Post
by Sonnyboy » Tue Dec 01, 2015 6:16 pm
I thought I had the perfect lifetime CPAP prescription.
Here is what happened today when I called to follow up on a late delivery.
My DME, Versus, told me my delivery was delayed due to their not having a prescription.
I reminded them they sent their first delivery to me 3 months prior so they did have a prescription and was told this was a complimentary delivery [not billed to Medicare] and did not require a prescription. [Strange answer. I will check my Medicare statements.]
I was told the Medicare schedule for pillow reimbursement is 5/month which is not true.
I also was told the doctor’s order needed to be very specific in terms of type of mask, quantity and frequency and every time I changed my mask type I would need a new prescription.
I faxed them my lifetime CPAP prescription during the phone call which allows me to choose my mask type and it was denied.
They sent me their requirements pasted below:
Choose ONE Machine type:
□ E0601 CPAP □ E0470 Bilevel
Pressure setting ________________ Pressure setting ________________
(blank is default to AUTO) *List additional diagnosis codes (if applicable)
□ E0471 Bilevel with backup rate, noninvasive
Pressure setting ________________
**Requires additional diagnosis – Dx:____________
Choose EITHER heated or non-heated Humidification
□ E0561 Non-Heated Humidifier □ E0562 Heated Humidifier
Choose ONE mask type and its corresponding cushions and/or pillows
□ A7027 Oral/Nasal Combo Mask, 1 per 3 months □ A7030 Full Face Mask, 1/3months
A7028 Oral Cushions, 2 per month A7031 Full Face Cushion, 1 per month
A7029 Nasal Pillows, 2 per month
□ A7034 Nasal Mask, 1 per 3 months □ A7044 Oral Mask, ______per ______month(s)
A7032 Nasal Cushion, 2 per month *contact payer for quantity and frequency
A7033 Nasal Pillows, 2 per month
Choose EITHER Heated or Non-Heated Tubing
All other supplies as needed as listed below:
A7036 Chin Strap, 1 per 6 months A7035 Headgear, 1 per 6 months
A7038 Disposable Filter, 2 per month A7039 Non-Disposable Filter, 1 per 6 months
A7046 Humidifier Chamber, 1 per 6 months A7045 Exhalation Port, contact payer for quantity/freq.
So if I want to change from a nasal mask to a full face mask in 3 months I must get a new prescription even though my doctor has checked off all types and written patient to choose.
This is crazy. Has anyone else experienced this???
Thank goodness we have CPAP.com. 2 days before Thanksgiving I ordered a new mask type using my original 1 year old lifetime prescription and received it yesterday. I placed my DME order with Versus about a month ago and do not know when I will receive it, apparently anywhere from 3 days to 2 weeks.
Based on today’s experience I regret I recommended Versus on this site.
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