klm49 wrote:That's curious Pugsy, I have medicare and my DME will give me a complete mask and extra cushions every 3 months. The mask and head gear are billed separate but it all comes in one package. I am sure Medicare is apying there billing as I have checked.
Medicare will pay for a mask every 3 months but they only pay for the headgear once ever 6 months.
Some DMEs will let the headgear that isn't covered at the 3 month mark to just slide and be happy with what Medicare pays minus the headgear. Some DMEs aren't happy and they won't let it slide. Mine isn't happy not getting paid for the headgear so they won't let me have a mask (and have Medicare be billed) but once every 6 months.
I always thought it was kinda stupid on Medicare's part to allow a new mask at 3 months but not the headgear but I guess maybe that is for people who already have the headgear and getting the same mask as they got before and supposedly won't need new headgear.
Mine won't give extra cushions/nasal pillows at the time of the 6 month mask purchase either...I have to wait a month and then I can get 2 each month...won't let me get 5 months of cushions/nasal pillows in one trip. I have to do the once a month thing....but it really isn't that big of a deal for me because my nasal pillows will last for months and months and months.
Right now I am working on 13 months on one nasal pillow.
Different DMEs can do different things depending on their own in house rules.
Your DME would rather sell 2 masks in 6 months and doesn't care that the headgear isn't covered on one of those mask packages. They still make more money selling the 2 masks minus one headgear than just selling one mask every 6 months.
I suspect they just adjust off the headgear portion of your bill when Medicare doesn't pay.
I may have to RISE but I refuse to SHINE.