the option of a prepaid credit card, but I believe that still leaves us open to being sent to collections if we end up with an unethical DME who autoships supplies we didn't ask for. If we "rent" the machine through a DME/Medicare, and choose not to continue with that DME company for any reason, are we only responsible for returning the machine without any further charges except the rental fee for the months we had it?

Initially I was inclined to just buy the machine outright, but then the prices skyrocketed due to the recall. It's a tougher pill to swallow knowing they were hundreds less just a few month ago, but the idea of battling it out with an unethical DME makes it a close call.

I did search on Medicare for our authorized suppliers (none of ours have the green M). We have Lincare and Apria, which most say to avoid. SoundOxygen/Adapt Health, which I prefer to avoid. And Northwest Medical, which our rx is being sent to so I can see if we feel comfortable doing business with them. I also see one more further out with a notation "Charges the Medicare-approved amount (so you pay less out-of-pocket)".

[Pugsy]

Medicare specifically prohibits auto shipments of anything. Any DME caught doing auto shipments is committing Medicare Fraud and most won't want to get caught in that trap.
For consumables that the DME might want to auto ship (conveniently on the replacement schedule that Medicare allows) they are supposed to only ship when the patient requests so and so. Now what they will probably do is keep calling and asking and telling the person that "it's time to replace" and encourage the "need to buy"....when actually Medicare says that just because it can be replaced....it shouldn't be replaced unless damaged or not working optimally.

The DMEs that accept assignment and participate in Medicare have very strict rules about what they bill and how they bill and most won't want to rock the boat and risk having Medicare take away their cash cow and maybe go to court.

Also...they are required by law to notify the patient in writing of any charges that Medicare might disallow.
It's an Advance Beneficiary Notice....patient must be notified in writing that Medicare might disallow something and if this isn't done...The DME can't collect or attempt to collect.
People have to watch what they sign though...often the ABN is worded in such a manner that it gets included in the multitude of documents one signs at the very beginning of therapy when they get their equipment.
Sneaky little devils.
They really are supposed to do ABNs for specific services at time of service and not do the blanket ABN.

For the machine itself...it's pretty cut and dry and what they quoted you for monthly amounts is probably very close to exact amounts and they won't usually screw with those charges.
It's follow up stuff that might cause a problem.
Did you know you can fire a DME if you decide you aren't happy with them?
Did you know you can change DMEs and get your other cpap stuff from a different DME and you don't have to return the cpap machine? You don't want to return the machine and get another machine from a different DME....because the 13 month thing will start all over again....but you don't have to even if you decide to get your other supplies from a different DME.

Chances are Apria and LinCare won't screw with the billing on Medicare patients as much as with non Medicare patients.
They can't auto ship for one thing and if they do they are breaking the law and they know it.
The patient just has to make sure they don't order or request something when the DME calls up and says "it's time to replace so and so".

The only thing that will be billed out monthly after the first initial set up...the machine itself.
All the other items are considered a one and done purchase.
Unless of course someone decides to try a new mask after 3 months or something gets damaged and needs replacement (I have dropped and broke 2 water chambers over the years).
The prices you were quoted above...pretty much what you will see from any other DME that is Medicare participating.
It may vary by pennies or how the DME handles that Part B deductible in January...some may want it all up front and some may do it in payments like the above quoted you.

Medicare closely protects their patients from abuse and DMEs know this.

If we "rent" the machine through a DME/Medicare, and choose not to continue with that DME company for any reason, are we only responsible for returning the machine without any further charges except the rental fee for the months we had it?

Correct...but I don't advise returning the machine itself because if you do then the 13 month thing starts all over again.
End up paying more in the long run if you do that especially if you were halfway through the 13 months.
Again...you can choose to change DMEs for your masks and other supplies if you wish...masks aren't tied to a machine purchase requirement. People change DMEs all the time...just have to do some extra paper work but there is zero requirement that they buy a new machine to get a new mask.
Now the DME might push a machine purchase but they can't require it. If they do say it is required you don't want them because they are liars...plain and simple.

Using Medicare is going to be the cheapest out of pocket way to go.....potential for hassles is actually rather small due to the way Medicare enforces their contracts with these guys.
Use a pre paid credit card for the monthly rental payments if you wish for long term or just one term and when it is used up they will just send you a monthly bill in the mail and you can write a check. They may not like it but they can't do anything about it. They want the credit card number because it's less work for them.

