Does anyone know how much this machine will end up costing me after medicare pays?
The DME didn't know anything about the cost.
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c-pap cost after medicare
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c-pap cost after medicare
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Hi Sharon,
I'm not entirely sure whether TN and MI are in the same Medicare "region" or not, but I "think" that they are. I'll give you my 2006 breakdown on Billing, Allowed, Paid and CoPay amounts as it will at least give you some idea.
CPAPs are a "capped rental" thru Medicare, i.e. Medicare pays rental on it for 13 months and then the patient owns the CPAP free and clear. The humidifier, mask, hose, etc. are all "extras" not included the in the rental but paid for outright after the first 30 days if compliance is established. Also all this DME is billed by HCPCS code (insurance code) and all straight CPAPS from bare-bones, compliance data only thru fully data capable autoPAPs are classified as and billed as straight CPAPs, HCPCS code E0601 and are paid at one set amount, regardless of the capabililty of the xPAP. (Bi-levels and the more "advanced" SVs, etc are an entirely different billing code and considerably more expensive). So a bare-bones straight CPAP only compliance data capable altho cheaper is paid the same amount as a fully data capable autoPAP. Therefore the local DME suppliers PREFER to protect their profit margin by trying to pawn off the bare-bones CPAPs. You will want, at the very least, a fully data capable straight CPAP such as a Resmed S8 Elite w/EPR or Respironics M Series Pro w/C-Flex.
That being said:
CPAP (Monthly for 13 months)
Billed $135.00 - Allowed $99.95 - Paid $79.96 - CoPay $19.99
ACCESSORIES (outright purchase)
Total: Billed $548.00 - Allowed $499.63 - Paid $399.70 - CoPay$99.93
ACCESSORIES BREAKDOWN
HCPCS code a7037 - tubing (hose) used with positive airway pressure device - Allowed $48.00 - Paid $32.82
HCPCS code - a7034 - nasal interface (mask or cannula type) used with positive airway pressure device, with or wi - Allowed $130.00 - Paid $94.11
HCPCS code - a7035 - headgear used with positive airway pressure device - Allowed $45.00 - Paid $31.80
HCPCS code - e0562 - humidifier, heated, used with positive airway pressure device - Allowed $325.00 - Paid $240.97
You will be allowed a new hose every 3 months. A new mask (but not the headgear - and local DMEs do not sell them separately) every 3 months, new headgear every 6 months (meaning most DMEs will tell you a new mask every 6 months).
Do you have secondary insurance? If so call them and ask them if they pay your Medicare copay for DME equipment and if so be sure to ask them what local DME suppliers they are contracted with as they usually will not pay the copays if the DME supplier you select if not contracted with them. Be sure to ask any DME supplier you do business with what their mask exchange policy is. Also, do NOT sign for and accept ANY equipment unless it is what you want because once you accept it you will have a devil of a time successfully getting the CPAP switched to what you want. But be reasonable, it might not be worth the effort to fight for an autoPAP as long as you get a fully data capable CPAP.
If at all possible talk to your sleep doctor, be right up front that you expect that he will order a fully data capable CPAP so that if you have any difficulties w/your CPAP therapy the data will be available for him to determine where the problem lies and to make any adjustments necessary based on the data rather than a compliance data only CPAP leaving him to make adjustments by guess and by gosh. You would not feel comfortable w/his adjustments w/o him having access to that data. Insist on the same w/the DME supplier.
Good luck and happy PAPping!
I'm not entirely sure whether TN and MI are in the same Medicare "region" or not, but I "think" that they are. I'll give you my 2006 breakdown on Billing, Allowed, Paid and CoPay amounts as it will at least give you some idea.
CPAPs are a "capped rental" thru Medicare, i.e. Medicare pays rental on it for 13 months and then the patient owns the CPAP free and clear. The humidifier, mask, hose, etc. are all "extras" not included the in the rental but paid for outright after the first 30 days if compliance is established. Also all this DME is billed by HCPCS code (insurance code) and all straight CPAPS from bare-bones, compliance data only thru fully data capable autoPAPs are classified as and billed as straight CPAPs, HCPCS code E0601 and are paid at one set amount, regardless of the capabililty of the xPAP. (Bi-levels and the more "advanced" SVs, etc are an entirely different billing code and considerably more expensive). So a bare-bones straight CPAP only compliance data capable altho cheaper is paid the same amount as a fully data capable autoPAP. Therefore the local DME suppliers PREFER to protect their profit margin by trying to pawn off the bare-bones CPAPs. You will want, at the very least, a fully data capable straight CPAP such as a Resmed S8 Elite w/EPR or Respironics M Series Pro w/C-Flex.
That being said:
CPAP (Monthly for 13 months)
Billed $135.00 - Allowed $99.95 - Paid $79.96 - CoPay $19.99
ACCESSORIES (outright purchase)
Total: Billed $548.00 - Allowed $499.63 - Paid $399.70 - CoPay$99.93
ACCESSORIES BREAKDOWN
HCPCS code a7037 - tubing (hose) used with positive airway pressure device - Allowed $48.00 - Paid $32.82
HCPCS code - a7034 - nasal interface (mask or cannula type) used with positive airway pressure device, with or wi - Allowed $130.00 - Paid $94.11
HCPCS code - a7035 - headgear used with positive airway pressure device - Allowed $45.00 - Paid $31.80
HCPCS code - e0562 - humidifier, heated, used with positive airway pressure device - Allowed $325.00 - Paid $240.97
You will be allowed a new hose every 3 months. A new mask (but not the headgear - and local DMEs do not sell them separately) every 3 months, new headgear every 6 months (meaning most DMEs will tell you a new mask every 6 months).
Do you have secondary insurance? If so call them and ask them if they pay your Medicare copay for DME equipment and if so be sure to ask them what local DME suppliers they are contracted with as they usually will not pay the copays if the DME supplier you select if not contracted with them. Be sure to ask any DME supplier you do business with what their mask exchange policy is. Also, do NOT sign for and accept ANY equipment unless it is what you want because once you accept it you will have a devil of a time successfully getting the CPAP switched to what you want. But be reasonable, it might not be worth the effort to fight for an autoPAP as long as you get a fully data capable CPAP.
If at all possible talk to your sleep doctor, be right up front that you expect that he will order a fully data capable CPAP so that if you have any difficulties w/your CPAP therapy the data will be available for him to determine where the problem lies and to make any adjustments necessary based on the data rather than a compliance data only CPAP leaving him to make adjustments by guess and by gosh. You would not feel comfortable w/his adjustments w/o him having access to that data. Insist on the same w/the DME supplier.
Good luck and happy PAPping!
_________________
| Mask: Quattro™ FX Full Face CPAP Mask with Headgear |
| Additional Comments: PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2 Software - Contec CMS-50D+ Oximeter - Respironics EverFlo Q Concentrator |
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go to http://www.billmyinsurance.com and get all the medicare information you need. That is cpap.com's sister web site specializing in providing equipment using insurance.
Or if you're in the US you can call their toll free phone number.
Free Coverage Checks, Copay Estimates and Advice. 1-800-266-1575
They are very helpful and will answer your questions. Don't guess. Find out the straight scoop.
I've spoken to them and highly recommend that you do as well.
Or if you're in the US you can call their toll free phone number.
Free Coverage Checks, Copay Estimates and Advice. 1-800-266-1575
They are very helpful and will answer your questions. Don't guess. Find out the straight scoop.
I've spoken to them and highly recommend that you do as well.
_________________
| Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear |
| Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
| Additional Comments: original pressure 8cm - auto 8-12 |
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