MediCare Rental is 13 Months Even With Replacement Machine

Grand-PAP wrote:Info that might be helpful to members on MediCare

I started therapy on 11-23-2011 on a ResMed S9 Elite CPAP. In March 2012, my doc switched me to a PR System One BiPAP autoSV.

At the time I was not able to get a straight answer regarding whether the 13 month rental period would start over with the ASV or if it would continue with the CPAP rental.

I just spoke with Apria today and she informed me that the ORIGINAL rental continued and as of 12-28-12, the rental was finished and I owned the machine.

But what does Medicare say?
Left hand, right hand--just saying.

chunkyfrog wrote:But what does Medicare say?
Left hand, right hand--just saying.

Just Saying......
http://www.urbandictionary.com/define.p ... 20sayin%27

That doesn't sound right to me because the two machines have different HCPCS codes. Apria would get cheated out of a lot of money if they aren't paid for the full 13 months at the bipap rate, which is higher than the CPAP/APAP rate. Did your copays go up when you switched?

I'm guessing they messed up the billing which is a boon for you (not a drop of sympathy for Crapria), or they may figure it out later and start hitting you up for more money.

chunkyfrog wrote:But what does Medicare say?

Janknitz wrote:That doesn't sound right to me because the two machines have different HCPCS codes. Apria would get cheated out of a lot of money if they aren't paid for the full 13 months at the bipap rate, which is higher than the CPAP/APAP rate. Did your copays go up when you switched?

I'm guessing they messed up the billing which is a boon for you (not a drop of sympathy for Crapria), or they may figure it out later and start hitting you up for more money.

Yeah chunkyfrog, I agree it is difficult to know about MediCare, even if one is talking with MediCare. However, in THIS case, I "think" I can trust Apria, because whether there was an error or not, they are no longer billing MediCare.

Yeah Janknitz, I totally agree. There has to be an enormous difference between the two codes. That is why I "assumed" that the rental period would start over with the ASV. Actually, I don't know about the co-pays. I have a supplemental plan which covers 100% of the co-pays. After what Apria put me through, I have NO sympathy for them. If they do come after me, there is be war!

it may work for you anyways if the billing was wrong. i hAd a thing with a special second party uncovered lab genetics test where i was going to have a big cost share. the in network lab draws the blood and sends it to the only lab that does it and is not in network. the hospital made a big mistake and billed tricare $1200 and was paid only $150 because of the way it was billed. my co-pay became $0 just like any other diagnostic. i went to the tricare regional office and asked them if the hospital could amend the billing and charge me. tricare said the biller only gets one bite of the billing apple, that they can not adjust the billing and if they try to bill me to let tricare know. i was never billed. maybe other insurance companies do the same thing. i'm thinking medicare thinks the same as tricare.

Grand-PAP should not have to return the Elite (It's paid off)--unless they give him CREDIT for it.
The new machine would normally start a new rental. But who knows? sometimes mistakes are never noticed.
When I had one of our sons, the hospital bill was missing several hundred dollars worth of charges;
(they forgot a big bunch of stuff); we borrowed the money, and quickly paid them off in full;
and made them note "PAID IN FULL" on the receipt. (our insurance was lousy)
They never caught the mistake--or at least they couldn't say anything about it!

greatunclebill wrote:tricare said the biller only gets one bite of the billing apple . . . i'm thinking medicare thinks the same as tricare.

Good info greatunclebill. After over 30 years of being responsible for resolving the most serious corporate problems/complaints, some of the most angry people have given me a LARGE bag of tricks that should prevent a second bite of the apple! I have neither high blood pressure nor ulcers, but if necessary, I can be a carrier.

A year ago after 6 years my 1st machine died and since Respironics no longer repairs them my DME supplied a new one. They are not billing medicare each month for the new machine.

Grand-PAP wrote:

Grand-PAP wrote:Info that might be helpful to members on MediCare

I started therapy on 11-23-2011 on a ResMed S9 Elite CPAP. In March 2012, my doc switched me to a PR System One BiPAP autoSV.

At the time I was not able to get a straight answer regarding whether the 13 month rental period would start over with the ASV or if it would continue with the CPAP rental.

