insurance reimbursement

jimmy christmas · Post by **jimmy christmas** » Wed Sep 28, 2022 12:01 pm

I have a script for a new CPAP machine. It has been over 5 years since I last bought a machine. At the moment I prefer a Resmed Autosense 11. I'm a long time CPAP user - over 20 years. Currently using an 11 yr old Resmed 9 since I shelved my Dreamstation due to the recall. I am aware I will eventually get a replacement from Phillips, but I would prefer to get the Resmed. My usual DME says they can't get them, at least quickly. However cpap.com has them in stock. My insurance (Humana medicare advantage) is 80/20 coverage either in or out of network. My concern is the provision that medicare has about renting a machine for 13 months, which is a joke since I have been using a CPAP for over 20 months. Will that 13 months be an issue or not. I can cover the initial costs and I know that I would have to do all the paperwork submittal. Would I have any issue with the 13 months? Anyone else had the experience that can tell me how it went for them?

LSAT · Post by **LSAT** » Wed Sep 28, 2022 12:51 pm

The normal procedure for Medicare is a rent to own program. Rent for 13 months and then you own it. When I got my last machine it was about $12 mo. I pay 20% of the insurance companies negotiated price.

beautifuldreamer · Post by **beautifuldreamer** » Wed Sep 28, 2022 3:38 pm

jimmy christmas wrote: ↑
Wed Sep 28, 2022 12:01 pm
I have a script for a new CPAP machine. It has been over 5 years since I last bought a machine. At the moment I prefer a Resmed Autosense 11. I'm a long time CPAP user - over 20 years. Currently using an 11 yr old Resmed 9 since I shelved my Dreamstation due to the recall. I am aware I will eventually get a replacement from Phillips, but I would prefer to get the Resmed. My usual DME says they can't get them, at least quickly. However cpap.com has them in stock. My insurance (Humana medicare advantage) is 80/20 coverage either in or out of network. My concern is the provision that medicare has about renting a machine for 13 months, which is a joke since I have been using a CPAP for over 20 months. Will that 13 months be an issue or not. I can cover the initial costs and I know that I would have to do all the paperwork submittal. Would I have any issue with the 13 months? Anyone else had the experience that can tell me how it went for them?

You should check your Explanation of Benefits for your Humana Advantage plan -
when I was researching the senior advantage plans offered by my former workplace, all of the EOB's for the Advantage plans that were offered, said you don't own the machine after 13 months, which could potentially mean I would have to keep paying the rental fee indefinitely

***you would have to inquire with Humana to find out how long you would would be doing the rental.

So, I chose Original Medicare with my Supplemental Plan does the 13 month rental until you own the device.

ChicagoGranny · Post by **ChicagoGranny** » Wed Sep 28, 2022 4:57 pm

jimmy christmas wrote: ↑
Wed Sep 28, 2022 12:01 pm
My insurance (Humana medicare advantage) is 80/20 coverage either in or out of network.

Policies vary by state and sometimes within a state. You should check with your insurance company. You can get incorrect information here. People will tell you what works in their case which might not apply to your case.

beautifuldreamer wrote: ↑
Wed Sep 28, 2022 3:38 pm
You should check your Explanation of Benefits for your Humana Advantage plan

EOB comes after a claim has been paid. I think you mean Evidence of Coverage. Yes, if Jimmy has a copy, he can check there.

beautifuldreamer · Post by **beautifuldreamer** » Thu Sep 29, 2022 2:56 pm

ChicagoGranny wrote: ↑
Wed Sep 28, 2022 4:57 pm

jimmy christmas wrote: ↑
Wed Sep 28, 2022 12:01 pm
My insurance (Humana medicare advantage) is 80/20 coverage either in or out of network.
Policies vary by state and sometimes within a state. You should check with your insurance company. You can get incorrect information here. People will tell you what works in their case which might not apply to your case.

beautifuldreamer wrote: ↑
Wed Sep 28, 2022 3:38 pm
You should check your Explanation of Benefits for your Humana Advantage plan
EOB comes after a claim has been paid. I think you mean Evidence of Coverage. Yes, if Jimmy has a copy, he can check there.

Thanks- Yes that is what I meant - "Evidence of Coverage"

Janknitz · Post by **Janknitz** » Thu Sep 29, 2022 9:02 pm

I don't believe you can get a machine from our hosts at CPAP.com and have Medicare reimburse you. Whether it's a perpetual rental or a 13 month rental, I don't think CPAP.com will do that. (I'm sure someone will correct me if I'm wrong). Online Cpap.com is sales only. See their FAQ's:

Does CPAP.com accept Medicare? No, CPAP.com does not accept Medicare assignment and has no relationship with them.

It's out of network for your supplemental insurance, so if you have private insurance that will PURCHASE a machine outright for you, you MIGHT be able to get reimbursement. But no luck if you have a Medicare plan (traditional or Advantage).

Okie bipap · Post by **Okie bipap** » Fri Sep 30, 2022 1:20 pm

There are online DMEs who accept Medicare. Try doing a Google search for online DME suplier accepting Medicare. My wife's machine came from an oline supplier that accept Medicare.

jimmy christmas · Post by **jimmy christmas** » Fri Oct 07, 2022 5:54 pm

Well surprise, surprise, I received my replacement Dreamstation2 yesterday. But after talking with a number of folks, I think I will still try to get Resmed 11.

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