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Re: Best argument for an autopap??
Posted: Tue Dec 02, 2008 6:53 pm
by ziggytosh
Songbird wrote:
Oh, yes -- straight from SEVERAL horse's body parts at my insurance company, though I'm not sure it was their mouths. Back then, I was on a calling spree to the point that people were recognizing my name. (You could almost hear, "It's HER again." I've been told that when I get on a quest, I can be like a very quiet, very patient, highly irritating Chinese water torture. ) Same answer every single time. And they absolutely understood the differences between ALL of the paps. They wouldn't budge, and neither will my doc. The truly amazing part is that my (wonderful) DME is also mystified. He'd gladly give me an APAP if only I could give him an Rx for it. And yes, I even tried doing an end run around my sleep doc and talked to my GP, who is usually very easy to work with, but no go there either, since he'd referred me to the sleep doc. I can't think of any other avenues, but if you think of any, I'm certainly open to suggestion. When I can, I'll get my own auto, but that'll be a good piece down the road.
Marsha
Man, that's lame. Well, misery loves company, so thanks for keeping me company!! Seriously though, I know no system is perfect, but could "socialized medicine" really be all that bad?? Anyway, best of luck to both of us!
Re: Best argument for an autopap??
Posted: Tue Dec 02, 2008 7:27 pm
by Slinky
Is there anyone in the forum from California who got their xPAP via Medicare who is still in the capped rental period or who still has the EOBs from their capped rental?lll
Medicare has cut reimbursement since 2006 but here is what my 13 month capped rental for the Resmed S8 Elite w/EPR cost then (Michigan rates).
MONTHLY:
DME Billed: $135.00 - Medicare Allowed: $99.95 - Medicare Paid: $79.96 - CoPay: $19.99
And here is the 2008 13 month capped rental for the Resmed VPAP Auto (bi-level):
MONTHLY
DME Billed: $239.92 - Medicare Allowed: $218.11 - Medicare Paid: $174.49 - CoPay: $43.62
Humidifier, mask, hose, etc. not included in the amount. They are outright purchases. And, of course, you've checked the online prices for the Escape, Elite and Vantage.
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Posted: Tue Dec 02, 2008 7:39 pm
by ZIFF
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Re: Best argument for an autopap??
Posted: Tue Dec 02, 2008 8:57 pm
by Wulfman
If you have a deductible.....and it starts over again on January 1st (as many insurance providers do), I'm guessing you're going to be starting over until your deductible is met again......so, it's going to cost you even more out-of-pocket. Too many people don't take some of these things into consideration in their 10 - 12 month rental plans. It's best to get the insurer to pay out the contract as soon as possible......immediately, if possible.
Den
Re: Best argument for an autopap??
Posted: Tue Dec 02, 2008 9:34 pm
by Guest
this thread is stupid
Re: Best argument for an autopap??
Posted: Tue Dec 02, 2008 11:49 pm
by 2girlsmom
Ziggy, if you can use a DME in Illinois by chance, let me know. I LOVE mine. Good luck to you as you figure all of this out.
Re: Best argument for an autopap??
Posted: Wed Dec 03, 2008 1:09 pm
by OldLincoln
Slinky wrote:Is there anyone in the forum from California who got their xPAP via Medicare who is still in the capped rental period or who still has the EOBs from their capped rental?lll
I have an APAP that was specifically prescribed and delivered as such paid for by Medicare and I am in CA.
E0601-RRKKJKX Billed $250 Medicare approved $78.95 & paid $63.16 Private Insur paid $15.79.
Note this is the same as was billed and paid for my CPAP before.
I got it from my ex-DME whom I left because they lied to me over and over about this very issue. That's when I went to my doc with research to prove I NEED an APAP and handed him the exact components I wanted including model numbers etc. He wrote it and may have written a letter of need (I don't recall that he did), but he did get the DME on the speaker phone and between us the DME got the message. I said the DME is required to fill the Rx as written (when specific) because even that DME admitted it is the law in CA.
I am really perplexed as to why Ziggy is having such a time.
Re: Best argument for an autopap??
Posted: Wed Dec 03, 2008 6:32 pm
by Slinky
Thanks, OldLincoln. And wow! Costs are HIGHER in CA but Medicare reimbursement LOWER! Billed over $100 more a month and reimbursed $20 less a month. Ouch! Still, even at $78 the DME is getting $1,000 for a $500 device and the "service" and "support" and "education" they provide. Yeah, right to the last 3!
Re: Best argument for an autopap??
Posted: Thu Dec 04, 2008 1:32 am
by Kerwin
If god created us in the image of himself, why is it that we still have evil within us? Why are we less perfect than god if perfectionist is what we were meant to become.