Monthly charge from DME

[Smargie]

I have Medicare and just got my first, surprisingly large, bill for my ASV from the DME. When I rented a CPAP from a different DME I got billed for supplies, but this bill includes rental of the ASV for $46.37, plus the tubing, humidifier, filter, and a couple of things I didn't get totaling $67.54. Is this a normal amount to get billed? I hope not, because I don't have room for this in my budget!

[Pugsy]

Should be a one time charge for tubing and filter and the other incidentals. Maybe humidifier...haven't seen how Medicare handles the humidifier charge with the ResMed humidifier being built in. When humidifiers are separate it's always been a one time purchase and you own it because it couldn't be returned.

Machine rental charge will be for 13 months.

Medicare used to never pay rental on the humidifier....only the machine itself was "rented".

[Smargie]

So I can expect to be charged $46 per month from now on? The start date of the bill is June 25th, so maybe this is an every other month charge?

The humidifier isn't really built into the ASV, in that it's removable. For some reason they charged me for 2 of them with different codings. They also charged for a chin strap that I didn't get. I can call about those issues, but you're saying that the charge for the machine is normal?

I guess I need to look into what Wellcare covers for durable medical equipment before I call. Boo!

[babydinosnoreless]

So I can expect to be charged $46 per month from now on? The start date of the bill is June 25th, so maybe this is an every other month charge?

The humidifier isn't really built into the ASV, in that it's removable. For some reason they charged me for 2 of them with different codings. They also charged for a chin strap that I didn't get. I can call about those issues, but you're saying that the charge for the machine is normal?

I guess I need to look into what Wellcare covers for durable medical equipment before I call. Boo!

My DME charges 76 + a month for my bipap rental. That is the allowed amount after all the discounts.

[Smargie]

Thanks for the response babydinosnoreless, even though it's not what I wanted to hear. I'll try not to shoot the messenger.

[Okie bipap]

The charge for my wife's Air Curve 10 VAUTO was right a $20 a month for 13 months. The price of the ASV is about twice that of the VAUTO, so I would expect the cost of the machine itself to be around $40 a month. The DME is allowed to price the humidifier (water reservoir), hose, filter, etc. seperately in addition to the machine. Your 20% copay will be slightly higher the first month to account for the humidifier, hose and filter. Your second month will probably be slightly lower (I would guess around $5).

[Pugsy]

The humidifier part that actually heats the water is built in....it's only the water chamber that is removable.
The AirSense/AirCurve model lines were the first to have the humidifier built in....in the past and even now with other machines the humidifier was a separate purchase under a separate billing code.
When DMEs bill out anything they always separate every little item so they can glean every possible dollar from insurance.

In the past the humidifier (the portion that heats up) was a separate device and removable from machines. Now on the Airsense/Air Curve models only the water chamber is removable. There is no separate billing code for the humidifier portion for the new ResMed product line even though it is no longer a separate device.

In the past since humidifiers were separate and once used considered non returnable item per most insurance....they were billed out totally with the first months bill and after that no more charges for the humidifier.
Water chambers are separate and have a different billing code.

I don't know how Medicare wants to handle the humidifier portion of the charges on these new ResMed models...no one has ever told me how their Medicare handled that part. You might call up Medicare and ask about it and pray you can talk to someone that actually can give you a straight answer.

The monthly rental fee portion that is your co pay...sounds about right for the ASV model which is a much more expensive machine and has higher allowable fees in general. A lot depends on where you live but 45 to 55 dollar copay for 13 months is about right. I used to have a copy of the fee schedule but its way outdated now and finding a current one takes about a full day of detective work going through the bowels of the DMEPOS fee schedules. If I have time I will see what I can find out. It's a bitch to go digging in and I am short on time right now.

[Smargie]

Okie Bipap, thanks for the info. Aren't you a 2 Pap household? I just picked up a new nasal pillow for my mask as well as 2 filters last week, so I'll be getting another bill soon.

Pugsy, please don't go digging around for fee schedules on my account. I'm sure you have better things to do with your time. Regarding a separate bill for the humidifier -- there doesn't seem to be one, so that's good news. On the bill it says "heated humidifier AirSense 2, but it's only $2.44 so that's gotta be for the reservoir. When the 13 months are up I'll have paid about $603. I wonder what it would cost without insurance!

[Pugsy]

You are paying 20% of the Medicare allowable fee. I would need to fire up some brain cells and do some algebra (which I swore when I too it in college I would never use in real life and got proven wrong many times) to figure out what Medicare actually approves.
Medicare pays 80% of the approved amount and you pay 20% (or if you had a supplement it would pay the 20 % but of course you also pay for the supplement).

So...let me see how to do the equation...20% of X is $47...convert to how to figure it....47 divided by 20% is 235....work it backwards to verify I did the correct function...yep...Medicare allows approx 235 a month for that ASV...and multiply that by 13 months equals a total of $3,055. Now sometimes the first and last payments don't always equal each other but that's close.
MSRP for that machine is right around $4,500. Probably what Medicare got billed for (divided by 13 months) and Medicare makes them reduce what they will be happy with in terms of payments.
You will be paying about $611 over the 13 months or there abouts for just the machine....I know it's pricey but thank goodness you have the medicare.

