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+--- Thread: [split] Medicare Beneficiary Being Balance Billed for Machine Choice (/Thread-split-Medicare-Beneficiary-Being-Balance-Billed-for-Machine-Choice)
[split] Medicare Beneficiary Being Balance Billed for Machine Choice - MikeyT - 12-09-2019
Hi, I have posted here before, but not much. I'm on medicare, with a MI Blue Cross supplement. I have been dealing with a local DME for the past 5 years. They provided me with my System One then. It's an AutoSet or whatever Respironics calls them. My only income is SS retirement. I called the DME today and asked for a ResMed Airsense10 Autoset. I was told that that would cost me $100 more than a brick because "reimbursement is down." Can you tell me if that is true, or should I be looking elsewhere? If need be, I can motor on with the machine I have, but???? Actually, I think I would like something that would be a little more technically modern.
RE: CPAP Machine Choices - read this before you accept a new machine - SarcasticDave94 - 12-09-2019
I could be wrong, but I'm inclined to think the DME wants you to make a $100 car payment for them.
I thought the brick CPAP and the ResMed AutoSet are the same price to them from Medicare.
Alternate answer, their patient monthly milking is down $100, so pay up.
RE: CPAP Machine Choices - read this before you accept a new machine - Gideon - 12-09-2019
Considering the DME markup is about $1000 Tell them that they eat the mark up or you will go elsewhere. And you want the AutoSet. And call Medicare because they have negotiated pricing.
RE: CPAP Machine Choices - read this before you accept a new machine - MikeyT - 12-09-2019
Thanks Dave, and thanks Fred. I'll be calling Blue Cross aka Medicare plus Blue aka BCBSM which is who gets my check each month.
RE: CPAP Machine Choices - read this before you accept a new machine - RayBee - 12-09-2019
It is a shame we have to play these games. Keep us posted on your progress Mikey.
Dave, I like the new Avatar. Good looking mug you got there.
Woof woof.
RE: CPAP Machine Choices - read this before you accept a new machine - SarcasticDave94 - 12-09-2019
(12-09-2019, 09:17 PM)RayBee Wrote: It is a shame we have to play these games. Keep us posted on your progress Mikey.
Dave, I like the new Avatar. Good looking mug you got there.
Woof woof.
Any tips? Can't get a mask to fit. FWIW that's a pic of Sinbad, was Mom's dog but he adopted me. Was a smarter dog than a politician.
RE: CPAP Machine Choices - read this before you accept a new machine - MikeyT - 12-10-2019
I just called BCBSM and I might as well have been talking to a fencepost.
Not sure where I'm going from here. I may just stay with the System One for now.
RE: CPAP Machine Choices - read this before you accept a new machine - PollCat - 12-11-2019
Mikey, I hear your pain and can sympathize with your plight. Several years ago I had the same problem with BCBS + Medicare. I finally gave up and bought the new CPAP with my funds and then submitted the paperwork for a (partial) reimbursement. However, I realize that not all seniors are capabale of paying for a new machine out-of-pocket.
RE: CPAP Machine Choices - read this before you accept a new machine - Sleeprider - 12-11-2019
(12-10-2019, 11:13 AM)MikeyT Wrote: I just called BCBSM and I might as well have been talking to a fencepost.
What is happening is the DME is "balance billing" which is not allowed for participating providers. It is possible your DME is not a Medicare participating provider, in which case, the unassigned claim may include surcharges like this. While BCBSM provides your supplemental coverage, this supplier is regulated by Medicare/CMS to provide DME at the negotiated price, only if it is a participating provider. I suspect your provider is actually not a participating provider, in which case there is no obligation to stay with them. Try this:
https://oig.hhs.gov/oei/reports/oei-07-99-00510.pdf
https://www.medicareresources.org/glossary/balance-billing/
https://www.aarp.org/content/dam/aarp/ppi/2017-01/medicare-limits-on-balance-billing-and-private-contracting-ppi.pdf
This DME could lose their Medicare participating provider status if you can document their misbehavior and then file a complaint with Medicare. If however the provider is not on the participating provider list, then you should seriously consider changing providers. The best alternative may be to find a "participating provider" that accepts Medicare and supplemental coverage as payment in full.
Check here for a list of DME providers in your area https://www.medicare.gov/supplierdirectory/search.html
Check here for your Medicare Benefit for CPAP https://www.medicare.gov/coverage/continuous-positive-airway-pressure-devices
MODERATOR NOTE: This thread was split from the sticky thread at the top of this page CPAP Machine Choices. The reason for splitting this out is that the discussion is specific to Medicare and is an important topic to be dealt with apart from the 15 page thread.
RE: [split] Medicare Beneficiary Being Balance Billed for Machine Choice - SideSleeper - 12-13-2019
Mikey, is your machine a PR System One 560?