A question MVP Healthy NY

Are there any CPAPers here who have MVP Healthy NY? Do they now cover CPAP and accessories? Thanks.

newyorknative wrote:Are there any CPAPers here who have MVP Healthy NY? Do they now cover CPAP and accessories? Thanks.

Ah, unfortunately I see you've had no takers on that. You can certainly call your insurance company. CPAP and accessories should be considered "Durable Medical Equipment" or (DME). Most insurance policies do cover DME costs. But some have an amazingly high deductibles. If that is your situation, you would be better off to use an online supplier than a local supplier. The costs (for you) would be lower that way.

Hope that helps.

When you find out your coverage, deductibles, etc, you can check the prices at CPAP.com (our sponsors)
There are other suppliers out there, but we're kind of partial to these guys. . .

I just found out that m v p healthy new york does not cover durable medical equipment at all. They do not cover physical therapy unless it is related to surgery in the hospital. Mvp sucks.

newyorknative wrote:I just found out that m v p healthy new york does not cover durable medical equipment at all. They do not cover physical therapy unless it is related to surgery in the hospital. Mvp sucks.

Really sorry to hear that. Fortunately the cost of CPAP equipment and supplies is MUCH lower online than if you go do a DME in your area. You can check with CPAP.com and other suppliers on prices.

I always recommend that people call their own insurance company and ASK. Various health plans may have differing provisions, depending on the contract you or your employer negotiated with the insurer. You may have DME coverage with a 10% co-pay, while someone with the same insurer but a different PLAN may have no coverage, or 100% coverage.

The only way to be certain what YOUR plan covers is to call your insurer and ASK, and you should do that BEFORE contacting the DME because the DME's often don't know or don't tell you all the ins and outs of your coverage plan--the DME may deal with 20 or 30 different plans a day, so they don't always get the details correct (at least, I like to think that's why they sometimes give you misinformation ).

You should ask:
1. Do you have DME coverage under your plan?
2. Are CPAP machines and supplies covered?
3. If so, is there a specific formulary of machines, or is any E0601 (CPAP/APAP) machine covered?
4. What portion (percentage) does the insurer cover, and what portion must you cover (typically 80%/20% but it can vary greatly, be sure to ASK!). What is the allowable amount for a machine, for the mask and supplies?
5. Do you have to use preferred providers (in network)? Who is in network in your geographic area?
6. Are there deductibles? When do the deductibles roll over?
7. ARe you required to rent the machine (if so for how long) or is it an outright purchase?
8. May the DME practice “balanced billing”? That is the practice of charging you the difference between the price your insurance company pays and the stated retail price. In most states and most insurance contracts, balance billing is not permitted. Some DME’s (and NOTE: it’s the DME, NOT your insurer who refuses!) will only provide you with the most basic machines unless you pay extra—most basic machines lack EFFICACY data that we here consider crucial and not optional.

For Medicare, DME’s may refuse to “accept assignment” (take what Medicare allows as payment in full). This means that they can charge you the difference IF they issue a written notice called an “Advance Beneficiary Notice.” But for every DME who refuses to accept assignment, there are more out there who do. Whether your insurer is Medicare or private, if a DME wants to upcharge you, walk away and find a DME who wants your long-term business.

Armed with those facts, you’ll be able to make informed decisions about your equipment and supplies.

You should always calculate your out of pocket costs (remember that a 13 or greater month rental period can require you to meet the deductible TWICE before the machine is paid for) and decide for yourself whether it’s worth going with a brick and mortar DME or ordering online.