Prescription Needed To Order New Mask

[jgcurtis1965]

Hi,
I am new to this forum. My Cpap just quit working and I was unable to get our local DME provider to sell me a new one. They said they only honor a prescription for 1 month from the day it was written so they wanted me to get a new sleep study and a new prescription even though I have been using a CPAP since 2010. I do not have access to my Dr. as he retired, but I did have a copy of my original prescription. I sent it to CPap.com and was able to order a replacement machine, since it had no expiration date marked on it. Funny how they were able to get me a replacement machine when my local DME provider wouldn't.

Anyway, I did not get a new mask with the machine because funds were tight. I now have the money to buy a new mask. My prescription for my CPap did not list which mask that I should use. Just that I was supposed to have a Auto CPap with a humidifier, and the initial settings that they wanted me to use. My question is being as the prescription did not list the type of mask that I should used is this going to keep me from being able to order a new mask? Is a separate prescription needed to order masks? I hope not because I don't want to pay for a whole new sleep study in order to be able to order masks, hoses, nasal pillows, ect.

[jcollins93012]

I was able to order a mask online w/o prescription by ordering the headgear and mask parts separately (in one order!). Assembled together they need a prescription; not assembled, no prescription needed. Welcome to dystopia.

[RogerSC]

You should be able to order any mask that you want using your cpap prescription. My cpap prescription doesn't specify a particular mask, just prescribes an apap. And that allows me to order any mask that I want to try. Your DME is an odd one, I've never heard of prescriptions only being good for a month, that's just weird, and not usual or customary in my experience. My prescription is about 4 years old now, and is still being observed and treated as valid by cpap,com (and my DME as well, who keeps trying to get me to buy more all the time *smile*) on any mask that I want to try.

In other words, you should be able to send your cpap prescription to cpap.com and order whatever mask that you want to try. Sounds like you need a new DME to me. It would be unwise for your sleep doctor to limit you to only one mask in any case, and they know that. So what not specifying a particular mask means is that you can just try any that you want to try. Sleep doctors in general just want you to get the best therapy. DME's seem to want to make the most money, and don't care much about the individual patient or their needs.

[Roman Hokie]

If your doctor was affiliated with a particular hospital, reach out to that hospital (or even the sleep lab where you were studied) to find out where his records might be. Of course, if he was a part of a medical practice, you could always see if they might direct you to the right place. Just because a Dr. retires doesn't mean he isn't responsible somehow for the retention of your records. That's the first thing.

Second, as others have said, 30 days to fill a Rx? That's ridiculous. That's typical for narcotics/controlled substances in several (all?) states, but for CPAP supplies? My DME for the past few years requires a new Rx every 15 months. Which was news to me as well. And my primary won't cosign on my sleep Rxs.

Regardless, if you're paying cash, and have your Rx here at CPAP.com, the fine folks here should be able to hook you up.

Good luck!

[LSAT]

CPAP prescription includes a mask whether it is listed or not. The prescription is good for a minimum of a year and possibly for 99 years. If you have a copy of your prescription you can go to any DME that is in your insurance network or if insurance is not involved you can go anywhere. If you don't already have it...get and keep a copy of your sleep study and your prescription.

[Sonnyboy]

I recently posted regarding a similar issue.

My doctor wrote a 99 year prescription in 2014 accepted by my first DME and Cpap.com as well. The various types of masks are listed on my doctor's prescription along with the correct billing codes. Patient to choose is also checked.

When I was transferred to a second DME for supplies, my MD prescription was not accepted because the new DME requires a separate prescription for each type of mask. The new DME independently contacted my doctor to sign a new order listing one type of mask only and I learned of this by chance and months after the fact.

I am also disturbed that a DME would call an MD to change a patient's prescription on file without contacting the patient. Doctor's can close practice suddenly for various reasons. I lost 2 doctor's this year, one to retirement and one to sudden serious illness.

Now my MD prescription on file with the medicare contracted DME lists one type of mask only. Next time I see my sleep doctor I will be asking for four life time prescriptions, one for each type of mask, and hope each of these prescriptions will be accepted in the future if I decide to order a new type of mask.

[amenite]

... Next time I see my sleep doctor I will be asking for four life time prescriptions, one for each type of mask, and hope each of these prescriptions will be accepted in the future if I decide to order a new type of mask.

In the beginning I was really surprised this even comes up as a question. The mask requirement is implicit in the prescription/order and nothing should need to be explicitly specified about a mask. The prescribed CPAP treatment cannot be applied without one. How a DME can get away with jerking people around like this is a mystery to me but I guess it mostly comes down to who can and who cannot afford to walk away from a DME for financial reasons.

