40% savings from Medicare on my vent???

[Diane H]

Shh, don't tell my DME because if this is a mistake I don't want them to fix it! Last year the breakdown on the cost of my vent was:
DME billed Medicare $3800
Medicare allowed $1500
Medicare paid the DME 80% of the allowed amount, 1200
I owed $300 before filing with my supplemental insurance.

As of January the bill is:
The DME billed Medicare the same $3775
Medicare allowed only $900
Medicare paid 80% , $720
I owe $180

WOW! That is a $40% decrease!!! I checked the codes they used both last years and this year and both are correct for 2015 and the new 2016 codes. Unless there is an error I can't see, Medicare whacked the allowable amount for a vent 40%. Has anyone else seen this change in their ventilator bill? Or is it a mistake?

 

[lgelb]

Yes, there was a drastic decrease in the allowable as of 1/1. That is why the DMEs are up in arms.

 

[gooseberry]

But also since things like the trilogy can only be rented and cost 12k to 15k if you could purchase them the charges are unreasonable

 

[Diane H]

But if you rent the machine is checked regularly and sent back for a full maintenance evaluation after so many hours. It is replaced if necessary at no charge. More importantly, you have 24 hour emergency response if it should fail or not work correctly.

 

[lgelb]

1) Trilogies can be purchased from sites like dotmed and individuals
2) Everyone who relies on a machine should have a backup, not necessarily the same machine but something that can get you through the night. Literally.