Prescription needed to order nasal cushions/mask parts?

[pwgphoto]

I was under the impression, which could be wrong, that I didn't need a prescription to order mask parts. A whole mask yes, but not for parts. I think I read it on one of these forums. When I called my DME today to order cushions, my contact said I needed a prescription to order the cushions and my doctor did not list supplies on his original order. She said that my doctor usually sends a separate RX for supplies and parts. I told her I thought I didn't need one for parts, like cushions and she said I did. I told her I could go to cpap.com an order parts without one (at least I thought I could).

So am I wrong? She said she would sent the doctor the request for the RX and it shouldn't be a problem and I really don't care as long as I don't have to go see, or pay, the doctor every time I need supplies. She also said she would request that he write the RX for all my needs in the future.

[LSAT]

Mask parts do not require a separate prescription. If you have a prescription for machine and mask it should cover parts. My prescription on file at my DME is 4 years old and I can get whatever I need. E-Bay has parts without prescription as does cpap.com.

[Cardsfan]

I bet you need the prescriptiion for parts to make sure your insurance pays. (not 100% sure of this)

[chunkyfrog]

I bet you need the prescriptiion for parts to make sure your insurance pays. (not 100% sure of this)

Insurance companies are often known for making the patient jump through hoops to get anything.
Complain to your benefits manager at work.

[Cardsfan]

I just checked. I have 2 different papers. One looks like a regular prescription that says RX sleep apnea, cpap machine
5 Cm h20.
I also have a paper titled "Physician Certification for Positive Airway Pressure Devices" It Looks like a really lenghty prescription. It says "good for 99 months, lifetime". And then lists 10 different items that need to be replaced, their insurance code #, the replacedment rate, and amount of items. One line reads:
A7032 Replacement Nasal Cushion devices. 2/one month.

But it lists every replaacement part you can think of, with the insurance code. I think you will only need to get this info. one time as it looks like it is good for life. I sent both of these papers to my DME, and for a year so far, had no problems.

[Wulfman...]

I was under the impression, which could be wrong, that I didn't need a prescription to order mask parts. A whole mask yes, but not for parts. I think I read it on one of these forums. When I called my DME today to order cushions, my contact said I needed a prescription to order the cushions and my doctor did not list supplies on his original order. She said that my doctor usually sends a separate RX for supplies and parts. I told her I thought I didn't need one for parts, like cushions and she said I did. I told her I could go to cpap.com an order parts without one (at least I thought I could).

So am I wrong? She said she would sent the doctor the request for the RX and it shouldn't be a problem and I really don't care as long as I don't have to go see, or pay, the doctor every time I need supplies. She also said she would request that he write the RX for all my needs in the future.

Technically, you're correct in your thinking. However, "Cardsfan" may have a point......AND......convincing your DME that they're "WRONG" may be an uphill/losing battle.

https://www.cpap.com/cpap-faq/Prescriptions.html

Prescriptions

Federal law requires we have a valid prescription on file before shipping your mask, machine and/or humidifier. To fulfill the requirement, please submit a script with a future expiration date, written for "lifetime need", or "99 months". As long as the prescription has these prerequisites, you can purchase CPAP equipment.

Even if you are making the purchase of a prescription-required item without insurance, we will need a prescription to fulfill the order based on Federal regulations. It is possible that you have previously purchased equipment without an Rx, but going forward all machines, masks, and humidifiers must be purchased with a prescription. CPAP Accessories and mask assembly kits are the only pieces of equipment sold without without a prescription.


viewtopic.php?f=1&t=43532&p=386201&hili ... on#p386201

https://www.cpap.com/DisplayNewsletter/77

viewtopic.php?f=1&t=47518&p=429546&hili ... on#p429546


Den

.

[IDontSnoreISwear]

I was under the impression, which could be wrong, that I didn't need a prescription to order mask parts. A whole mask yes, but not for parts. I think I read it on one of these forums. When I called my DME today to order cushions, my contact said I needed a prescription to order the cushions and my doctor did not list supplies on his original order. She said that my doctor usually sends a separate RX for supplies and parts. I told her I thought I didn't need one for parts, like cushions and she said I did. I told her I could go to cpap.com an order parts without one (at least I thought I could).

So am I wrong? She said she would sent the doctor the request for the RX and it shouldn't be a problem and I really don't care as long as I don't have to go see, or pay, the doctor every time I need supplies. She also said she would request that he write the RX for all my needs in the future.

You're not wrong. The DME could sell you parts if they wanted to, but it's not profitable enough. I needed pillows and asked a local DME and they refused to sell to me unless I became their client for everything. (Nope!)

[archangle]

The medical mafia protects their profits. The doctor$ like you to have to make unnecessary office vi$it$ in order to get pre$cription$ and supplies.

The DME's want to be on the good side of the doctor$, so they tend to not want to do anything that might pi$$ off the doctor$.

