this is a rant...

[jstl]

So I called a company (180 Med) to find out what my out of pocket expense would be for my supplies after Medicare coverage. I have traditional Medicare. They told me I would have to set up an account to find out. To set up an account, I have to provide my doctor's contact info and my Medicare #. Why do they need access to my doctor when I haven't yet agreed to buy from them? How is this ok? Do any of the suppliers offer transparency in their pricing or at the Medicare stage do you just have to take your chances that they are above board? What happened to no surprise medical bills? I've been paying out of pocket up til now and it would help to have coverage, but I need to know if I will actually pay less with coverage than I do without. This shouldn't be so hard....... End of rant. Thank you.

[Mara]

You should certainly be able to find out costs without giving your personal information I would hope - if not, take your business elsewhere. In my case Medicare pays 80% and my supplementary the remaining 20% so I don't really need to know the details as I believe Medicare pays the same to all providers. But it sounds like you might not have supplemental coverage so you need to know...good luck!

[jstl]

Hi Mara,
Thanks for your response. I actually have both traditional Medicare and a supplemental so yes, Medicare would pay 80%, Supplemental would pay 80% of the 20% not covered by Medicare, and I would pay the rest, which presumable would be a low amount. My position is: First, I haven't met my deductible yet, so I would incur a greater cost until I do meet it - and as a product user, I want to know ahead of buying what my cost will be. I can't think of another context in which would I agree to buy something without knowing the cost upfront. Also, as a taxpayer, I would like to know how much is charged to Medicare for the products I use (are prices inflated, discounted?). Even if Medicare were to pay 100% of the cost, I would still have stake in knowing the total cost. Our supply companies should have accountability to us as users of products and as taxpayers.
The requirement to provide my physician's contact information and Medicare number just to get a price seems less than on the level to me. The rep could not explain why they needed this info, just that it is part of the process of setting up an account. I'm just a bit irked, incensed, or what ever word is correct, that because I depend on the products, I'm expected by the company to agree blindly to whatever terms they set.

[Bob Webtech]

Hi jstl,

First, I hope you realize that the particular supplier you called (180 Medical) is owned by a manufacturer (ConvaTec), so they don't sell any brands of ostomy supplies except ConvaTec supplies. I would prefer to order from a supplier which is manufacturer-neutral, rather than a supplier owned by a manufacturer.

You can certainly find the amounts Medicare would pay for the products. In fact, I've posted a list on the website I do for my local support group -- see https://www.ostomyok.org/newsletter/news1603a.shtml -- but some caveats in using this list: These amounts change every year. The amounts currently posted on that site are for 2022. The current rates (for 2024) appear to be 11.5% higher than the 2022 rates. Also, that list is for Oklahoma, and some of the rates vary in different states. You can find the latest rates in each state by downloading from a Medicare website at https://www.cms.gov/medicare/payment/fe ... dule/dme24 -- this downloads a compressed file with many files inside it. After expanding that file, the individual file you'll want is named DMEPOS_JAN.xlsx

Also, the amount you'll pay depends on whether your supplier accepts Medicare "assignment", i.e., whether the supplier accepts the Medicare fee as full payment. Some suppliers state on their websites whether they accept Medicare assignment.

[jstl]

Thank you so much, Bob! Those are great resources! I appreciate it.