New Medicare CPAP Policy 1 July 2013

[BobF]

I just contacted our CPAP supplier. They are not on the list and will not be supplying Medicare after July 1. However, they told me if you have equipment that is still in the 13 month rental period you will have the option of keeping it and Medicare will continue to pay them for the machine AND SUPPLIES until the rental period is over. I also just received a letter outlining these terms. It is interesting that you also have the option of changing to a new, listed supplier and starting the 13 month rental all over.

Hi. That's interesting. When I first called my DME they did not tell me that. They said if they were not authorized by Medicare after 1 July 2013 that they would pickup the equipment after a short grace period so that I would not be without my CPAP until I got a CPAP from another DME. I have called twice and left a message to have them call back with no response. If I don't hear back I am calling the Gen. Mgr. or the owner. I am particularly interested as my 13 months happens in mid July. Bob.

[SuperSleeper]

I wonder what the government is using for criteria to determine which DMEs will be placed on the preferred list? I don't think it's based upon product pricing, since Medicare already has pre-established reimbursement amounts for each product and service, and each DME gets paid the same amount by Medicare for the same product or service (generally speaking).

This almost seems like they're restricting the market to fewer suppliers. I never like things like this, because it opens up opportunities for favortism, kick-backs and bribery in order to "get on the government's approved list". Not saying that's happening, just that when there's government employees making market decisions, it usually never ends well (more expensive and poorer service for the patients).

[PaulaO2]

I'm waiting to see if the Scooter Store makes it as an approved supplier. They're under investigation for Medicare fraud. But since, like most government offices, the left hand doesn't know what the right is doing, I'm betting they make the list.

[BobF]

I just found this pdf file:

http://www.medicare.gov/Publications/Pubs/pdf/11307.pdf

It explains it in more detail and answers some of our questions.

Bob.

[ret-doc]

Has anyone else received a letter from Medicare about the new policy in effect on 1 July 2013 about diabetic testing supplies. It is not only for diabetic testing supplies. You can go to medicare.gov/supplier and scroll down to CPAP. They have a new Preferred Supplier list and Medicare will only pay the suppliers on the new list. Many of the previous suppliers have not been included in the new list. If your supplier has been dropped they probably will ask for the CPAP machine back on 1 July 2013 and you will have to get your CPAP from a new approved supplier. One new supplier told me that if you have been receiving a CPAP machine for 13 months, or more that, the machine is yours. My supplier has been dropped. When I called Medicare at 1-800-633-4227 I asked about the policy and they confirmed it. My present supplier has been dropped. They said they had put in for acceptance but have not heard back yet. According to the Medicare agent I spoke to if they have not been notified of their acceptance by now they probably won't be. Bob.

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Bob,
Thank You for the heads-up!!!
A person has to love going from paying the whole tab to getting the govt to give some of it back.

ret-doc

[archangle]

Be sure to complain to your congresscritters if this policy harms you.

Congress generally works for the benefit of those who pay them the biggest bribes, but if they get enough complaints from the voters, they sometimes listen.

[missajn]

Hello ..I saw your post and I also have medicare. I have horrible apnea and for almost 2 years straight I used to order my bipap supplies from the same company I used for my oxygen (which plugs into my bipap machine) I seriously used to get charged 30$ copay per mask. Thats a lot for me as you can get a new one every month so it was crazy. One day online I found this place called ionmyhealth. For almost 2 years now I get my supplies from them.Every 3 months they call me and it takes 30 seconds and I get my 3 masks,new headgear,filters and tubing. Here is the part I want you guys to know..THEY ACCEPT MEDICARE ASSIGNMENT as FULL PAYMENT. Mmeaning they accept whatever medicare pays them AND I NEVER HAVE PAID THEM A DIME.I just got my new supplies last week and I am so grateful as money is TIGHT! I thought when I saw this post..I wondered if you guys are STILL PAYING for your supplies? anyway im just a person struggling and wanting to help..[link removed]--i filled out that page and received a call asap [contact information removed]..if you dont want to wait. I thought why would this do for free? But its been 2 years..anyway I hope it helps someone on medicare with not a lot of money-email me if you need help ..

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[me50]

Straight medicare is scary. If a person goes into the hospital, the deductible is around $1000 EACH TIME they are admitted to the hospital UNLESS, within 6 months of the admission, they are admitted again for the SAME condition (that means exactly the same condition).

I pay the medicare premium but do NOT use medicare. I am not eligible for supplemental medical insurance so I have a medicare replacement insurance policy (with an additional premium) and so far, it has been a great policy. I have NO deductibles unless I go out of network. I have NO copays unless I go to an Urgent Care rather than my doctor (in my opinion, I can wait until my doctor's office is open if it is a cold, flu or something minor or go to the ER if it is urgent and cannot wait for an appt. with my doctor) or to the ER and the deductible is small and waived if I am admitted.

Urgent care cannot deal with broken bones, etc. and mostly deal with flu, colds, and things that do not require the interpretation of x-rays, ultrasounds, etc. DON'T go to urgent care for heart attacks or serious injury or illness b/c they will just call an ambulance to transport you to the hospital and you end up with an added expense and precious time wasted in a life threatening situation.

That being said, that is so sad you had a $30 co-pay for a cushion. I would check with your insurance company about that and make sure that the DME/supplier wasn't charging your insurance company for the mask instead of the cushion.

I am glad you found a reliable supplier that will provide your life saving supplies without costing you a fortune and adding stress to your life. That is worth a million right there!!

[justMongo]

I received a letter from Medicare back before 01 July.
Medicare asked for competitive bids from DME suppliers. Some of them just did not make the cut.
My sleep apnea DME is on the list of providers.

Fortunately, I have a Medigap supplement from my former employer that covers those pesky 20% co-pays.

[KarenK]

If you are on a Medicare Advantage poli cy, the competitive bid is not for you - just straight Medicare patients.

I received a letter from Medicare back before 01 July.
Medicare asked for competitive bids from DME suppliers. Some of them just did not make the cut.
My sleep apnea DME is on the list of providers.

Fortunately, I have a Medigap supplement from my former employer that covers those pesky 20% co-pays.