Question RE: Medicare Advantage Plan

I received a letter today from UCare MN/WI, my Medicare Advantage Plan, and I am not sure exactly what it means. Maybe someone with MA plan and more experience in the world of such can help me out. I will type this in, my printer/scanner is currently not accessible:
“Services Approved: DURABLE MEDICAL EQUIPMENT CPAP MACHINE
Number of Units/Visits approved: 9
Dates of Service: 06/03/2014 – 02/04/2015”

It goes on to say that services are only approved for the dates listed, and if I need additional services my provider must let them know….

“We may not pay for these services if you do not follow the rules in this letter” or in the Evidence of Coverage.

My take on this is that I’ll need to have another sleep study at the end of my first year on CPAP, which would put it at end of January, or other documentation from my doctor. What are the rules in this letter? I’m not certain of the meaning of this number of units/visits. Is this a reference to sleep doctor visits? I am not charged for visits to the in-house DME managed by my clinic, except for supplies. I do have to pay for my compliance checks, but the DME does not do that, the clinic does, at the rate of a doctor’s visit.

Not necessarily do. I have a Medicare advantage plan. After my first year nothing changed. About 1/2 way through the 2nd year I was having. Problem exhaling with cpap due to copd so my ADR ordered a study with bipap, I did much better got a new machine and so far no problems, I get my supplies from my DME when I need them and life is better . Just work through your Dt and DME and you won't have any trouble with your insurance. Good luck

It sounds like they have approved 9 monthly payments (rental) on your equipment. If you need additional use after the dates mentioned your DME or RT will have to request additional payments.
Medicare seems to allow 10 to 12 monthly rental payments after which you own the equipment.
I am about to enter into a conversation with senior management at my Medicare Advantage provider regarding the perpetual rental agreement I seem to have. The only reason we have not started the dialogue yet is the protecting them from me. I may have found the chink in their arm our on Thursday, and I have been known to be fairly persistent.

I would start with a call yo your MA customer service and ask them to explane the letter and the terms under which your equipment and supplies are provided. Then have them provide a follow up in writing to confirm what you were told. Don't let them go until you are sure you understand and agree with what they tell you.

If it were me, I'd call the Medicare Advantage plan provider and find out what that means, rather than guessing. Best to get it from the horse's mouth.

I'd be surprised if they're having you do a sleep study in a year unless you need it (they're expensive), or that they were having you check compliance every month (that would also be expensive). So I agree, this is curious.

I do plan to call the MA on Monday; I just wondered what it was. My DME said it was a 13-month rental after which I will own the unit and Feb '14 will be the 13th month of payment for the rental so that adds up. I have met the compliance rules... so it sounds like I'm good to go... but I will call anyway to confirm that.

It sounds to me like they have approved coverage for you to rent it through Medicare I think the visits means Dr visits. Once 12 months is up ( not sure why they listed a 7 month rather than 12 month time frame) You own it. Does your insurance renew in Feb? That might explain it

My DME does my compliance checks.

No, my insurance year starts in Jan. My machine rental is 13 months, first payment was Feb. '13, so 13 month payment will be Feb. '14, and I'm thinking now that the 9 units/visits thing it would be for rental payments as there are 9 months left of the rental. I have not seen my sleep doctor since I had my RX in Jan. A nurse at the doc's office does my compliance checks, and for the for the required face-to-face meeting she captures a doc who's walking down the hall, shows my report, and the doc walks in to say hello. For this I'm charged for a complete "brief exam." I think I'm understanding more what this is about but I will call the MA to confirm on Monday.

For me, I had one compliance check after a month, then 4 months after that, and now at 8 month intervals, that's my sleep doctor's schedule, and I'm on Medicare as well. While Medicare does require compliance checks, I don't think that they require once a month compliance validation. If they do, that's a new one on me *smile*. I'm hearing more like once a year after the initial one or two compliance checks.