Rental Period Over?

My record shows that we've had our machine since 9/2/08,actually 8/23/08 when we were given the M Series Plus and I made them exchange it for APAP, so with either date the 13month Medicare rental period is over and we should now own our machine. Will we get a letter regarding that from Medicare or DME or should I be requesting some proof of purchase? Our only contact with DME is when we need new mask, filters,etc. Thanks.

I'm not on Medicare yet, but my DME, Apria, had been getting auto-payments from my credit card for the co-pays on the rental, and they stopped. No other word from anyone. Earlier I had asked my insurance about when it would happen, so I was expecting it.

My DME erroneously billed my Ins for an extra month and they rejected the claim. Two days later I received a bill for my portion. That was how I found out the rental period was over. I called them and (politely) told them if my ins said the time was up, then I wasn't paying anymore either. She apologized for the overbilling and said the machine was now mine free and clear.

I would have felt more comfortable if they had kept track and not billed that extra month. Good thing I got the rejection from my Ins Co or I might have just kept paying for a month or two.

Watch 'em like a hawk!

Dori, I was on medicare when I got my my first machine. When the 13 month rental was up my wife called and requested a receipt or letter stating that the machine was mine and was paid for. They informed me they did not do that but that it was in fact mine. After a call to medicare and they told me that they had to send me conformation that it was mine. The lady at medicare said they would take care of it. Sure enough after about 2 weeks we got a letter/receipt marked paid in full in the mail.

Jerry

Thanks Jerry, now I know how to handle it. I want something in writing. That reminds me of the first time we went to the DME for a replacement of the same mask we were using with success. They said they don't stock the UMFF anymore, can't "special order" it and we'd have to take the Quattro which we had tried before with terrible nose sores. I called Medicare immediately and the nice lady said if a mask is still being manufactured the DME is obligated to supply it for their customer. Told me she'd take care of it and 2hrs later the DME called and said they just happened to find some hidden on the "top shelf" and would run it over to our house right away, no mention of a call from the Medicare lady. Who's kidding who(or is it "whom").

These are interesting to me as I start Medicare in December. I started back in 2002 on Bipap and I've paid for my machine out of pocket, 2 actually. I'm probably ready for another with humidifier, filters, hose and new mask. I guess I will find out what the copay is, seems my paperwork said I pay 20%. Will have to find out I guess. My first one from a DME was a discontinued model they said I would pay about $3500 for. Seems they billed my insurance about $400 a month but I had a life time limit that was used up. So, I ended up purchasing on the Internet since it was less costly than a DME by less than half. I have an advantage plan and seems all of those are going up in 2010. I want to get one while in December which is a better plan. I have my original Rx so I hope I don't have to do the sleep lab again. With the auto bipap, it titrates anyway up and down to whatever is required.

I am on medicare to. My 20% copay was 16.76 for a Remstar M with humidifier . When my rental period was over my Dm did send me
a letter. I also use an O2 concentrator. I believe an O2 concentrator falls under another category and requires a much longer
rental period maybe as long as 32months. My copay on it was $39.16 and after a few months I just bought a used one out of pocket.

With all of the diagnostic testing this year to determine just what the heck was wrong with me, I have met my out of pocket max for the year. (Who knew that much of it was just that I needed some good sleep!) I'm renting my machine for the first month to make sure I like it and then the DME indicated I could purchase it outright. I'll be interested to see how much they bill the insurance company. I'm a notorious bargain shopper and it just kills me the mark up on this equipment! But fortunately the machine and mask will be zero cost to me this year. When I get my next mask, I'm going to see which will be cheaper -- my 10% in network charge or 30% out of network buying online. I suspect it will be the online route.

Probably so. The Bipap machine I had that was discontinued they wanted $3500 through a DME. I purchased a new model Bipap online for $1500, better than half the cost. I could have bought 2 online and had $500 left over. But if insurance is paying, that's another story. Zero cost is alot better than my $1500 out of pocket. I'll have to look at the co-pay rental and add it up and compare to a straight online purchase. Mine will probably be the co-pay rental.

