Can I have more than one dme at a time

[knightlite]

My problem is I have 8 months to go on my medicare rental machine(then it will be mine) but my dme is not wanting to give me supplies medicare says I can have. I want this machine to become my back up machine in the end . I am purchasing (out of pocket) a new better machine now (From this online supplier) but I don't want trouble with medicare. Can I go to another dme for supplies without notifying the other dme. I just want a backup mask and some occasional supplies. I don't want to be one of those demanding every single supply I can get, I know the medicare piggy bank is low . I intend to make my masks last 8 months or so with a cushion change out at times because of my oily skin.
If this is not kosher then I won't do it ! I would just like to know.
Thanks for all the great info on this forum seems everybody is trying to help others. Thanks for the sleepy head people--- it helps your best doctor , your own brain.

[Pugsy]

Can I go to another dme for supplies without notifying the other dme.

Yes, you can go to any DME you wish for those supplies. The new DME will still need a copy of your RX though.
Just explain things to them...you aren't happy with supply service and are tied into the machine rental through the first DME but want to buy your masks and other supplies from someone who will adhere to the replacement guidelines that Medicare has set up. Tell them the truth.
That's what I did with my current DME. I didn't buy my machine from them (actually paid for it out of pocket but it doesn't really matter where it came from).
Now you might run into a DME that doesn't want your business without the machine business...they are greedy. There's no reason for that at all.

[chunkyfrog]

My first machine was paid for by insurance, and that DME sold me maybe 3 masks.
Then I changed (never told the first guys, and stayed cordial, just let them know I couldn't afford them)

[Jay Aitchsee]

What reason has your DME given for not filling your requests? As you seem to be aware, medicare will pay for more equipment than the average person should need. Maybe your DME is like mine and doesn't like to order something unless he sees me. I think, but don't know, he can charge for an office visit if I sit down with him rather than just ordering over the phone. The other thing DME's tend to do is push equipment that you don't need. For example, you might get a mask and the DME will provide 2 more sets of cushions with it which will be for your next two month's allowance.
The only reason I can think of not to go to another DME is to be sure you haven't already used your current medicare allowance through your current DME.

[knightlite]

Well I was refused a new mask after 90 days , dme says that all his masks come with headgear so he can't give me a mask until the 6 month point , I had already posted this info to see if that was a common practice. He did agree to give me a new cushion and a hose. maybe this is his way of policing people who demand too much . He also stated the the two machine filters are lifetime . Which I know is not right . He is a small time dme owner with lots of experience in the field , I kind of like him , and perhaps he is busy trying to please medicare . But in the end I will switch . I am glad that I'm not a DME with this new competitive bidding coming down the way. He also refused to give me a apap by my prescription , he did give me a new 460p that has auto trial and that was a better machine than any of the others around here were giving out. I realize he has to have room to make money so I relented. Being a baby boomer I know things are going to change fast now because we are the big wave hitting the senior circuit.
I have a clue on a new dme
Thanks Jay,pugsy,chunky, all good advice hope this topic helps some other folks.

[Jay Aitchsee]

Here's a link to a guide published by Phillips regarding medicare replacement. I can not verify the accuracy, but I can tell you that I have received several masks from my DME without headgear.
http://www.respironics.vgm.com/files/Me ... t-2012.pdf

[Jay Aitchsee]

It sounds as if the real problem here is the headgear. You can get a new mask every 90 days, but new headgear only every six months. So, one way around this is to get the mask, without headgear, from your DME and then get the headgear out of pocket from our host. Now, I suppose it's possible that there are some masks where the headgear is intregal and this strategy might not work.

J

[fredr500]

I've been looking at the Tap Pap Nasal Mask https://www.cpap.com/productpage/tap-pa ... .html#back since reading Pugsy's reviews of it.

Does that mean I can get one 3 months after getting my last (actually my first) mask? Since it has no headgear and the prices seem to line up it appears that I'm eligible every 3 months?

Right?

[Jay Aitchsee]

Does that mean I can get one 3 months after getting my last (actually my first) mask? Since it has no headgear and the prices seem to line up it appears that I'm eligible every 3 months?
Right?

Fred, unless something has changed in 2013 that I'm not aware of, you should be eligible for a new mask every 3 months under medicare rules. Go for it.
J

[Nooblakahn]

It sounds as if this Dme is just a hard ass or uninformed. You are eligible for a new mask every three months... but headgear at 6. I think the idea is to switch out the pieces of your current mask... not really a new mask. I know my Dme would throw the headgear away... but would still give me the mask. Mine did tell me that if I switch mask types at 3 months... they will give me the new headgear free of charge, and mentioned most Dme s would not do this. Still I don't see them denying you what you are due. Not like they don't get paid for what they provide...

[StuUnderPressure]

I just got a new Nasal Mask covered by Medicare.

For the actual mask, Medicare's regs say "with or without headgear"

I take that to mean that they pay the same with or without the headgear.

Regardless, I got a new ResMed SoftGel Nasal Mask WITH the headgear in the same sealed ResMed plastic bag.

In addition to that, the DME ordered & shipped to me AND Medicare paid for a separate Headgear - all in the same order & Medicare claim. The Headgear was in a separate sealed ResMed plastic bag.

Did the DME pay for 2 Headgears, but was only reimbursed by Medicare for 1?

The DME says no.
I actually tried to return the separately packaged Headgear to them because I figured they would ask for it later when they realized that they were only paid for 1.
The DME told me they do it this way all of the time & Medicare always pays for it.

Now, I do question whether the outcome would have been different if they had my Nasal Mask in stock & did not have to order it & ship it to me directly.
I am thinking that then I may have gotten only 1 Headgear - even if Medicare would have paid for 2. Nah - a DME would NOT do that would they?

Below is the detail of the claim that Medicare paid.
The 1st amount for each item is what the DME charged.
The 2nd amount for each item is what Medicare reduced it to.
Notice the part "I" posted in red.
Although it was truncated, it does normally read "with or without headgear".

Procedure Details
Claim Line # Procedure Code Total Units Date Amount Charged Medicare Approved Amount
1 A7034 - Nasal Interface (Mask Or Cannula Type) Used With Positive Airway Pressure Device, With Or Wi 1 01/14/2013 $140.00 $109.77
2 A7035 - Headgear Used With Positive Airway Pressure Device 1 01/14/2013 $50.00 $35.29
3 A7036 - Chinstrap Used With Positive Airway Pressure Device 1 01/14/2013 $28.00 $15.11

[edm_msu]

I've been looking at the Tap Pap Nasal Mask https://www.cpap.com/productpage/tap-pa ... .html#back since reading Pugsy's reviews of it.

Does that mean I can get one 3 months after getting my last (actually my first) mask? Since it has no headgear and the prices seem to line up it appears that I'm eligible every 3 months?

Right?

It is doubtful. I have BCBS insurance and I think Medicare has a similar policy. BCBS will only pay approved DME's. There are no internet approved DME's, including cpap.com. Unless your DME can get the Tap Tap, BCBS, and probably Medicare, will not cover it. The Tap Tap is not made by a large company such as Resmed.