Medicare Reimbursement

[Poppajack]

I am on Medicare. I purchased a CPAP online, not from a DME. How can I get reimbursed from Medicare for expenses incurred in the use of the CPAP such as masks, filters, tubing etc.

[Slinky]

Almost all local DME providers accept Medicare.

Get a copy of your script, the doctor's dictated results of your in-lab sleep evaluation PSG and your in-lab titration PSG plus the full scored data summary report w/condensed graphs from both in-lab PSGs.

Shop the various local DME providers, take COPIES of the script and reports w/you and shop the various providers to find one you like, staff that you feel comfortable with and that you feel are fairly truthful and upfront w/you.

Most of them will accept a copy of your script and sleep studies as sufficient for Medicare reimbursement. You "might" also have to provide a data printout of compliance and results from your CPAP.

[Janknitz]

Here's what the Medicare rules are:
"Medicare only covers durable medical equipment if you get it from a supplier enrolled in the Medicare Program. This means that the supplier has been approved by Medicare and has a Medicare supplier number.
To find a supplier that is enrolled in the Medicare Program, visit http://www.medicare.gov and select “Find Suppliers of Medical Equipment in Your Area.” You can also call 1-800-MEDICARE (1-800-633-4227) to get this information." This info was from: http://www.medicare.gov/Publications/Pubs/pdf/11045.pdf

So unless your online supplier was Medicare approved, you cannot get reimbursement. There are some online suppliers that are Medicare certified (I've seen t.v. ads for Liberty Medical and I know there are others), but most are not (You can call the online supplier and ask).

It's a bit silly because the full retail price you paid is likely less than the Medicare Reimbursement. Medicare pays for CPAP's on a "capped rental" basis, meaning that they pay 80% of a monthly fee (set by Medicare according to the state you live in) for 13 months, after which you own the machine. The capped rental rate ranging from about $76 to $110 per month, depending on location, usually comes out to more than you pay online.

You'd think Medicare would appreciate saving money by reimbursing you for your online purchase, but that's not the case. Medicare wants some regulatory control over the DME, and they can't unless the provider participates in their program. It's also the reason that the DME providers who take Medicare charge and receive more--because they have to meet Medicare compliance requirements including a huge documentation burden. Most online DME retailers do not. It's one of those unintended consequences of the medical reimbursement process--ironically, you get better service from vendors you buy from directly because you are the payor, not the government.

[LSAT]

Slinky...Papajack already purchased his machine...NOT from a DME.

I have a Medicare Advantage plan from AARP and it is relatively easy to send in for reimbursement on most items...(I don't know about a CPAP). I don't know what the government proceedure is...have you tried to call the Medicare 1-8-- number?

[6PtStar]

What Slinky said. You might also want to ask if they are a Medicare Contractor or a Medicare Provider. Medicare sets the price and reimburses the DME 80% with the remaining 20% paid by you or a secondary insurance if you have one. Medicare Contractors will take the 80% and be happy. Medicare Providers will take the 80% but can bill you more than the 20% if their price is higher than Medicare allows. It is a precentage more but I can't remember how much, the sky is not the limit. Medicare Contractors are a bit harder to find than Medicare Providers in my experence but your cost is generally less if they are a Medicare Contractor.

Jerry

[Slinky]

Thank you, LSat, but my understanding was/is that PoppaJack was inquiring whether he could get his accessory supplies such as mask, hose, filters, etc. paid for by Medicare from a local DME provider, not whether he could get reimbursment for the PAP he purchased online.

6PtStar, thanks for clarifying about Medicare Provider and Medicare Contractor. I wasn't aware of those distinctions.

[Patrick A]

I am on Medicare. I purchased a CPAP online, not from a DME. How can I get reimbursed from Medicare for expenses incurred in the use of the CPAP such as masks, filters, tubing etc.

Go to Liberty they will do all of the paperwork and bill Medicare and your Secondary Insurance company. Other wise if you don't have a secondary insurance you will have to pay a co-pay.

[Poppajack]

Thank you one and all for your replies and suggestions. It was nieve of me to think that I could deal directly with the government and unreasonable as well since I'm sure there are good reasons to have it set up as they have it.

[Slinky]

PoppaJack, I fail to see why or that you can not get your accessories such as mask, etc. from a local DME provider w/Medicare reimbursement.

You would need to provide the local DME provider w/a copy of your equipment order (script) but you have a LEGAL RIGHT to that script under HIPAA so all you would have to do if you don't still have a copy is request another from your original ordering doctor.

[JeffH]

I tried to submit a claim to Medicare for a cpap machine bought online in February but was turned down. I was told the only way they were going to pay for a machine was the 13 month rental. Of course I got twice the machine for half the money, but that didn't phase them.

JeffH

[Slinky]

No, Medicare can't and won't reimburse for the PAP bought online but future accessories would be covered w/the original script for the time being until it expires under present regulations.

[Janknitz]

Slinky,

Have you (or anyone else) had success getting coverage CPAP supplies from an online supplier that is not a Medicare Provider????

If I had the money to pay for things out of pocket, I'd happily use an online provider for everything rather than letting Crapria make a profit off me

[Slinky]

No, I haven't, Janknitz. But I dumped the first local DME provider I had, and the local I use now has been very good to me so I've not had reason to buy much of anything online that is covered by Medicare. Most all of the few things I've bought online are not Medicare reimbursable to begin with. Aside from a nebulizer the sheister DME told me Medicare wouldn't pay for and something else, I can't remember what, the sheister said Medicare wouldn't pay for that I later found out was eligible for Medicare coverage.

[cpapquuen1]

You can get the supplies through a DME. They will need serial number of your unit; date and where purchased. Will also need compliance data and notes from your doctor that you have used it for > 4 hours per night and are benefitting from PAP therapy.

[Janknitz]

I'm pretty sure that I came across another online provider that it Medicare certified, but the link is on my laptop which is in the shop for a checkup. I hope to have it back tomorrow and I'll look.

I don't know anything about Liberty Medical other than the fact that I saw a commercial for it--same folks who sell mail order diabetic supplies and bill Medicare. Hmm, says something about the demographics of the show I was watching.