Newbie - DME not covered question

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Berks
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Newbie - DME not covered question

Post by Berks » Tue Jan 16, 2018 7:34 pm

Hey - I just got diagnosed today with moderate sleep apnea. Unfortunately, my insruance doesn't cover the cost of a CPAP. I don't really mind the up front cost of a quality machine but it seems like the replacement schedule for parts is excessive and would get crazy expensive. Is it really necessary to replace parts that much? What do people do to afford it? (I'm sure this has been covered before but it didn't come up in my search of previous threads)

Thanks!

SewTired
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Re: Newbie - DME not covered question

Post by SewTired » Tue Jan 16, 2018 7:51 pm

No, you don't need to follow that schedule AT ALL for replacement parts. When you are paying for everything, you are not stuck to a schedule and can order AS YOU NEED IT. The schedule is for those who are getting their stuff paid for by insurance or Medicare.

Replace filters when you need to - some people have to do it biweekly, others not for months. Depends on the dust in your bedroom. Nearly all the filters sold online are not brand name - they are knockoffs, so you will get them relatively inexpensively. If you have allergy issues in warm weather, consider getting hypoallergenic filters.

I initially bought a mask based on what was most popular, but I also knew I wasn't a mouth breather. Bought it from our sponsor cpap.com. I suggest getting your mask from them and getting the replacement insurance until you know you have the perfect mask (you can exchange a mask that doesn't work for you). Be sure to carefully read the return policy. Masks (excluding Circadian which wear differently) can last anywhere from 7 months to over 2 years. Some only need part replacements rather than a full mask replacement. For some it's the headgear for others, its the mask.

Unless you step on your hose, your dog chews it, or some calamity happens, your hose can last for years. My brother has gotten about 2.5 years out of his hoses. I seem to step on mine - a problem I'm trying to solve. One backup is all you need.

I recommend having at least 1 backup humidifier bin. You can always order another one.

How often you replace nasal, full face cushions or nasal pillows depends on the person. I can get 4-6 weeks out of nasal pillows. Some get much longer, some a little less. With the exception of the Dreamwear cushions, when they start leaking, you can boil for 5 minutes and extend the life of the pillow. Doesn't seem to work with Dreamwear.

Finally, I recommend you figure out how to contain water when your humidifier bin eventually leaks without warning. For some it's a nonproblem, for others, it will damage stuff. I use a 1/2 inch melamine tray. I just don't want to deal with the cleanup. My brother's leaked when he was at a nursing home and anything on the floor would have been wet.

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Last edited by SewTired on Tue Jan 16, 2018 8:05 pm, edited 2 times in total.
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Pugsy
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Re: Newbie - DME not covered question

Post by Pugsy » Tue Jan 16, 2018 7:53 pm

It is NOT necessary to replace items per the allowance schedule or what the manufacturer "recommends". Remember they want you to buy more stuff as often as possible so they can make more money.

With common sense care these items can last months and years depending on what you do with your cleaning routine and which mask, etc.
I have a heated hose that went through 4 machines and I retire it with probably over 14,000 hours on it. Retired it because I finally got a new machine and it wouldn't work with the new machine.

It is a good idea to have one spare of each item though. You never know when something will get torn, dropped and broken or even the dog might decide the mask makes a good chew toy.
Couple of months ago I dropped the water chamber and broke the seal and it leaked something awful. Happened on a Friday night...I had a spare and didn't miss cpap therapy and had a new one ordered that night and it arrived 3 days later on Monday.

Masks....it depends on the mask and facial oils and cleaning routine. I use a nasal pillow mask and I can get 6 to 8 months out of one nasal pillow.
Insurance allows 2 per month. Now some people might not get that long out of a cushion or nasal pillow but with common sense care this stuff can last months even years because there are some parts that pretty much will last forever....plastic mask frames, short hoses, etc.

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SewTired
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Re: Newbie - DME not covered question

Post by SewTired » Tue Jan 16, 2018 8:09 pm

Pugsy wrote: I use a nasal pillow mask and I can get 6 to 8 months out of one nasal pillow.
I am so envious! No matter what cleaning routine I use, even just plain water once-in-a-while, I can't get more than 2 months out of a pillow, max.

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Diabetes 2, RLS & bradycardia
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jim22
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Re: Newbie - DME not covered question

Post by jim22 » Tue Jan 16, 2018 8:30 pm

I dont know if anyone mentioned it, but youncan also find a CPAP or APAP machine for less than a DME would charge.
Jim

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chunkyfrog
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Re: Newbie - DME not covered question

Post by chunkyfrog » Tue Jan 16, 2018 10:32 pm

Don't forget---a mask liner, like PadaCheek, can greatly extend the life of many mask parts.

