dme monitoring fee

I've been consistently using CPAP for 17 years, but I'm new to medicare and recently completed the 90 day compliance period for a new machine. My DME is still charging me $10 a month for monitoring, which apparently medicare or my additional insurance doesn't pay. Do I need to keep paying this. I have Myair and an SD card for Oscar if somebody needs to see my usage.

paulm1 wrote: ↑

Wed Mar 05, 2025 8:08 am

I've been consistently using CPAP for 17 years, but I'm new to medicare and recently completed the 90 day compliance period for a new machine. My DME is still charging me $10 a month for monitoring, which apparently medicare or my additional insurance doesn't pay. Do I need to keep paying this. I have Myair and an SD card for Oscar if somebody needs to see my usage.

Have they been charging you $10 per month for 17 years? That's over $2k that, in my opinion, you've been ripped off for!

DME monitoring fee? I've never heard of this, and I certainly have not paid any such fee in the 12 years or so that I've been using a machine.

You need to question the need for this 'monitoring fee'. It sounds like the kinda BS that a car dealer would pull.

Until I turned 65 I didn't have insurance that paid for DME. I'm on medicare now, and I can sort of understand why they monitored the device so they can send a report to my doctor after the required 30 days of usage probationary period. Now that's over with, I'm not sure if I have to pay this PAP Monitor device fee while I'm still renting the machine from the DME provider for what I understand is 13 months.

You probably should verify directly with Medicare but I don't think you are responsible for that charge since Medicare has disallowed it. The only way a supplier (who is a Medicare provider) can charge you (and expect you to pay) for a service or product, if Medicare disallows something, is if you have signed in ADVANCE the Advance Beneficiary Notice (called an ABN).

Did you have explained to you and signed the ABN????

I have no idea if or what I signed. I think I've resolved this after a 25 minute call with billing. At first I was told that the $10 was a lease fee to cover the cost of the modem, which would be fulfilled after 13 months. I then asked if I could return the modem (I was pretty sure this wasn't an easy thing to do). After checking she told me if I make a 3rd payment to cover the 3 month probationary period she could end this billing going forward. Fingers crossed this should be the end of it.

IF a DME ever got that type of fee from me, my next moves would be a request for a refund followed by a complaint to Medicare and a small claims suit.

paulm1 wrote: ↑

Wed Mar 05, 2025 9:37 am

Until I turned 65 I didn't have insurance that paid for DME. I'm on medicare now, and I can sort of understand why they monitored the device so they can send a report to my doctor after the required 30 days of usage probationary period. Now that's over with, I'm not sure if I have to pay this PAP Monitor device fee while I'm still renting the machine from the DME provider for what I understand is 13 months.

In my case, the only monitoring by my DME was during the initial compliance period, 90 days. After that, the DME wasn't involved at all in monitoring. If my sleep doc needed a report, he accessed my data from his computer or I was asked to bring in my data card, the DME was out of the loop at this point, except for supplies of course.

I'm on the side of contacting Medicare (IF you can get through to them right now) to see if you have to pay that monitoring fee.

Medicare (and you and/or your supplemental insurer) pay MORE than the retail price of the machine, because the DME is expected to do certain things--monitor compliance, adjust the settings according to prescription, maintain the machine. I'm not sure they can charge you extra to read the data and send the report electronically to your doctor to document compliance for Medicare.

Let us know what you find out.

From the CMS website: https://www.cms.gov/medicare-coverage-d ... leId=52467
"Claims for A9279 (MONITORING FEATURE/DEVICE, STAND-ALONE OR INTEGRATED, ANY TYPE, INCLUDES ALL ACCESSORIES, COMPONENTS AND ELECTRONICS, NOT OTHERWISE CLASSIFIED) are denied as statutorily non-covered (No Medicare benefit)."
That doesn't necessarily mean they can't charge YOU for it. So make sure the question you ask Medicare is not whether Medicare pays for it--they don't. But whether you can be required to pay for that service. And whether an ABN should have been issued for the service since Medicare denies that service.