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Permalink Reply by RockRpsgt on June 11, 2010 at 9:41pm

From what I have been told medicare only pays 30% of any medical bill.

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Permalink Reply by Judy on June 11, 2010 at 10:43pm

I received my CPAP thru a local DME provider via Medicare. In these circumstances Medicare will only purchase a CPAP via a 13 month rent to own type of purchase.

The local DME provider claims a BILLABLE amount, Medicare dictates an ALLOWED amount of which Medicare pays 80% and the patient has a 20% copay - for 13 months. The humidifer, mask and any other accessories are outright purchases paid by Medicare in the same fashion, i.e. BILLABLE amount, ALLOWED amount, PAYABLE amount and COPAY amount except as outright purchases rather than the 13 month capped rental.

In Michigan in 2006 for CPAP for 13 months:
DME Billed: $135.00 - Medicare Allowed: $99.95 - Medicare Paid: $79.96 - Patient CoPay: $19.99

In Michigan in 2006 for humidfier and accessories outright:
DME Billed: $548.00 - Medicare Allowed: $499.63 - Medicare Paid: $399.70 - Patient CoPay: $99.93
(Hose, mask, headgear, humidifier)

Now, Medicare may well handle out of pocket purchases applying for reimbursement under a different formula. But even if they reimbursed at 30% that would be $200 on a $668 purchase.

Have you tried contacting Medicare directly?

Now, we have on a couple of occasions made use of medical services by providers who were not Medicare participants for Medicare covered services. In these cases Medicare sent the reimbursement check direct to us and we had to then pay the provider. I have no idea what the % rate was.

I believe that Medicare is now only paying claims every 3 months so it may be that you will receive a check from Medicare in due time and the 30% of that $110 is considered the Patient CoPay that your Medicare Supplement insurance is responsible for???

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Permalink Reply by Mary Z on June 13, 2010 at 2:10pm

Medicare reimbursement also depend on your supplemental medicare policy. Some pay more than others. My Optima is $148/month, but pays very well.
I tell you , even with what both of them pay, the reimbursement is so far below the actual billed cost of treatment I'm surprised Doctors keep accepting Medicare patients.

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Permalink Reply by Judy on June 13, 2010 at 2:57pm

Well, actually the billing cost is raised considerably to help offset the Medicare reimbursement rates as insurances often pay even less for many items, procedures, etc.

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Permalink Reply by Perry mcNeal on June 17, 2010 at 9:06pm

I finally received my answer by getting a very nice and knowledgeable person on the phone at Medicare. She said that my mistake was by trying to buy for cash and bill back Medicare through Humana. Medicare does not pay except to authorized providers, and I am not one. Live and Learn. I used my last machine for about seven years, so if this one stays "current' for that long, the out of pocket cost will be minimal.(My old one still works fine, I just wanted an auto Cpap.

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