Medicare Advantage and Apria Problem

[Unknown]

Aetna rents continously for 10 months and then goes on maintenence and service which books one rental every 6 months there after. Maintenance and service covers any repair or replacement as long as you have the equipment and the same insurance. DME providers do not make the rules of rental, the insurance companies do and they are the same regardless of which DME provider you use. Same for the amount. Furthermore... ANY plan that takes over your Medicare benefits is considered an HMO in the eyes of Medicare, even if your plan (Aetna for instance) does not say it is an HMO.

[sjishimoto]

I always have billing problems with Apria, they're always delayed. I pay upfront, you can't leave there with equipment, though I get a bill about 10 days later! Other than that, I prefer to rent the equipment because if I were to outright buy it, I would be responsible to the whole upkeep. While the insurance and my co-pay rent the machine, all we have to do is pay co-pay every 6 mos after the initial 13 months and we're able to get the machine serviced for free every six months. that's a great piece of mind to me

[GumbyCT]

DME providers do not make the rules of rental, the insurance companies do and they are the same regardless of which DME provider you use. Same for the amount.

Which is why she is asking WHY?

[Janknitz]

Furthermore... ANY plan that takes over your Medicare benefits is considered an HMO in the eyes of Medicare, even if your plan (Aetna for instance) does not say it is an HMO.

I started this HMO thing and I was incorrect. Another part of Medicare Advantage is "Private Fee For Service" plans (PFFS). They are kind of like an HMO in that Medicare pays them a per capita rate (a flat fee for every enrollee) and the PFFS plan sets how much it will pay for each service, DME, and supply. It is true that you can go to ANY provider that accepts the PFFS payment. You are not restricted to in-network providers like an HMO.

Around here (in an area once called "the Beirut of Healthcare"), almost NOBODY will accept the PFFS payments from the insurance companies that provide it, so it's not a great idea to sign up for one of those plans. Patients who take on a PFFS plan in this area (high cost of living, low reimbursement rates) can't find doctors to see them, labs to run their work, hospitals to accept them, or DME's to provide to them. In other areas of the country, there might be many providers who are willing to accept it, so it can be a good deal, depending on where you live and what PFFS plans are available to you.

So, your plan may allow you to go to any doctor or provider on this Aetna plan, but make sure before you abandon your doctor and Apria that you can find someone else who will accept your insurance. Don't burn your bridges too fast!

[Irene P.]

Janknitz, fortunately most providers here in middle TN do accept private fee for service plans.

I'll talk to Aetna again on Friday, and hopefully get this worked out.

[Kevin G.]

Maintenance plans or service contracts are a waste of your money. The machines are low maintance and long life and you are protected by manufacturers warrenty. The DME's know this and thus consider them to be very profitable.

If you end up with a rental only machine I would find out how much you could buy the machine for from an Internet supplier. I would then look at how much you will pay in co-payments for the next 5 years and if it is cheaper I would buy the machine from the internet surplier. Finally I would request reimbursement from the insurance company for purchasing the equipment from an out of network surplier.

[Irene P.]

Thanks, Kevin. I agree with everything you said. No way would I keep my machine if they make it a continuous rental. In fact, I've already purchased a backup machine on Craigslist, so I'm prepared.

The maintanance plan thing is something I've been thinking about, wondering if it would be worth it. The worst part to me is still having a financial connection with the DME. I just want rid of them.

Irene