Airtouch not available through Medicare--!?

As mentioned earlier, I have requested an Airtouch cushion for my Airfit for her mask.
Apparently, the dealer cost for mask or cushion exceeds Medicare allowable.
My DME is filing for an exception (to/supplier or Medicare?)
In the event she is not successful, I may try a non-contracted DME. (This item only, for now)
Medicare part B, plan F will pay a moderate upcharge, but only within a certain percentage.
Contracted DME cannot upcharge.
Any helpful information is welcome.

Some DME's will not supply the AirTouch because ResMed is charging the DME too much and the cost is more than the Medicare allowable or pennies below - not cost effective for them. You could alway have the DME bill Medicare non-assigned for you, but you'd have to pay what they charge for the cushion and you'd only be reimbursed the Medicare allowable.

Mwarn, do they do that? In my experience, Medicare is all or nothing. Either they cover it or they cover nothing. There are no partials. I ran into this problem trying to get a wheelchair for my brother. The quality ones for higher weights cost a lot more and Medicare wouldn't allow us to just pay the extra for the added cost. That said, our froggy friend is on an Advantage plan, I believe, and bro has original Medicare. Could be different on that.

I ordered an AirTouch F20, and it arrived this week. My cost will be copay 20% x $170 = $34 for complete mask kit. This is with a Medicare Advantage plan.

SewTired wrote:. That said, our froggy friend is on an Advantage plan, I believe, and bro has original Medicare. Could be different on that.

Oh, HELL NO!
I would not EVER have an "advantage" plan-- unless I had no choice. ( meaning no money)
I have original medicare, plus a part B, plan F supplement, which pays copay, and for now, deductible, too.
This combination costs me, but so far, they are not making much profit off me, and I save mucho dinero.

Advantage plans trigger Froggy.

If it's a covered HCPCS code, Medicare "allows" it. Your DME may just not like the reimbursement they get for it. That's the DME's problem, not Medicare's. Make sure you let your DME know you don't appreciate their BS. If they refuse to supply it because of the lack of profit, the least they can do is be honest about it.

ChicagoGranny wrote:Advantage plans trigger Froggy.

As they should!

ChicagoGranny wrote:I ordered an AirTouch F20, and it arrived this week. My cost will be copay 20% x $170 = $34 for complete mask kit. This is with a Medicare Advantage plan.

I was curious so I pulled out my billing for the Air Fit F20 that I purchased earlier this year on my Medicare Advantage Plan.
Mask: ....... Billed $225..... Plan Approved: 66.80 .... My Copay cost: $13.36
Head Gear:.. Billed $50 .....Plan Approved: 14.05 .....My Copay cost: $ 2.81.....Total Cost for complete mask kit $16.17

My DME seems to be honest. The Medicare payment/allowable? is around $5 or $6 less than their COST--just for the CUSHION.
Maybe I can call Medicare to see how I can get the cushion anyway.
I like these guys, and would hate to deal them a hardship.

SewTired wrote:Mwarn, do they do that? In my experience, Medicare is all or nothing. Either they cover it or they cover nothing. There are no partials. I ran into this problem trying to get a wheelchair for my brother. The quality ones for higher weights cost a lot more and Medicare wouldn't allow us to just pay the extra for the added cost. That said, our froggy friend is on an Advantage plan, I believe, and bro has original Medicare. Could be different on that.

It is kind of different for a wheelchair. A standard chair is a K0001 and a heavy duty is K0009. If you are 300# or under, Medicare will not cover a heavy duty. The only way for a DME to give you a heavy duty is to "down code" the chair to a standard K0001 and either give you a free upgrade or charge you the difference between the two. Some DMEs do not want the hassle of paperwork, so they do not offer this option and they do not have to if you do qualify for the standard equipment.

chunkyfrog wrote:My DME seems to be honest. The Medicare payment/allowable? is around $5 or $6 less than their COST--just for the CUSHION.
Maybe I can call Medicare to see how I can get the cushion anyway.
I like these guys, and would hate to deal them a hardship.

It's $54 retail if you buy just the cushion online. Is it worth that to you?0

Just curious, who is your DME?

54 bucks is kind of a big deal.
The donut hole puts my copay for insulin around $300 a month, and I am dangerously close to bottoming out on my IRA.
If i can get my caviar-priced supplement to foot the bill, it would be only what I effin' PAID FOR ALREADY!
Of course, Resmed's money grubbing is totally at fault. It is all their doing--all their GREED.