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Berks
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Re: Newbie - DME not covered question

Post by Berks » Wed Jan 17, 2018 9:55 am

Thanks for the feedback everyone!

Berks
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Re: Newbie - DME not covered question

Post by Berks » Wed Jan 17, 2018 4:17 pm

chunkyfrog wrote:Don't forget---a mask liner, like PadaCheek, can greatly extend the life of many mask parts.
didn't see this post earlier... man I'm glad I found this forum. all the advice here is great - so much helpful information

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RiverDave
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Re: Newbie - DME not covered question

Post by RiverDave » Wed Jan 17, 2018 4:58 pm

Using DME is not worth it. There may be a few gems out there, but most don't know what they are talking about. Machines and equipment from DME will cost you (in my case) more than double for new online. If you want new equipment, there are places online to buy them. Used is even cheaper.

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dadbar1
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Re: Newbie - DME not covered question

Post by dadbar1 » Thu Jan 18, 2018 1:46 pm

Buy your supplies on line. They will be far cheaper. I replace my mask about once a year or so.

I use a ResMed nose mask- the wear parts for these (the silicone bits) are all available separately and last a long time. I usually wash mine out every few months.
On my Respironics series 60 machine, I just wash the filter in the sink by hand and reuse it. Unless you have a unusually dusty room it's not a big deal.

My DME tries to nickel and dime me to death by charging separately for the headgear even though it comes with the mask. And they badger me with robocalls every 3 months goading me to order more overpriced supplies online. I no longer fall for this moneymaking ruse.

I don't use the humidifier which makes things a whole lot simpler. If you can get away with using one, you will save money and hassle.

If you do a lot of traveling like I do, it pays to have a second machine for that. Travel puts a lot of wear and tear on them. I recently bought a new Dreamstation Go for travel- it is a fantastic machine.....replacing my old system 5 series Respironics unit which just started getting unreliable.
PR System One Auto A-flex
ResMed Mirage Ultra Mask
Sleepmapper for Android
No humidifier (I take my air shaken, not stirred)

Berks
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Re: Newbie - DME not covered question

Post by Berks » Fri Jan 19, 2018 12:49 pm

So I followed up with my union at work about CPAPs and supplies not being covered by my insurance. They told me I can purchase my CPAP and supplies any licensed medical company of my choice, as long as they can provide my with a tax ID number. I see a tax ID number on this page https://www.cpap.com/cpap-faq/Insurance.html but I can't find anywhere it says they are a "licensed medical company" - I'm sure it's obvious and I'm just not seeing it/understanding correctly... Anyone know the answer?

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Pugsy
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Re: Newbie - DME not covered question

Post by Pugsy » Fri Jan 19, 2018 12:50 pm

So if you jump through all their hoops and its a "licensed" company and has a Tax ID...are they going to help out with the money going out of your pocket?

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

Berks
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Re: Newbie - DME not covered question

Post by Berks » Fri Jan 19, 2018 12:57 pm

Pugsy wrote:So if you jump through all their hoops and its a "licensed" company and has a Tax ID...are they going to help out with the money going out of your pocket?


ha I guess I left out that detail... they said I can submit 1. Copies of doctor’s prescription, 2. Detailed invoice (including the billing codes) and 3. Proof of payment - then they will reimburse me at 80% and it usually takes 6-8 weeks to process...

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Pugsy
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Re: Newbie - DME not covered question

Post by Pugsy » Fri Jan 19, 2018 1:09 pm

I don't know what constitutes "licensed medical company" in your union's eyes...you need to check with them directly as to what requirements they have and who does the licensing.
Point them to the cpap.com website and ask if they fit the bill...they should.
I think if you ask cpap.com to send you a universal insurance form they will which will have the tax ID number on it.
They used to do this routinely when I bought a mask but I never printed it off because with my insurance it wouldn't matter anyway.

I am thinking that maybe "licensed medical company" might mean a real business as opposed to my selling you a machine and giving you an invoice type of thing but I can't be sure of that.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

Berks
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Re: Newbie - DME not covered question

Post by Berks » Fri Jan 19, 2018 1:33 pm

cool - I called CPAP.com who said they have a "medical device distributor license" - I just sent an email to my union to confirm that counts - I'd be shocked if it didn't...