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[Equipment] Getting reimbursed by Medicare for direct purchase of supplies
#1
Question 
Getting reimbursed by Medicare for direct purchase of supplies
I see that the price of supplies such as mask cushions on Ebay are half or a third or even less what they cost from an online major CPAP supplier, much less a local healthcare supplier.  For all of that, if I buy from the local healthcare provider (who hands me off to an annoying mass fulfillment location with an 800 #), I don't have to "pay anything".

But this means that Medicare, the government and the taxpayers get soaked.  I want to give my local supplier some business but for the long run, I want to cut out the middlemen and markup parasites that make medical care (and supplies) so horrendously expensive.

Is there a way to buy the supplies I need direct from Ebay and still submit for payment to Medicare?
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#2
RE: Getting reimbursed by Medicare for direct purchase of supplies
(10-01-2019, 03:54 PM)sdean7855 Wrote: Is there a way to buy the supplies I need direct from Ebay and still submit for payment to Medicare?

The short answer would be no. At least not from places like EBay, Craig’s list, etc., simply because they are not DME’s.

Now if you purchase from an online DME, even though most won’t submit claims to your insurance, you can get a print out of the invoice from them with the appropriate billing codes. You can then submit to insurance or Medicare for reimbursement. Just be aware that the reimbursement may be a lot less than dealing with your local DME that is contracted with Medicare.

You have to weigh the pros and cons, and what is beneficial for you. But buying from places like EBay, your pretty much on your own with the cost.
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#3
RE: Getting reimbursed by Medicare for direct purchase of supplies
Keep in mind that Medicare approved suppliers agree to to a "secret price" that is not the invoice price. Medicare pays suppliers and providers a relatively low negotiated rate/price and you don't know what it is. In addition, the bureaucracy of billing increases the cost of providing services. I would not worry too much about soaking hte taxpayer (you) on supplies. If you don't have copay or deductible, you are also paying for supplemental coverage that is picking up the cost.
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#4
RE: Getting reimbursed by Medicare for direct purchase of supplies
Thanks for the replies, they make sense, telling me things I didn't know and hadn't thought of or thought through.
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#5
RE: Getting reimbursed by Medicare for direct purchase of supplies
My local Resmed dealer has  an abysmal customer service record, so when I was ready to change out my 10-year-old, 18,000 hours, S9, I decided to buy my new Resmed Airsense 10 from Supplier #1.   I sent the prescription and Invoice(which I paid, because Supplier #1 does not do Medicare) with a claim form off to Medicare yesterday. I imagine that they will likely have some issue and will deny the payment, but I will just persist.
Be interesting to know if anyone has had an experience with having Medicare cover replacement machines bought from Supplier #1.



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#6
RE: Getting reimbursed by Medicare for direct purchase of supplies
(10-01-2019, 03:54 PM)sdean7855 Wrote: Is there a way to buy the supplies I need direct from Ebay and still submit for payment to Medicare?

Nope.  Medicare does not reimburse for things you buy yourself except in cases where the person was eligible but the provider coverage rules fell between the cracks. For instance, it took my brother 2 years to be reimbursed for a $400 walker he needed that would have been covered had he been issued it while in the hospital. However, he was UNABLE to walk when he was first discharged to the nursing home.  He needed the walker 10 days later in order to come home. They said it would be 6-8 weeks before Medicare would approve a walker, so we just bought it for him.

Yes, it drives us all nuts how Medicare does things.  Presumably, the point was to reduce fraud.
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#7
RE: Getting reimbursed by Medicare for direct purchase of supplies
(10-01-2019, 04:37 PM)Sleeprider Wrote: Keep in mind that Medicare approved suppliers agree to to a "secret price" that is not the invoice price.  Medicare pays suppliers and providers a relatively low negotiated rate/price and you don't know what it is.  In addition, the bureaucracy of billing increases the cost of providing services.  I would not worry too much about soaking hte taxpayer (you) on supplies.  If you don't have copay or deductible, you are also paying for supplemental coverage that is picking up the cost.

Medicare should send you a monthly statement that shows what the provider charged, and what medicare approved. So you do find out the "secret price", although it is after the fact. Since most providers accept Medicare, the Medicare-approved amount is the total paid to the provider. Medicare actually only pays 80% of the approved amount. You are responsible for the remaining 20%. You may have "Medigap" insurance which will cover your portion. If your provider does not accept Medicare you may be responsible for the difference between the Medicare-approved amount and the full price charged by the provider. If this is the case you should change providers as quickly as possible.
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#8
RE: Getting reimbursed by Medicare for direct purchase of supplies
I seriously doubt eBay is going to fly, but with legit DME's, including online, you are looking for form CMS-1490S "Patient's request for medical payment".
 
https://www.cms.gov/Medicare/CMS-Forms/C...12949.html

Good luck!
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