I just spoke with Apria today and she informed me that the ORIGINAL rental continued and as of 12-28-12, the rental was finished and I owned the machine.

Comment,

You're not clear with your post. Which machine did you own on 12-28-12, and what's the meaning of "rental period would start over with the ASV" ?

As I understand from the following guidelines given to me by my DME, if the CPAP does not work for you within the 13 mos you could then replace it with a BiPAP or ASV per a physician Rx and probably another sleep study. In such a case the DME would charge Medicare more for the more expensive machine. Then after the 13 mos you own the new machine. If the CPAP does not work for you after the 13 mos period then you could get a new rental for a BiPAP or ASV, and you need to show a new Rx and probably need a repeat sleep study:

•If the CPAP device is not working, or if you cannot tolerate the CPAP machine, your doctor may also try to use a different device called a Bi-Level or a Respiratory Assist device, and Medicare can consider this for coverage as well.
•Talk with your provider if you are having problems adjusting to the therapy. There are a lot of variations that can make the therapy more comfortable for you.

avi123 wrote:You're not clear with your post. Which machine did you own on 12-28-12, and what's the meaning of "rental period would start over with the ASV" ?

Nov 2011 (After two sleep studies) Doc put me on a CPAP . . . 13 month lease began.

Mar 2012 (ASV Sleep Study) ASV Prescription. Apria picked up the CPAP and delivered an ASV . . . QUESTION: Does the original lease continue or does a NEW 13 month lease begin on the ASV?

December 31, 2012, I spoke with DME and was informed that, as of December 28th, I owned the ASV machine . . . The original 13-month lease ended.

Grand-PAP wrote:

avi123 wrote:You're not clear with your post. Which machine did you own on 12-28-12, and what's the meaning of "rental period would start over with the ASV" ?

Nov 2011 (After two sleep studies) Doc put me on a CPAP . . . 13 month lease began.

Mar 2012 (ASV Sleep Study) ASV Prescription. Apria picked up the CPAP and delivered an ASV . . . QUESTION: Does the original lease continue or does a NEW 13 month lease begin on the ASV?

December 31, 2012, I spoke with DME and was informed that, as of December 28th, I owned the ASV machine . . . The original 13-month lease ended.

You can see your actual Medicare claims online if you sign up for a "My Medicare" account.
Then you can see exactly how much your DME charged Medicare & exactly how much Medicare paid for each of the months in the 13 month lease.

StuUnderPressure wrote:You can see your actual Medicare claims online if you sign up for a "My Medicare" account.
Then you can see exactly how much your DME charged Medicare & exactly how much Medicare paid for each of the months in the 13 month lease.

Thanks StuUnderPressure!

I went to . . .

https://mymedicare.gov/

. . . and created the account and I was able to view every MediCare claim.

There were some confusing Apria claims, but it looks like:

Aprea Billed MediCare $331.52 and MediCare paid $92.94 -- For THREE months

Aprea Billed MediCare $1,890.56 and MediCare paid $535.71 -- For TEN months

And the Elite has been rented to someone else or sold outright? (hopefully at a discount)
Apria made out like a bandit!

Grand-PAP wrote:

StuUnderPressure wrote:You can see your actual Medicare claims online if you sign up for a "My Medicare" account.
Then you can see exactly how much your DME charged Medicare & exactly how much Medicare paid for each of the months in the 13 month lease.

Thanks StuUnderPressure!

I went to . . .

https://mymedicare.gov/

. . . and created the account and I was able to view every MediCare claim.

There were some confusing Apria claims, but it looks like:

Aprea Billed MediCare $331.52 and MediCare paid $92.94 -- For THREE months

Aprea Billed MediCare $1,890.56 and MediCare paid $535.71 -- For TEN months

So, I am assuming you do not owe your DME provider or anyone else any more money.
13 months of payments were made at the rate for the machine you had at the time AND the DME will now REsell the Elite.

Having an online "My Medicare" account is a great way to more fully understand your Medicare claims.

I highly recommend that everyone on Medicare set up an online "My Medicare" account.