[jgcurtis1965]

Thanks everyone for your replies. I thought it was crazy when they told me it was only good for a month! I live in a very rural area and they are the only DME provider within a 60 mile area. They
know this and I think it is a gotcha kind of thing since there aren't other options in the area. I was able to send it to CPap.com and get a replacement machine. At the time I ordered my replacement machine funds were tight and I couldn't afford the mask too so I used my old mask. I was questioning the ability to order a new mask because I have seen other posts that mentioned needing a prescription for a mask.

[Sonnyboy]

... Next time I see my sleep doctor I will be asking for four life time prescriptions, one for each type of mask, and hope each of these prescriptions will be accepted in the future if I decide to order a new type of mask.

In the beginning I was really surprised this even comes up as a question. The mask requirement is implicit in the prescription/order and nothing should need to be explicitly specified about a mask. The prescribed CPAP treatment cannot be applied without one. How a DME can get away with jerking people around like this is a mystery to me but I guess it mostly comes down to who can and who cannot afford to walk away from a DME for financial reasons.

I asked the DME for documentation supporting their demands and was sent:

https://www.cgsmedicare.com/jc/mr/pdf/M ... t_PAP1.pdf

"Refill request for non-consumable supplies" was shaded yellow by the DME. [Page 3-4]

Looks like specific prescription demands may be a prospective question when shopping for a DME change or simply buying from Cpap. com to avoid the hassel.

[LSAT]

Thanks everyone for your replies. I thought it was crazy when they told me it was only good for a month! I live in a very rural area and they are the only DME provider within a 60 mile area. They
know this and I think it is a gotcha kind of thing since there aren't other options in the area. I was able to send it to CPap.com and get a replacement machine. At the time I ordered my replacement machine funds were tight and I couldn't afford the mask too so I used my old mask. I was questioning the ability to order a new mask because I have seen other posts that mentioned needing a prescription for a mask.

If cpap.com has your prescription on file you can order masks from them.

[palerider]

[
I asked the DME for documentation supporting their demands and was sent:

https://www.cgsmedicare.com/jc/mr/pdf/M ... t_PAP1.pdf

"Refill request for non-consumable supplies" was shaded yellow by the DME. [Page 3-4]

Looks like specific prescription demands may be a prospective question when shopping for a DME change or simply buying from Cpap. com to avoid the hassel.

yes, the simple solution is to not give them anymore of your money.... and I'd tell them why, if I were you

"your stupid restrictions have lost you a customer"

you can buy masks online, mask parts on amazon, and ebay... rarely do you need a whole new mask, just new pillows or whatever.

[Sonnyboy]

[
I asked the DME for documentation supporting their demands and was sent:

https://www.cgsmedicare.com/jc/mr/pdf/M ... t_PAP1.pdf

"Refill request for non-consumable supplies" was shaded yellow by the DME. [Page 3-4]

Looks like specific prescription demands may be a prospective question when shopping for a DME change or simply buying from Cpap. com to avoid the hassel.

yes, the simple solution is to not give them anymore of your money.... and I'd tell them why, if I were you

"your stupid restrictions have lost you a customer"

you can buy masks online, mask parts on amazon, and ebay... rarely do you need a whole new mask, just new pillows or whatever.

I agree and likely I will do this but it is a shame given I pay for Medicare and additionally for a Medigap supplemental policy and all supplies should be covered 100%. So to me the whole DME/Medicare issue regarding multiple prescriptions and multiple MD visits for a lifetime medical supply need is just ridiculous and only benefits the DME supplier and possibly the MD too.

[chunkyfrog]

Huh? My Medicare is much less restrictive.
My original sleep study (2010) was good enough, though the lab is not even "approved" by Medicare
I need a new doctor's note each year, mostly to reassure Medicare that I am still alive.
Could you have an "Advantage" plan, (that can be OK in some places, but horrific in others)?
Edit: Sounds like you have a Plan F, like me. I would contact Medicare directly.

[Sonnyboy]

Huh? My Medicare is much less restrictive.
My original sleep study (2010) was good enough, though the lab is not even "approved" by Medicare
I need a new doctor's note each year, mostly to reassure Medicare that I am still alive.
Could you have an "Advantage" plan, (that can be OK in some places, but horrific in others)?
Edit: Sounds like you have a Plan F, like me. I would contact Medicare directly.

Hi Chunkyfrog,
Checkout: https://www.cms.gov/Regulations-and-Gui ... m83c05.pdf
These are the Medicare rules updated 11/2015.
Reading this stuff totally clogs my brain.
It appears that my new DME is totally anal when it comes to following Medicare rules or maybe the rules or changing?

[palerider]

I agree and likely I will do this but it is a shame given I pay for Medicare and additionally for a Medigap supplemental policy and all supplies should be covered 100%.

here's a thought... maybe a DME with more sane rules somewhere else, where you've got friends, could get your rx, fill it for you, and you could get a friend to pick the stuff up and mail it to you... if that DME wouldn't ship...?