Medicare to begin competitive bids

[Janknitz]

Has anyone had experience with a competitive bid provider? Medicare reimbursements used to be standardized--you knew by state how much Medicare would pay and what the co-pay was. Now it's supposed to be "less" because of competitive bidding, but what exactly does that mean? Does it vary by DME, based on the bids they won the contracts with? Does this give the consumers the option to go price shopping?

Has anyone had trouble getting the model CPAP they want?

How are newbies handled, if they haven't already been using a particular make and model? Are data capable machines part of the DME's provision contract?

I did read on Medicare's literature for competitive bidding that if you move to a competitive bidder from your current DME they will issue you new equipment and start the 13 month rental all over again. That means 13 more months of co-pays and annual deductibles, too--not a great thing unless you can parlay that into a better piece of equipment. Otherwise, it's a loss for you and "grandfathering" will be a much better deal.

[renatae]

I just got my first shipment from a competitive bid provider and I am very satisfied! In my local area, the closest two were Lincare and Apria - both come complete with bad customer service reputations.

I am still in the 13 month rental stage with a supplier who lost the bid. I was very happy with them. They told me I could continue to get supplies from them as long as the machine was still rented from them. And I did decide to stay with them - no way did I want to start this process all over! My rental period isn't up until October, but they sent me a note mid-August saying my new provider would be CPAP Care Club. I have no idea why they switched me before October. I was unsure if the "Club" was a genuine competitive bid provider, but it is, and it is all mail order with free shipping. It's probably there on your list, but if you don't live close to them (I don't) it may be several pages down.

They sent me six sets of pillows - enough to change every two weeks. They sent a new Bella mask set with headgear (on this I am a little leery, because I got a new one just 3 months ago so I'm afraid I may end up paying for it,) six filters and a new heated hose. All but the filters were genuine ResMed parts. They were very polite on the phone and the shipment took only about a week even though they told me since I was new and they had to check with Medicare that it might take two weeks. I couldn't be happier and I hope they continue in this manner, with the exception of the replacement of the entire Bella set. I didn't realize they would be sending anything except the pillows, so I will double check next time.

Of course, I can't answer to whether they would have supplied me with the ResMed s9 if I required one. It's nice to think so, but I'm pretty nervous about what will happen when it comes time to replace my machine.

[LSAT]

I just got my first shipment from a competitive bid provider and I am very satisfied! In my local area, the closest two were Lincare and Apria - both come complete with bad customer service reputations.

I am still in the 13 month rental stage with a supplier who lost the bid. I was very happy with them. They told me I could continue to get supplies from them as long as the machine was still rented from them. And I did decide to stay with them - no way did I want to start this process all over! My rental period isn't up until October, but they sent me a note mid-August saying my new provider would be CPAP Care Club. I have no idea why they switched me before October. I was unsure if the "Club" was a genuine competitive bid provider, but it is, and it is all mail order with free shipping. It's probably there on your list, but if you don't live close to them (I don't) it may be several pages down.

They sent me six sets of pillows - enough to change every two weeks. They sent a new Bella mask set with headgear (on this I am a little leery, because I got a new one just 3 months ago so I'm afraid I may end up paying for it,) six filters and a new heated hose. All but the filters were genuine ResMed parts. They were very polite on the phone and the shipment took only about a week even though they told me since I was new and they had to check with Medicare that it might take two weeks. I couldn't be happier and I hope they continue in this manner, with the exception of the replacement of the entire Bella set. I didn't realize they would be sending anything except the pillows, so I will double check next time.

Of course, I can't answer to whether they would have supplied me with the ResMed s9 if I required one. It's nice to think so, but I'm pretty nervous about what will happen when it comes time to replace my machine.

Your supplier should not be sending you supplies unless YOU order them. Medicare has rules about that.

[renatae]

I did order them. I think there was a misunderstanding about the mask and while I said I needed pillows, she didn't specify how many she'd be sending. I said I needed hose and filters as well. However, I will be more careful in the future. It did not occur to me they would even dream of sending me more than the minimum necessary. What they did send was the maximum allowed.

[NateS]

I did order them. I think there was a misunderstanding about the mask and while I said I needed pillows, she didn't specify how many she'd be sending. I said I needed hose and filters as well. However, I will be more careful in the future. It did not occur to me they would even dream of sending me more than the minimum necessary. What they did send was the maximum allowed.

I had a good first experience with CPAP Care Club too. I was very leery of dealing with them because their website does not provide a method for ordering in writing through either their website where I could do a screen printout nor through any email address, and I do not like to do business by phone because of the lack of a paper trail.

However, the young woman on the phone did emphasize that they were recording the call because she claimed the new Medicare regs prohibit automatic shipments and they claim they have to have a recording to back up my okay of every item they send me. Of course, the recording doesn't help me prove or disprove anything since it is only on their end, but I thought I would take one chance with them since my mask straps were stretched out and my Bella nosepiece was shot. She offered me the same package as renatae. I declined the filters because I still thought I had a bunch of them (which now I can't find) and I declined a new heated hose. She gave me no argument and sent me exactly what I agreed to order and it came promptly. I just would still prefer a paper trail to protect against the one future time there might be a misorder. Maybe I'll record the conversation next time too on my end, just to be sure.