Now you will get hit with the Part B deductible again come Jan 1 and I don't know what it will be next year but this year it is $185. Usually goes up a little each year but not huge amounts. This year it went from 183 in 2018 to 185 in 2019.
It will remain to be seen what kind of Part B service you end up getting that the deductible will get applied to...might be a doctor visit or something else if it gets billed in before the ASV rental charge gets to Medicare.

You have to pay the Part B deductible before Medicare starts paying their 80%.
All CPAP equipment falls under the Part B coverage.

[Pugsy]

Oh...whatever you do don't switch over to one of the medicare advantage plans without fully reading all the coverage information.
A lot of the Medicare Advantage plans are going to perpetual rental for cpap machines...you never own it and the monthly rental never ends. So if this fall you want to change .....thoroughly investigate the fine print of how they do cpap machines.
I have a Medicare Advantage plan....it clearly states I never own it and the rental period is indefinite.
So If I ever decide to get a new machine again...I won't be using my Medicare Advantage plan to pay for it.
Not all Advantage plans are doing this but quite a number are...and they can change every year.

[Okie bipap]

We are a two bilevel family. I was initially diagnosed in 1996, but opted for surgery (UPPP) to keep from carrying a large machine around with me. My job required a lot of travel by car and air and I was already packing a nebulizer with me. In 2014 I was in the hospital for total knee replacement and the nurses noticed my blood oxygen would drop when I slept. My doctor ordered a sleep study for me. In 2017 I told our PCP that my wife was snoring and would quit breathing while sleeping, so she scheduled my wife for a sleep study. She was upset with me for doing it, but now she is sleeping much better and uses the machine every night. My wife uses the same model machine and mask as I do. The only difference is, hers has a pink hose cover and pink strap pads and mine are blue.

[bwexler]

Here in San Diego area all the advantage plans I checked were perpetual rental. And I think I checked them all.
I found a good low hour resale here on CPAP. Com and paid cash.
I was doing the same arithmetic Pugsy did and repued to pay perpetual.

[Smargie]

Oh...whatever you do don't switch over to one of the medicare advantage plans without fully reading all the coverage information.

Uh oh...I switched from straight medicare to WellCare in January of this year. I hope this didn't put me in perpetual payment hell. Though my husband said that even if this is the case, we're saving enough in other areas to make up for it so it wouldn't be worthwhile to switch back. Thanks for doing the algebra. I just multiplied the monthly payment by 13 to see what the total payment would be, not the fancy what medicare allows stuff.

Here in San Diego area all the advantage plans I checked were perpetual rental. And I think I checked them all.

When did you check all the plans? I live in Kentucky now (but am a native Californian and lived in the Bay Area for 40 years). Can you tell that I don't like saying I live in KY? Anyway, I have a feeling those advantage plans are probably nation wide, even though EVERYTHING costs more in CA. I'm scared to check my plan now. I have complex sleep apnea and have to use an ASV so it may be harder for me to find a used one.

In 2017 I told our PCP that my wife was snoring and would quit breathing while sleeping, so she scheduled my wife for a sleep study. She was upset with me for doing it, but now she is sleeping much better and uses the machine every night

Has she forgiven you yet? My husband snores a lot and wakes me up several times a week. If he naps on the couch (always on his back) while I'm watching TV he's so loud that I use earbuds instead of the regular speakers. But I've never observed him stop breathing and gasp for air in the 20 plus years we've been together, so I don't think he has apnea. But come to think of it he never observed me do those things either...just some occasional snoring.

[Pugsy]

You can snore and not have sleep apnea.
You can have sleep apnea and not snore.
Just because you don't see someone stop breathing doesn't mean it doesn't happen....but when you do that's pretty much a dead giveaway.

About the new plan you just got...call them up and ask them.
I have heard that when pushed even the perpetual rental stuff has the option to convent over to the 13 month usual Medicare.
I have no documented proof though which is why I don't mention it...don't want to give false hope.
Personally I don't understand why they are going to the perpetual rental...the only people making more money on the deal is the DME.
The insurance is paying longer and the patient is paying longer...Seems like a stupid way to do things when they could easily stop at 13 months at least from a business practice.
On the other hand if you don't own it and it's always a rental...if it craps out at 3 years...it gets replaced without much of a hassle.
Still not worth the cost in my thinking just to maybe replace the machine.

[Janknitz]

If you have supplemental insurance (Wellcare?) they may pay part or all of the 20% co-pay. Check in with them--they should issue an EOB to tell you what your out of pocket share is. Or it might be the $46 because that seems kind of low for an ASV co-pay. But contact them to clarify before you pay it.

Here in San Diego area all the advantage plans I checked were perpetual rental. And I think I checked them all.
I found a good low hour resale here on CPAP. Com and paid cash.
I was doing the same arithmetic Pugsy did and repued to pay perpetual.

Does that include Kaiser?