You can tell the DME "do not call" "We will call you if we want something"...and they might play nice and put you on a do not call list...or if they don't...block them if they call urging "it's time for replacing so and so".
That's what I did with my DMEs robocalls telling me "it's time to buy so and so". I just blocked them.
They aren't supposed to call you if you request a do not call...but it's most often a robocall and we all know how ineffective those requests are in real life.

Make sure your dad knows to just reply "no I don't need or want anything right now, don't bother me anymore".
If you do need something...you make the call.
Now I do recommend that people make use of the replacement schedule at first just to have a spare handy.
Like the water chamber replacement...6 months and it is allowed I think. I would go ahead and get one just to have it on hand in case the one in use gets broken or leaks. Murphy's Law says if you have an accident with the water chamber it will happen on a weekend or holiday where it is hard to get a replacement quickly.
Both times I dropped and broke my water chamber it was late on a Friday night.
I also suggest getting a spare hose when it is allowed...just in case something happens to the original hose.

After you have spares of everything...then just tell the DME "I don't need anything thank you" and hang up.

Remember Medicare says that the patient has to say that so and so is needed and that isn't up for discussion.
If the DME auto ships anything...they are breaking a real important law and most DMEs don't want to be on the wrong side of Medicare. A threat to report them to Medicare works very well.

[Pugsy]

Here's a hint about filters for the cpap machine. You can find them in bulk at Amazon or other online retailers for final cost less than Medicare allowed amount in most instances.
Medicare officially "allows" 2 disposable filters per month. DMEs are allowed to ship 6 at one time (3 month allowed at a time). ResMed says replace the filter every 6 months or sooner if it appears dirty, has holes in it or damaged in any way.
It is extremely rare that a filter needs to be replaced twice a month.

Buying online can often save money or even if it is a wash in terms of cost....avoiding the hassle factor and potential billing issues is priceless.
Last filter purchase for me...Amazon...paid 12.99 for 60 hypoallergenic filters and that included mailing them to me.
My co pay if I used my Medicare for one filter was a little over a buck. I used Medicare one time to get a filter from the DME just so I could see what my 20% copay was so I could compare it to online purchase.
And the filter I got through the DME was NOT a ResMed brand filter at that. It was a generic aftermarket filter that when I compared it to a name brand filter I had...couldn't tell any difference.

Medicare does allow DMEs to ship in 3 month quantities and it isn't considered auto ship as long as the patient requests the item. Like mask cushions for a full face mask are "allowed" at 1 per month....it is allowed to ship 3 or 3 months worth.
It helps with shipping costs and is allowed but again....the person has to request the replacement.
The DME can't just up and start shipping anything without asking first.

Here's the replacement allowance guideline for Medicare.
Again just because Medicare might allow it...doesn't mean that Medicare wants you to use this guide as a set in stone automatic thing. Medicare wants people to have common sense and not abuse the system. If it ain't broken they don't want people to just stock pile products. Unfortunately a lot of people do abuse it...we see a lot of the abuses end up on EBay from private sellers. Maybe they have a supplement and thus they don't have any out of pocket costs so they sell the extra stuff on EBay and make a few bucks. Keep one spare of each item you might need and then don't stockpile stuff you don't need. Just don't order until the spare has been used. Most of this stuff lasts a LOT longer than the time allowed between replacements. I had one heated hose that had over 20,000 hours on it before I replaced it and I replaced it because I got a new machine and it no longer was compatible with my machine. That hose was used on 4 different machines until I changed machine models and it no longer would work. I ended up giving it away when I sold my last S9 machine and it became someone else's "spare".

[PopIsGettingGrumpy]

Fabulous. Thanks for that wealth of info. It really helps a lot.

Now... to throw one more consideration into our plan --- we just found a used Resmed 10 Autoset/Humidifier in our area for $500 with some additional masks. Supposedly it has less than 10 hours on it in a non-smoking home. We are told that they used it for 12 days and the company wont take it back due to covid so they are out the money they paid for it as well as their insurance. With that in mind, I'm wondering if we should consider this used one instead of medicare. It would be about $150 more than a new one from medicare, we would lose any warranty but have no compliance or dme concerns. Any reasons to think this may be a bad idea? Any way to confirm that the used machine is fully their property to sell? Anything I'm not considering?

