DME Claims Question with Medigap-advice Appreciated

[TN_agent]

Ok, situation I have not come across before (which is not hard because I have only been doing Medicare a short time and let me tell you Medicare is a different animal entirely).

Client has been on Medicare A and B since 2/1/2015. He was covered under employer plan until January 31st of this year (paying for a and b the whole time). Now he is on an F supplement with 3/1/ start date. We decided that was best for him because he wanted low OOP and was willing to pay more in premium for it.

At no point during any of our three meetings does he mention that he is on a CPAP, doesn't not name any sleep doctors, etc. I asked about prescriptions and health, sleep apnea was not mentioned. Guy was GI anyway.

When he left his work, his residence went from one county to another. The new county is in a competitive bid area for DME.

He has received denied claims from his old CPAP supplier, who is not an approved competitive bid vendor in his new county. Since group insurance was cut off 1/31. I guess he is still renting it from them, not sure how long that has been going on--they were approved vendor on group plan and general Medicare approved, but not specifically approved in the new county of residence that has the competitive bid process. The old supplier says he has to turn the machine back in.

My questions:

How does this guy get a new CPAP?
Is Medicare going to deny his claim and he now has to pay OOP completely for a new one because of moving to the competitive bid area (for example, if he hasn't had it long enough to qualify for a new one)?
Will the old company switch his CPAP prescription to the new company or will they be jerks about it?
How can I make this transition easier for him? I would have prepared him better for this, except I had no idea he used a CPAP.

 

[WCMason]

The link below explains how CPAP equipment is covered both for those diagnosed with OSA after Medicare eligibility and those already receiving treatment when they become Medicare eligible.

You mention not knowing about the OSA. What would you have done differently if you had known?

https://www.medicare.gov/coverage/sleep-apnea-and-cpap-devices-and-accessories.html

 

[TN_agent]

Thanks for the link.

I would not have signed him up for a different product, I just would have asked who he used for DME and mentioned that he might have to switch if he had told me about the cpap. He has 3 months of unpaid rental on his current CPAP due to original company not being in his new county (2 since going on medigap).

Not sure how much he will be billed and not sure if he is going to have major OOP of buying or renting a CPAP that Medicare won't pay for because he isn't "due" for a new one yet and they just paid for one. It seems from the link you posted that maybe his 13 months rental just starts over I assume he has had the one getting repo-ed less than 13 months, or they wouldn't be asking for it back because he should own it, but maybe the rules were different on the group plan he just came off of.

Just a lot of unknowns, I don't like unknowns.

 

[NIAMAN]

I'm a CPAP user, and just an FYI0you can outright purchase a machine online for less than half of what most Home Supply outlets want. Unless his insurance is going to cover it, no reason to buy local. The 13 month rental is a trap !1arghh: