Anyone else have this issue with insurance?

I have PEEHIP (teacher) in a state which shall remain nameless. According to my policy, my insurance company will pay for two (2) CPAP masks per year. At the same time, my policy has a deductible for medical supplies (not to be confused with other deductibles) of $400, which is "coincidentally" about the cost of two masks.

So for my first and second masks within a given year I get charged because I haven't yet met the deductible, and for the third and fourth masks, I get charged because I have exceeded the maximum. (strange point- a couple of times over the last 6 or 7 years, the company actually did pay for the mask)

Anyone know if there's some way I can appeal this tomfoolery?

I hate to say it, but it sounds like you are out of luck with your insurance. My suggestion is to check eBay for masks, cushions, etc. I have purchased several masks and cushions there at much less than you can get them at a local or on line DME. Quite often you will see a listing for a cpap mask frame, but if you look at the picture and description, you will see it is for a complete mask.

Tanuge wrote:I have PEEHIP (teacher) in a state which shall remain nameless. According to my policy, my insurance company will pay for two (2) CPAP masks per year. At the same time, my policy has a deductible for medical supplies (not to be confused with other deductibles) of $400, which is "coincidentally" about the cost of two masks.

So for my first and second masks within a given year I get charged because I haven't yet met the deductible, and for the third and fourth masks, I get charged because I have exceeded the maximum. (strange point- a couple of times over the last 6 or 7 years, the company actually did pay for the mask)

Anyone know if there's some way I can appeal this tomfoolery?

Why do you need 4 masks a year. I use my mask for over a year and just buy a cushion when I think it's needed. Most insurance and Medicare only allow 2 masks per year. I don't know where you get your masks but they are available on line for MUCH LESS.

I can make a mask last two years or more if I just change out (in my case) the pillow. 4 masks a year would be an excess of riches for me. My insurance pays for almost nothing so I buy stuff off ebay....would you believe my insurance pays for two pillows a year?

I have 4- P10 masks and rotate them ever 4-5 days, some of the pillows are several years old and still good because I have installed O-rings on two of them. They still feel as good as new ones, almost... I have several new head bands on hand and have only had to replace one so far. They each get the HOT water treatment ever time they are used and cleaned.

I'm probably nuts, but it works for me....

grybeard77 wrote:I have 4- P10 masks and rotate them ever 4-5 days, some of the pillows are several years old and still good because I have installed O-rings on two of them. They still feel as good as new ones, almost... I have several new head bands on hand and have only had to replace one so far. They each get the HOT water treatment ever time they are used and cleaned.

I'm probably nuts, but it works for me....

I would really like to see pics of this O-ring setup.

O ring thread here
viewtopic.php?f=1&t=76193&p=696113&hili ... gs#p696113
unfortunately links to images are broken so if anyone uses the O rings and can get a picture of what it looks like to give people and idea what it is could you please post the image in the O ring thread?