I have had the benefit of over twelve years of speaking with our patients regarding their trials and tribulations regarding their healthcare insurance concerns. They seek answers to questions not clarified by the agents they use. I was a certified California Health Insurance Program counselor for over five years. I have worked as a Revenue Cycle Manager, Compliance Officer, and a California Medical Board-approved Billing Monitor in the healthcare industry. You, our patients, have prompted me to begin this quarterly blog. I hope you will find it valuable and helpful to you and your loved ones. Let’s start with, Open Enrollment.
Most of you have received your “Medicare & You” booklet. You may have started seeing commercials such as: “money back monthly”; or “extra services.” Each insurance company states they are “the best as they offer more for less.” The adage, “too good to be true,” applies here. Each of you has a unique set of circumstances. My suggestion has always been to put pen to paper or fingers on computers and write down your prescriptions, Durable Medical Equipment (DME) included. Do you require various specialists to care for your illnesses? Do you only need to see the doctor for general health concerns? Do you require routine vision, hearing, or dental visits for an ongoing condition(s)? Once you have the answers to these questions and perhaps others, you are ready to start searching for the best option that meets your needs. Please keep in mind that Medicare allows you to receive a CPAP Machine every 5 years. While the accessories vary in frequency the following applies to your CPAP Pro – maskless CPAP: one mask every 90 days and the nasal pillows may be refilled at 2 pairs per month.
Despite what I have heard many agents tell beneficiaries through beneficiaries whom I have spoken to, Traditional Medicare (TM) and Medicare Advantage (MA) have differences. The most relevant is that when you sign up for a MA plan (Part C), your claims are submitted to that insurance company, NOT Medicare. Your policy under an MA plan is with that insurance company, NOT Medicare. You can switch back to Traditional Medicare during the next open enrollment. If you sign up for an MA plan in October and want to change your mind before Open Enrollment ends, you can.
May I suggest you visit a State Health Insurance Program (SHIP) in your area to assist you with clarifying your available choices? The counselors are state certified and cannot advise; they only provide clarification to your questions. The decision is yours to make with an unbiased approach. The following important fact: it is a FREE service through the federal government. Here is the link to search for your local SHIP: https://www.shiphelp.org
Lastly, if we are billing Medicare for your CPAP Pro mask and other accessories, please remember we do not bill Medicare Advantage plans. Each year we have numerous patients who switch over to an MA plan to find it is not TM, and we can no longer bill their claims. They state “How can they stay compliant with their CPAP therapy without the CPAP Pro.” We hope to avoid this situation come January 2023 by being forthcoming.Our best to all our patients during the holidays, and here’s to a good night’s sleep! Look for our holiday specials! We are always here to help feel free to submit your questions and we will do our best to answer them!