Also, if what they are saying is true, is it possible that companies really aren't taking machines back due to covid? If we get a new one rented through Medicare, I assume they have to take it back if we don't want it, correct?

[SAG]

we just found a used Resmed 10 Autoset/Humidifier in our area for $500 with some additional masks.

Jump on right away. Just be prepared to climb the steep learning curve. This will give pop an opportunity to get used to it and you can always consider getting one from a DME and have this for a backup.

https://www.youtube.com/watch?v=TK58N4B ... ETB02Dluc

http://www.bigroads.com/sleepapnea.html ... ZcSX29-24

[PopIsGettingGrumpy]

Is there an easy way to confirm that the machine is their property (not still owned by the dme or insurance company?). I asked the person as well, but I just want to be sure, since the email from the person with the used machine was phrased as follows:

This is AutoSet. IT is the newest version of Resmed Airsense 10+. The humidifier chamber was drying out in the bathroom. It absolutely has it. We/I don't smoke.

I just received this due to a misdiagnosed Sleep Apnea situation in July 2021.
The company who provides them does not take them back due to COVID protocol.
(I have had no symptoms during or around when using the device, but a few days in a hot car would kill anything)

The device was used for 9 out of 12 days for less than 10 hours. It shows that on it's display. It's brand new.

The company has already charged me $400 and wants to charge my insurance $1100 which they will probably get.

[SAG]

Is there an easy way to confirm that the machine is their property (not still owned by the dme or insurance company?). I asked the person as well, but I just want to be sure, since the email from the person with the used machine was phrased as follows:

This is AutoSet. IT is the newest version of Resmed Airsense 10+. The humidifier chamber was drying out in the bathroom. It absolutely has it. We/I don't smoke.

I just received this due to a misdiagnosed Sleep Apnea situation in July 2021.
The company who provides them does not take them back due to COVID protocol.
(I have had no symptoms during or around when using the device, but a few days in a hot car would kill anything)

The device was used for 9 out of 12 days for less than 10 hours. It shows that on it's display. It's brand new.

The company has already charged me $400 and wants to charge my insurance $1100 which they will probably get.

Not with the info provided. Just make sure you see, smell and power on this unit before giving up any money.

[Pugsy]

Checking for hours of use is easy. Get familiar with the manual
https://www.respshop.com/manuals/ResMed ... %20her.pdf
There are 2 hours of use reported...therapy hours and run hours.
Therapy hours can be reset to zero...run hours can't. Learn how to find run hours...it's not hard...the manual shows examples of where it is...it's in the same area as the clock setting and calendar setting is.

It's a fair price in the current market for a low hour machine...if really only 10 hours...I consider that brand new.

And yes...in the current covid situation a lot of things aren't returnable that used to be returnable.

And you can always later do what SAG says...get one through a DME if you want to and this could be a good back up machine.

There is a learning curve but it isn't rocket science and in all honesty...not that hard to learn what you need to learn.

No way to confirm the people have the right to sell it....you have to trust them but there is also no way for anyone to know you have it unless you tell them. The police won't show up on your doorstep 6 months from now. No one tracks these things.
What they told you is most likely the truth. How much they paid for it you have know way to know...might be insurance paid for the most of it or maybe they have a high deductible and they paid for it all out of pocket. Doesn't really matter.

And actually...depending on when the machine was made...you might still have some warranty available.
It won't be from a DME but I know of a repair facility that can check for warranty remaining...more on that later.
The warranty can follow the machine if you can find someone with the ability to deal with ResMed...and I know of such a place.

If we get a new one rented through Medicare, I assume they have to take it back if we don't want it, correct?

I don't know the answer to that question...I think it all depends on the DME and how much they are willing to do.
This Covid thing has put a monkey wrench in a lot of things. Technically yes...assuming the DME is willing to do necessary cleaning but I don't know Medicare's official position on this.

Covid living on a cpap machine....it can't but it still scares people. Covid can't live very long on inanimate objects.
Way big over reaction IMHO but it is what it is.

[PopIsGettingGrumpy]

Much appreciation to you both. We're planning to go see the used machine, check for run hours/smells and any issues when powered on. If it looks good we'll likely take it. I assume we'll also go through medicare - is having a backup machine normally overkill, or is it a good thing to have? I figure we made it this far with his sleep study and the medicare machine will be about $350-$400 for us with a full warranty.