Medicare filed directly ... how much trouble?

Hello all :

waaaay back in (03) I registered and posted here ..... senility has set in and I've forgotten my name from then ...lol

I obtained a lot of valuable info and am indebted to the friendly help I received here

this has NOTHING to do with the "new" medicare rules, am just seeking assistance on how much trouble it is to file without using a DME

my old machine ... a RemStar legacy with c-flex serves me fine ... absolutely no complaints and I am really fond of my F&P Oracle mouthpiece

as I'm starting to get an occasional error message from the Legacy I took it in to see if it could be fixed

the DME told me I was eligible for a new machine ..... wellll ..... when I inquired how much would MY COST .. the COST TO ME ... be for a new box .... I couldn't get an exact price, or for that matter even ANY price ...huh

for the past three years I've put off using Medicare for any of my mask purchases .... could buy them for $80 and not file any insurance or file and my costs were nearly the same ... maybe filing was about $70 ... but what irked me was that Medicare would be billed AND pay the DME about a hundred bucks more.

I've been treated very nicely over my lifetime by the USA and didn't feel this small amount of dif I paid was hurting me too badly and, again, it irked me that Medicare had to pay nearly a hundred bucks more than I did.

I suspect this same imbalance is getting ready to happen here now

I can buy a new Phillips System One with Cflex and heated humidifer along with an Oracle for around $600
while something tells me (after visiting three (3) DMEs) that when Medicare, and my Aetna supplement pay their share that it is most likely to cost me around $400 .... I'm totally guessing on this because I've been unable to get a "cash out of my pocket figure" out of any of the three.

I've already obtained the prescription for a new machine and mask from my doctor, and I've advised the 3 DMEs that I have the scrip in hand.

how much trouble will it incur on my part to buy the stuff myself and then file myself for the repayment to me?

any help here

Welcome back, Medicare is rental-only on the machine; all prices are jacked up over our host site--sometimes a LOT!
Of course, cpap.com is out of network, so you are totally out of pocket.
Some find savings either way (depending on your insurance), but with Medicare there are many hoops to jump through.
It's your call, but check the prices before you "walk onto the lot".
I am using Medicare myself, and have yet to hit them up for a machine, but my part B, plan F supplement covers all co-pays.
(unlike BCBS when I was working; which had huge deductibles and was a total pain to work with)

My recent experience with Medicare is similar. It took time to line up the doctor's progress notes showing a need for a sleep test, and then have a doctor's appointment to review the completed sleep and titration test. To submit to Medicare, my Medicare contracted DME needed the progress notes before the sleep test, the sleep test and titration tests results, the follow-up doctor's appointment progress notes, and the doctor's prescription for the APAP machine, including the recommended pressure range. This process took me about 8 weeks.

When all was in order, Medicare and my part B plan F supplement covered everything (the testing, doctor's appointments, the machine rental, mask, and supplies)--no out-of-pocket. It was frustrating getting everything together that was needed, but in retrospect, it was definitely worth the effort financially.

Within the first 90 days of usage, I had one more doctor's appointment, again at no cost, and submitted those progress notes to the DME to show usage compliance and health benefit with AHI under 5.0. Now Medicare has the documentation it needs to continue to pay the rental cost for the remaining 10 months, at which point the machine will be mine to own.

It's true that the DME will receive more money than if you buy directly from an online source. In my own experience, the DME has been helpful, especially since I went in knowing that I wanted a machine that was fully data capable and had my doctor indicate that on the prescription. And having ZERO out-of-pocket was necessary for me.

The Legacy is no longer sold (except maybe privately, 2nd hand) so that might explain your problem with it. I have what might have been the last one Cpap.com sold a few yrs ago, but use it now as my back-up - very few hrs on it - or for such time as I may not afford an every day one. They are/were very good - not called the Tank for nothing!