Something is screwed up. The billing codes for BiPAP and Ventilators changed on Jan. 1 and it is very likely the Medicare is denying the claim because the DME is using outdated an outdated or incorrect code. Most likely they are trying to bill the Trilogy as a BiPAP. "Ventilators must not be billed using codes for CPAP (E0601) or bi-level PAP (E0470, E0471, E0472). Using the CPAP or bi-level PAP HCPCS codes to bill a ventilator is incorrect coding, even if the ventilator is only being used in CPAP or bi-level mode. Claims for ventilators used in CPAP or bi-level PAP scenarios will be denied as incorrect coding.code".
Or they may be correctly calling the Trilogy a ventilator but using an outdated code such as E0450, E0460, E0461, E0463, or E0464.
If your billdoesn't show the code used, go to mymedicare.gov and sign up so you can see your bills. Click on the long number at the left of a claim and you will see the the breakdown of the claim and, at the bottom, the code used.
You will also see the amount the DME is charging Medicare for one month's rent and the amount Medicare allows. The DME will only get that amount regardless of what ridiculous amount they bill Medicare for. The next number is how much of the allowed amount Medicare pays them. That is 80% of the allowed amount. The remaining 20% is what you owe. The DME is not allowed to bill you for anything more than that 20%. That will be billed to your other insurance and they will pay their covered % of that, and the rest is what you actually owe. You won't get anything from your insurance for the first the first part of the year. They won't pay until you have met your deductible and your Out of Pocket amount (which is probably several thousand dollars). I am not sure whether that $1400 is for a BiPAP or a vent, the amount billed to Medicare or Medicare's allowed amount, but there is no way you owe the DME $1400 a month even if your insurance isn't paying anything at all yet this year!!!