[Cardsfan]

I don't think the medical field is trying to screw him over. He is just missing a certifiication to get his ins. to pay for the parts he needs. His DME has already said they were going to contact the Dr. office to get it. And that should be good for his lifetime needs.
And to the OP- you can contact your Dr. office and request a copy of your prescrption and certifiction for supplies so you have it- make sure it says it is good for 99 months, (lifetime). I took a pic. of mine on my cell phone and keep it. That way, if you ever need suppliies in a hurry, you can email it to any vendor you want.

[johnnygoodman]

Howdy All,

Den asked me to chime in here. Your DME needs a prescription for mask parts, but not for the reason they gave you. Your DME needs a doctors order (aka prescription) in order to make the mask parts they provide you billable per common insurance policy of denying claims for all items not explicitly doctor ordered.

The prescription side is a little less firm but here's the deal. The FDA defines the class of medical devices and their prescription level. CPAP is Class II meaning you need a doctors order. The manufacturers are regulated by the FDA and have to mark items that are prescription required as prescription required on their labeling. For things with serial numbers, they do this carefully and properly most of the time. For things like mask clips, it is rare anyone bothers to label it as prescription required. Reasonably, it shouldn't be and technically, without the label no Rx is required. This is true of any product coming off the line from a mfg. As they label it, so it is, as we they are doing so in compliance with and at the direction of the FDA.

From the dealer side, be it CPAP.com or a DME, we are regulated by the states. We are to have Rxs on file for products requiring Rxs. The regulations don't explicitly state which products require a prescription - they only say we inherit the policy of the FDA. Usually the people conducting the inspections are former RTs and so the convention is machines, humidifiers and masks need Rxs though other inspectors will say "anything with Rx printed on the label is Rx". There have been situations where a given product had the rx printed on the label for a run, then changed to not be on the label, then changed back.

Most dealers don't get this far into the weeds or aren't even aware this is a thing.

For our part, we watch the products we buy and adjust what can or can not be kitted based on the direction we receive from manufacturers based on their labels. We adjust kits available accordingly. Other dealers do other things, often opting to work a little closer to the horns. The thing is, they are involving their customers in that behavior too, likely unwittingly. Reasonably you'd say "so what, we're talking about $5 of plastic here." The regulatory environment in our country is punitive and excessive. It seems unlikely that a regulator would involve customers is an issue discovered but after what I've seen and the experiences I've heard others in the industry endure, I'd rather not risk it for our customers or our business. So we go off the labels per batch and comply with the letter of the law as best we can in good faith.

Johnny

[Sir NoddinOff]

Howdy All,

Den asked me to chime in here. Your DME needs a prescription for mask parts, but not for the reason they gave you. Your DME needs a doctors order (aka prescription) in order to make the mask parts they provide you billable per common insurance policy of denying claims for all items not explicitly doctor ordered.

The prescription side is a little less firm but here's the deal. The FDA defines the class of medical devices and their prescription level. CPAP is Class II meaning you need a doctors order. The manufacturers are regulated by the FDA and have to mark items that are prescription required as prescription required on their labeling. For things with serial numbers, they do this carefully and properly most of the time. For things like mask clips, it is rare anyone bothers to label it as prescription required. Reasonably, it shouldn't be and technically, without the label no Rx is required. This is true of any product coming off the line from a mfg. As they label it, so it is, as we they are doing so in compliance with and at the direction of the FDA.

From the dealer side, be it CPAP.com or a DME, we are regulated by the states. We are to have Rxs on file for products requiring Rxs. The regulations don't explicitly state which products require a prescription - they only say we inherit the policy of the FDA. Usually the people conducting the inspections are former RTs and so the convention is machines, humidifiers and masks need Rxs though other inspectors will say "anything with Rx printed on the label is Rx". There have been situations where a given product had the rx printed on the label for a run, then changed to not be on the label, then changed back.

Most dealers don't get this far into the weeds or aren't even aware this is a thing.

For our part, we watch the products we buy and adjust what can or can not be kitted based on the direction we receive from manufacturers based on their labels. We adjust kits available accordingly. Other dealers do other things, often opting to work a little closer to the horns. The thing is, they are involving their customers in that behavior too, likely unwittingly. Reasonably you'd say "so what, we're talking about $5 of plastic here." The regulatory environment in our country is punitive and excessive. It seems unlikely that a regulator would involve customers is an issue discovered but after what I've seen and the experiences I've heard others in the industry endure, I'd rather not risk it for our customers or our business. So we go off the labels per batch and comply with the letter of the law as best we can in good faith.

Johnny

Thanks for clearing that up Johnny and for making it easy to understand

[chunkyfrog]

Thank you, Johnny.
This also helps explain why some vendors may be so inflexible,
inspecting each batch (and trusting that nothing was missed) would be too much work/worry for most.
Thank you, once again, for all you do.