Reimbursement / Competitive Bidding Question

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Gschultz1
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Reimbursement / Competitive Bidding Question

Post by Gschultz1 » Tue Feb 24, 2015 5:33 pm

I was wondering if anyone knows what private pay / commercial insurance reimburses for a CPAP and face mask? I've seen numbers all over the place. Medicare used to be ~$100 for a CPAP and is now ~$50 monthly after competitive bidding took effect. And, for a full face mask, it looks like it went from $150 to $100 (per 3 months). At least that's what I found on ResMed's website. Anyway, I'm trying to figure out what my commercial insurer would pay / reimburse a DME...any help would be truly much appreciated! I know it varies a lot by carrier and region but I'm just trying to get a sense if commercial is in-line with the "new" medicare or if it's different. Thank you!

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LSAT
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Location: SE Wisconsin

Re: Reimbursement / Competitive Bidding Question

Post by LSAT » Tue Feb 24, 2015 5:42 pm

Call your insurance carrier

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mike1953
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Joined: Sun Aug 31, 2014 7:15 pm
Location: Kansas

Re: Reimbursement / Competitive Bidding Question

Post by mike1953 » Tue Feb 24, 2015 5:50 pm

The Competitive Bidding Program applies to Original Medicare only. If you’re enrolled in a Medicare Advantage Plan (like an HMO or PPO), your plan will let you know if your supplier is changing. If you’re not sure, contact your plan.

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bwexler
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Location: San Marcos, Ca. USA

Re: Reimbursement / Competitive Bidding Question

Post by bwexler » Tue Feb 24, 2015 9:45 pm

The
Medicare Advantage plan I had last year would not disclose what they paid even on the monthly disclosure form. They would only list some wild retail price and a * where what they paid was to be listed. When I called and asked or demanded to know what they actually paid they told me it was none of my business.
New company this year new rules. No DME stuff yet. So no idea what they will do.

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chunkyfrog
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Re: Reimbursement / Competitive Bidding Question

Post by chunkyfrog » Wed Feb 25, 2015 7:20 am

My Part B supplement (Aetna) sends me statements every so often, detailing what the DME asked for, what Medicare allowed, and what they paid (20% of the allowed). I am told competitive bid is not only behind schedule, but has turned out to be a such a humungus clusterfrank that it may be abandoned.

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