To give you a rough idea for a bi-level at 2008 prices and payments (13 months):

DME billed: $239.92 - Medicare allowed: $218.11 - Medicare paid $174.49 - CoPay $43.62

Thanks slinky. That is some help in calculations. At that rate for 13 months the pay out of pocket would have been $567.06. If this relates to a Bipap auto also, like the M series with intergrated humidifier, it would be about $700 cheaper than a straight purchase over the internet. It seems like the DME billed my insurance back in 2002 about $400 a month for a Bipap. Of course, it terminated after one month because of my lifetime limit for OSA had been reached. That was $400 I could have applied toward a machine online had I known then. Just curious, if Medicare allowed $218.11 and the monthly billing was $239.32, why did Medicare only pay $174.11 and you paying $43.62? Seems you would pay the difference of only $21.21? I'm still trying to learn Medicare. I do know all of it is going up for 2010.

sthnreb wrote:Thanks slinky. That is some help in calculations. At that rate for 13 months the pay out of pocket would have been $567.06. If this relates to a Bipap auto also, like the M series with intergrated humidifier, it would be about $700 cheaper than a straight purchase over the internet. It seems like the DME billed my insurance back in 2002 about $400 a month for a Bipap. Of course, it terminated after one month because of my lifetime limit for OSA had been reached. That was $400 I could have applied toward a machine online had I known then. Just curious, if Medicare allowed $218.11 and the monthly billing was $239.32, why did Medicare only pay $174.11 and you paying $43.62? Seems you would pay the difference of only $21.21? I'm still trying to learn Medicare. I do know all of it is going up for 2010.

Medicare pays 80% of their allowable: (the billed amount is really irrelevant). The patient then pays the remaining 20% .

sthnreb wrote:Just curious, if Medicare allowed $218.11 and the monthly billing was $239.32, why did Medicare only pay $174.11 and you paying $43.62? Seems you would pay the difference of only $21.21? I'm still trying to learn Medicare.

Most DMEs are Medicare participating providers meaning that they accept whatever Medicare allows as payment.
The amount that is initially billed is rather moot because all figures on who pays what are base on the allowed amount and not the billed amount.

Simplified version example.
Something is billed out at $400
Medicare allows 300 it is like the $400 amount never existed
Medicare pays 80% (assuming deductible has been met) of the allowed $300 which would be $240
The remaining 20% of the allowed $300 is $60 which the patient is responsible for if a medicare supplement is involved, it will pay that copay amount.

So in Slinky's example the 20% owed as co pay is based on the amount allowed
20 % of 218.11 is 43.62

The difference between what was originally billed and what medicare allows gets written off as an insurance adjustment by the DME. They cannot collect that amount.

Edit to add: If a provider is NON participating with Medicare then the difference between billed amount and medicare allowed amount is billable. DMEs that aren't participating with medicare would be extremely rare.

Yup, this was for the Resmed VPAP Auto (January 2008 release) bi-level auto. And, yup, what Pugsy and ScrappinMom said. I've been fortunate to have good secondary insurance so I had no out of pocket cost.

My supplimential Medicare insurance of $144 a month would be more maybe than I would use. I opted for an advantage program so far. I believe there is no deductible for DME and 20%/20% copay it shows. So, I guess I will be paying 20% of whatever the allowed amount will be. I assume that is true for mask, hose, filters, etc. Maybe that's included at time intervals? Supplimental insurance would total $1728 a year over the already SS deduction. It would take a lot to make up that difference to begin with. United Healthcare had a $3200 limit at which time they pay 100%. I think that will increase to $4200 in 2010. The $1728 would be a definate payment whereas it's taking a chance with the advantage program that you won't need it. I'm sure glad Obama is going to make it less expensive and easier to understand. ROFL. My private insurance deductible has been met for the year and I'm good through December on medical bills, excluding OSA. I had a ICD implanted 9-15-09.