I am following her advice to replace the nosepiece (cushion) more frequently and it has reduced my wake ups due to leak substantially.

Best wishes, Nate

I do miss my most recent local DME however who was less than a mile away and very good.

[idamtnboy]

However, the young woman on the phone

You sure she is young? Years ago at work I used to talk regularly to a woman at another facility. Man she must be beautiful, the dream of every lustful man's eyes, her voice was so smooth and sexy on the phone. One day I met her. About 5'3", 190 pounds, and, well, not so great looking!! Gotta be careful what criteria you use to judge a person!

[NateS]

However, the young woman on the phone

You sure she is young? Years ago at work I used to talk regularly to a woman at another facility. Man she must be beautiful, the dream of every lustful man's eyes, her voice was so smooth and sexy on the phone. One day I met her. About 5'3", 190 pounds, and, well, not so great looking!! Gotta be careful what criteria you use to judge a person!

My own "young woman" is sitting right next to me on the sofa and she is over 70 and beautiful too!

"Bei Mir Bist Du Shein!"

https://www.youtube.com/watch?v=Xe2UXccid40

Regards, Nate

[renatae]

Glad you had a good experience, too, Nate. And now I'm glad I got the mask set because I was sorting through my things and my "backup" loops, which I replaced because I, too, had managed to stretch them out, were worse than just stretched out - I found a hole in one of them. So now I have a good backup.

I'm thinking too that I may replace my pillows more often, because I have some leak issues as well. My first set of straps got stretched out too far for me. I used to just yank them off for my frequent trips to the loo, and then I found I was having leaks and suddenly couldn't get them snug enough to prevent the leaks. So I'm much more careful now.

[MagsterMile]

From day to day, I get a different story from my DME about what is going to happen to me because of they didn't win the 'competitive bidding' process. It seems that the closest supplier 'winner' (10 mi.) doesn't accept Humana Medicare Advantage so now I can choose between Apria & Lincare (lucky me!) which are about 25 mi. away. Fortunately, they will deliver by mail. At first the DME said that I was 'grandfathered' in but now I understand that they are dumping me in November. I'm wondering about subsequent needs to see the sleep Dr. or the RT for any problems I might have. I guess I'll be on my own come November.

Speaking of Humana Med Advtg ins., once again is unable to pay a claim I have. Just got an RX for glasses from the opthamologist. Naturally my eye care benefit for glasses is of the 'discount' variety which means that they don't pay for out of network. Before I went to order the glasses, tried in vain to get HMA to give me a list of in network providers but they could only fax me the list (don't have a fax machine) and couldn't send an email. I was advised to go to their web-site which I did but never could locate the supplier list. I ended up at Costco for the glasses and low and behold, they aren't in the network! What a surprise.

Recently, my dentist 2 mi. away didn't make it to the in-network list and I ended up paying that too. A dentist who is about 4 mi. and has higher prices made it to the in-network list. Another surprise

[NateS]

Magstermile,

You might consider MaxEmail service. I've used them for years after throwing out my fax machine because it was always jamming and it is a great two-way tool with which to communicate with medical offices, insurance companies, etc.:

https://www.maxemail.com/max/pricing.html

For $25 a year, they give you an 815 number and only 10 cents a page. I find it is a very handy way psychologically to get doctors' offices to send you medical records and even to request prescription renewals etc.:

1) Outgoing mail from doctors' offices is a neglected chore - it is delayed and put off as non-priority, but it takes away a lot of excuses to say "Just fax it to me" - no typing up an enclosure letter; no envelope; no stamp, etc.

2) Almost everybody in a doctor's office is trained to just walk up to their fax machine, drop their paper records into it, and hit the send button;

3) Doctor's offices get a lot of time-sensitive material overnight and all day long by fax from hospitals, etc. so the office people are trained to check the fax machine constantly, and act immediately on what comes in;

4) And best of all, they KNOW that you have PROOF in writing that they GOT YOUR fax requesting the information - MaxEmail emails it to you with the exact date and time it landed in their machine - no excuses for procrastination on their part. When you request something BY fax and ask for it to be sent back to you BY fax, it's like a certified letter for which you get an almost instant return receipt. And of course it is much cheaper and faster than going to the post office to send a certified letter.

It may seem like an archaic method of communication, but I have found it to be the "inside track" to requesting and getting info not only from medical offices but also various other offices. Once you get their fax number, often unpublished but freely given out verbally, you have an "inside priority track" with which to request and receive what you need and request.

When I call these offices on the phone for something, the turnaround time is 7-10 days or more. If I request by a short fax letter and ask whatever I want to be sent back by fax, the turnaround time is typically 24 hours!

Best wishes, Nate

[idamtnboy]

From day to day, I get a different story from my DME about what is going to happen to me because of they didn't win the 'competitive bidding' process. It seems that the closest supplier 'winner' (10 mi.) doesn't accept Humana Medicare Advantage so now I can choose between Apria & Lincare (lucky me!) which are about 25 mi. away.

Competitive bidding applies only to Original Medicare, not Advantage plans. You should see no change.

[StuUnderPressure]

Never mind, I answered my own question