Reimbursement / Competitive Bidding Question
Reimbursement / Competitive Bidding Question
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!
Re: Reimbursement / Competitive Bidding Question
Call your insurance carrier
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Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion) |
Additional Comments: Back up is a new AS10. |
Re: Reimbursement / Competitive Bidding Question
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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Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
Additional Comments: Using a Buckwheat pillow its great |
For Medicare Assistance by State http://www.seniorsresourceguide.com/dir ... onal/SHIP/ or here http://www.medicareinteractive.org/
Re: Reimbursement / Competitive Bidding Question
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.
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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Mask: SleepWeaver 3D Soft Cloth Nasal CPAP Mask with Headgear |
Additional Comments: AurCurve 10 ASV Also using Sleaplyhead 1.1, ResScan 6 and CMS50i |
- chunkyfrog
- Posts: 34545
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Re: Reimbursement / Competitive Bidding Question
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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Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
Additional Comments: Airsense 10 Autoset for Her |