Insurance policies vary widely in their coverage. The most important step is to be certain that the DME (Durable Medical Equipment ) provider is covered by your insurance if your insurance requires you to use "in network doctors and other providers. If your copy of the policy isn't specific you may
want to call the insurance company. I don't particularly trust insurance companies and I am not certain
I would want to give them a heads up on what you are considering doing. If you call them, document what you
are told, the date, time, names and job title of the person you talk to, and take notes.
Talk to respiratory equipment suppliers in your area. Your insurer may be familiar to them so they may
be able to tell you what is covered. Make an appointment to see or call someone at the billing department,
not whoever answers the phone. Document what you are told, the date, time, names and job title of the
person you talk to, and take notes. Ask how much they charge for vent rental as well as for supplies; hoses
and filters, suction machine, suction catheters, gloves, replacement trachs, gauze squares for around the
trach, neck collars for the trach. Ask what the requirements are to have a back up vent. All this will give
you some idea of what to expect -- and contact people to call when the bills are undecipherable!
If the monthly out of pocket expense is obviously unaffordable, ask the vent supplier if they have a
financial assistance program. Apria has one and to apply for assistance you need to fill out a full report
on income and expenses. You may be eligible for reduced rental or even no rental fees. Hopefully you will
be able to pay for a couple of months charges before you have to ask for financial assistance. Asking for
it up front would allow them to refuse you as a patient but once you are on the vent they can't come in
and take you off the vent!
By time you need a ventilator you will be eligible for Medicare (if you have paid into Medicare). The
tricky part is whether Medicare will be your primary insurance (pays first and any remaining amount is then
filed with any other insurance you have) or if it is secondary (filed after your other insurer has paid
their allowed amount.) If you are covered under a company policy of someone who is still working, Medicare
will be secondary. Medicare will be primary if the policy holder is retired even if their retirement
package includes a Medicare Supplement policy.
The best I can do is give you my 2016 cost. (Remember, this is my cost and every equipment supplier and
insurance is different!)
I am on Medicare and have a Medicare supplement policy.
The vent rental and maintenance is billed at (Gasp!) $3775 per month per ventilator. Ignore
this ridiculous number. Providers are free to bill Medicare any outrageous amount but Medicare
will only approve a part of that and the provider has to go along with that amount. Suppliers who
accept Medicare patients are not allowed to come back and bill you for any more than your 20% Medicare
Medicare allows $896 of which they pay 80% or $703. That leaves me with a monthly bill of
My supplemental has an "out of pocket" $3000 yearly minimum so unless I have other
claims, they pay nothing. Two vents would cost $358 per month for 9 months if I don't have other claims
to reach the out of pocket sooner.
Vent supplies (suction catheters' replacement hoses, filters, etc.) are not included in the monthly
rental. The same idiocy applies to these items. They bill Medicare over $500 for 75 suction catheters
and I end up paying $36. And I can get them for less than that online!
By filing a financial hardship form detailing your financial situation, you may be eligible for a
reduced payment or write off of your bill.
It is possible to purchase your own vent but you will not receive any of the services provided along
with vent rental. When you rent, a Respiratory Therapist visits frequently at first, then less often. The
therapist does no patient care. The therapists are there to check the equipment, not me. If I have any
problems I call the doctor and the therapist can intervene to work with the doctor to change settings or
recommend other equipment. During visits the therapist will run checks on the vents, suction machines,
batteries, chargers or other equipment. They arrange for very prompt replacement if needed. They keep
records of all the machines so they are regularly exchanged and sent in for a full "tune up".
They are on call 24/7 for equipment emergencies. Equipment is replaced at no charge if there is a problem
with it. We order our supplies by phone through Apria as well and they are very prompt with most