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 backup 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.To apply for assistance you need ask for a form to fill out. (they don't automaticaly offer it!) It is a standar report on income and
expenses. You may be eligible for reduced rental or even no rental fees.(I currently don't pay any ventilator rental fee thanks to my provider's Financial Aid program.)
By the 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 a typical 2016 cost. (Remember, this is my cost and every equipment supplier and
insurance is different!)
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 copay!
Medicare allows $896 of which they pay 80% or $703. That leaves me with a monthly bill of $179.
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 your DME provider 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 the patient. 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 our vent provider as well and they are very prompt
with most items.
