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.
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.