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Medicare, Insurance and Portable Concentrators

Will Medicare or our Insurance Company Pay For A Portable Oxygen Concentrator?

Customers daily, come to us and ask us this same question!

Will Medicare pay for a Portable Oxygen Concentrator?

First off, I wish they would pay for this much needed device! Its a very important and common question, for anyone looking to purchase a Portable Oxygen Concentrator. We understand the cost involved, and its unfortunate. However; I will try explaining to you why it is very unlikely or extremely difficult at best, to get a Portable Oxygen Concentrator through Medicare or any other insurance funding channel.

You have been searching and came accross this article, then chances are, you have already discovered how difficult if not impossible, to find a Medical Equipment Supplier, that will supply a Portable Oxygen Concentrator thru Medicare or your Insurance Carrier, much less, find the model needed or suited for you and your lifestyle.

 

Will Medicare help pay for a Portable Oxygen Concentrator? Unfortunately the answer is NO, but its not that simple! It not just a simple yes or no!

  • Medicare has always paid a certain amount for all oxygen equipment. However, in recent years, that amount has continued to be reduced. In fact, in the summer of 2013, Medicare reduced payment for Portable Oxygen Concentrators by almost 50%.
  • Due to the Medicare reduction in payment, this is why we hear so many oxygen users say their respiratory equipment supplier told them Medicare does not cover Portable Oxygen Concentrators (POC).
  • The truth is these respiratory suppliers can't afford to provide you a Portable Oxygen Concentrator costing thousands of dollars when they can get by setting you up with oxygen tanks costing a few hundred dollars.

If you qualify, Medicare and other insurances do have the new reduced rental fee for Portable Oxygen Concentrators, which means they can pay a certain amount to the equipment companies for this technology. However, the respiratory equipment suppliers are not convinced a Medicare average payment of 17:00 per month, is not enough for them to see a return on their investment. They are not required by Medicare to give you a portable oxygen concentrator.

They are only required to supply equipment that maintains your oxygen needs. As a result, most Medicare oxygen equipment providers do not deal in portable oxygen concentrators.

Why?...Because the cost of the Portable Oxygen Concentrator: far exceeds the amount Medicare will reimburse the equipment company. This is why most of the oxygen equipment companies are choosing to NOT carry portable oxygen concentrators. Medicare has set the price for Portable Concentrators, below the cost to provide them to clients.


Understanding How Medicare Pays: Whether you have a home oxygen concentrator, liquid oxygen, tanks, or a portable oxygen concentrator, all of this equipment is considered a rental item in the eyes of Medicare and the equipment company. An equipment company provides the oxygen equipment to you, then they bill Medicare a monthly fixed rental fee. Oxygen equipment is limited to a 36-month rental period. Due to the reimbursement guidelines, respiratory suppliers who bill Medicare tend to be cautious and very selective with what types of oxygen equipment they provide to you.

Once you qualify for supplemental oxygen, Medicare will begin paying the respiratory supplier the monthly rental fee for 36 months (3 years), and then just a small "service fee" for the following 24 months. Medicare oxygen equipment suppliers that provide oxygen to you are required to maintain the equipment for a total of 60 months (5 years).


To frustrate you even more, Medicare made things a lot tougher by implementing their National Competitive Bidding (NCB) process for medical equipment supply companies in most areas of the country. Companies with the lowest bid were those awarded Medicare contracts. This means the Medicare rental fee for portable oxygen concentrators, that is reimbursed to the equipment companies, has been reduced even lower. You also have less oxygen equipment companies to choose from because bidders who were not among the lowest priced are excluded from the market and not allowed to serve new oxygen patients. Now there is less and less financial motivation for oxygen equipment supply companies to provide you up with a portable oxygen concentrator.

 




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