CPAP Basics - 5 - Insurance and Reimbursement

prodigyplace wrote:That is a very good document with good definitions. Was it removed dur to updated Medicare rules?

I don't think it was removed or moved for anything other than Respironics periodically moves documents around on their website. I have saved links to various things at Respironics in my saved folders that are now broken and the same information might be available elsewhere if I took the time to look.
Respironics redid their entire website a while back and a lot of links became broken because they just moved information to another page somewhere.

As for Lincare auto shipping to Medicare patients...not suprising..they will do whatever they can get away with to make money regardless of legality.
They aren't suppose to auto ship...the patient is supposed to say "I need so and so" and provide some semblance of a reason.
Verbal is good enough. No one checks for "proof" or anything like that. We aren't required to bring so and so in and show that it is tired or leaking or whatever.
I suspect that Lincare may have some sort of "record" in their paper work that someone called and requested whatever they happened to ship out as part of the auto ship. It would be easy to make up.
If it was me and I was using them and they auto shipped to me...I would turn them in to Medicare for fraud.
I would send a note to Medicare that I got stuff shipped to me from Lincare that I didn't request.
But that's just me..I would like to stick it to places like Lincare that are hard to deal with just because I can.

I should have clarified. I am on Anthem insurance, not Medicare. The insurance companies and DMEs seem to base their policies off Medicare guidelines in my experience.

prodigyplace wrote:The insurance companies and DMEs seem to base their policies off Medicare guidelines in my experience.

They (DMEs) get to pick and choose which part of the Medicare guidelines they wish to adopt.
So they can choose to ignore the auto ship ban for Medicare patients if they wish.
Just because Lincare may choose to use the replacement allowance or some other Medicare guideline doesn't mean they have to use all of Medicare's guidelines.

If you wonder about whether your Anthem allows auto ship or not...you will need to check with Anthem. It all depends on the plan. Not everyone who has Anthem will have your plan and what is allowed or covered can vary between the various plans that Anthem offers.

prodigyplace wrote:That is a very good document with good definitions. Was it removed dur to updated Medicare rules?

I notice that the DME cannot auto-ship supplies, but Lincare seems to currently do that even though their email says you need to contact them first.

If you are an original Medicare patient, then Lincare shouldn't be auto-shipping. I'd call your Lincare rep. I'm having a heck of a time trying to get them to send me supplies for 3 months so I don't get bugged monthly, but so far, nuthin'.

Not Medicare, just Anthem but they follow many of Medicare's guidelines.
Some replacement times are more flexible, though. The Humidifier tank is "as needed" instead of 6 months, for instance.

The wayback machine link also did not work for me, so I did some searching. This may be the new home for the information:
https://www.usa.philips.com/c-dam/b2bhc ... lHints.pdf