CPAPtalk.com

Just out of curiousity, on Medicare, can you purchase a machine out of pocket and file for reimbursement to avoid the 13-month lease?

booksfan wrote: ↑

Mon Feb 24, 2020 7:06 pm

Just out of curiousity, on Medicare, can you purchase a machine out of pocket and file for reimbursement to avoid the 13-month lease?

Nope. Medicare doesn't have anything in place for patients to file for anything. Everything has to go through an official provider.
They tell you that you can file for an exception but that has to be a really, really special situation and since Medicare already has a policy in place for cpap stuff...they are going to deny it.

Pugsy wrote: ↑

Mon Feb 24, 2020 7:13 pm

booksfan wrote: ↑

Mon Feb 24, 2020 7:06 pm

Just out of curiousity, on Medicare, can you purchase a machine out of pocket and file for reimbursement to avoid the 13-month lease?

Nope. Medicare doesn't have anything in place for patients to file for anything. Everything has to go through an official provider.
They tell you that you can file for an exception but that has to be a really, really special situation and since Medicare already has a policy in place for cpap stuff...they are going to deny it.

Thanks, Pugsy!

booksfan wrote: ↑

Mon Feb 24, 2020 7:06 pm

Just out of curiousity, on Medicare, can you purchase a machine out of pocket and file for reimbursement to avoid the 13-month lease?

Medicare does not work that way. On Traditional Medicare, they cover only a 13 month capped rental, no purchase. On Part C (Medicare Advantage and PPO plans) it's either the 13 month capped rental or perpetual rental, no purchase.

It always pays to calculate your out of pocket expenses and decide if YOU want to purchase outright (no Medicare or supplemental insurance reimbursement for this) to avoid the hassle and especially the perpetual expense if you have Part C. Don't forget to factor in the annual deductibles. The 13 month capped rental period is specifically designed to cost you two annual deductibles. You'll be hit EVERY year with Part C unless your Part C coverage waives deductibles.

Out of pocket means more choices--especially the sponsors of this forum.
I did the math, and ended up getting my S9 Autoset from cpap.com with my Flex dollars.
--before Medicare--after several months suffering with an S9 Elite.
(Single pressure + frog = misery.)

I had a similar problem with Lincare. My insurance originally was United Healthcare when I got my S9 and the terms of their agreement for these machines was to lease, with a cap of 8 months on payments. To any sane person, the intent is that the patient keeps the machine and it's theirs since after 8 months you continue using it indefinitely and not be charged. But in my case, 2 years later my insurance changed to BCBS and Lincare decided they could start charging me (and my new insurance) for it. That was a bitter argument with the guy on the phone. "That's just how it works" he says. I'm pretty sure if I had called BCBS and explained what Lincare was doing, they would have seen it differently. After all, they were being expected to partially foot the bill for a used machine! I ended up speaking with someone at the local office and they were more reasonable. They backdated a return on the machine for me so I wouldn't be charged for it again (yes, I got to keep it).

Just an update. I received another statement from Apria and it shows a zero balance. I believe this issue is closed.

james arizona wrote: ↑

Fri Mar 13, 2020 8:16 am

Just an update. I received another statement from Apria and it shows a zero balance. I believe this issue is closed.

Color me shocked. Case wasn't closed. I do not understand why, perhaps their accounting determined paying full price after leasing for over a year or what. But, I received a check from Apria for $520.

Not gonna lie. After all the horror stories I read here and elsewhere I am pleasantly surprised.

Well that's good news!

I went through an appeals process with Crapria once. Had a three way call with them and my HMO on the phone. They said I was definitely wrong and owed the money and my HMO agreed (I did not). It was a small amount and not worth the aggravation so I just paid it to save my credit rating.

Six months later, I got a full refund in the mail.

Janknitz wrote: ↑

Wed Jul 01, 2020 2:42 pm

Well that's good news!

I went through an appeals process with Crapria once. Had a three way call with them and my HMO on the phone. They said I was definitely wrong and owed the money and my HMO agreed (I did not). It was a small amount and not worth the aggravation so I just paid it to save my credit rating.

Six months later, I got a full refund in the mail.

the non-squeaky wheel gets the grease???

I am seeing this late, but DMEs in the Phoenix AZ area seem much worse than other states I have lived in.
I am using preferred homecare and they are actually decent. Yes, they want to sell you parts sooner than you need them, but...
They don't automatically send things to you, so you can ask for it instead.
They will actually fit a mask to you - not during covid, but during the old normal (and future normal) times. They have several there (over a handful) to try on. [One DME had only one style, a pillow, and if you tried it on you bought it even if it didn't fit, with no returns.]
So you might see if they will work with you.
They told me my machine was a rent to own, which is what most insurance companies do.

Norma45 wrote: ↑

Wed Jul 01, 2020 4:57 pm

I am seeing this late, but DMEs in the Phoenix AZ area seem much worse than other states I have lived in.
I am using preferred homecare and they are actually decent. Yes, they want to sell you parts sooner than you need them, but...
They don't automatically send things to you, so you can ask for it instead.
They will actually fit a mask to you - not during covid, but during the old normal (and future normal) times. They have several there (over a handful) to try on. [One DME had only one style, a pillow, and if you tried it on you bought it even if it didn't fit, with no returns.]
So you might see if they will work with you.
They told me my machine was a rent to own, which is what most insurance companies do.

I haven't found anyplace great here. I tried to switch once and wound up sticking with my current one because no one else appeared any better and they make all make it a pain to switch.

I agree, DMEs seem especially bad in AZ, and our health insurance even agreed. My DH tried about 7 and one was good then got bought out by a larger company and service went downhill. The rest were horrible. He ended up just buying his cpap using flex money because we could not find any decent DME at that time.
That is why I mentioned Preferred Health. They are more like ones we had used in other states.
While they didn't do the buy outright for me - as a new user I don't think my insurance would do that, but they did clearly say it was a rent to own with the typical 13 months of rental (I think it was 13, it was definitely less than 2 years).
I have only interacted with them 2 times, but they were tons better than all the other ones we tried.

Norma45 wrote: ↑

Wed Jul 01, 2020 9:30 pm

I agree, DMEs seem especially bad in AZ, and our health insurance even agreed. My DH tried about 7 and one was good then got bought out by a larger company and service went downhill. The rest were horrible. He ended up just buying his cpap using flex money because we could not find any decent DME at that time.
That is why I mentioned Preferred Health. They are more like ones we had used in other states.
While they didn't do the buy outright for me - as a new user I don't think my insurance would do that, but they did clearly say it was a rent to own with the typical 13 months of rental (I think it was 13, it was definitely less than 2 years).
I have only interacted with them 2 times, but they were tons better than all the other ones we tried.

I don't remember now if they were on my insurance list. I have enough supplies to last for a while tho, thank goodness since I'm not sure how much longer we can keep paying for our cobra plan. I have at least two backups of everything as well as cushions and filters to keep me going for a while. I also bought a backup machine from a forum member before the pandemic so keeping fingers crossed everything keeps running !