Can I still get a mask

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
smith972
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Can I still get a mask

Post by smith972 » Tue Apr 17, 2018 10:16 pm

I am not using my insurance to get my machine because my insurance ends at the end of the month....we just can't afford COBRA for me and hubby.
The hospital gave me the mask that they used for my sleep study. I am a mouth breather so I have respironics amara view. I only used it that one night but I was able to read and watch tv as I drifted off. I like it...but I have used it for only one night....who knows how I will feel after a few nights.

Anyway.....Can I go to a local DME to get masks thru the insurance? Just thinking I might be able to actually get something free since we have already met our out of pocket part and everything else is covered at 100%.

Thanks

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palerider
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Re: Can I still get a mask

Post by palerider » Tue Apr 17, 2018 10:39 pm

smith972 wrote:
Tue Apr 17, 2018 10:16 pm
I am not using my insurance to get my machine because my insurance ends at the end of the month....we just can't afford COBRA for me and hubby.
The hospital gave me the mask that they used for my sleep study. I am a mouth breather so I have respironics amara view. I only used it that one night but I was able to read and watch tv as I drifted off. I like it...but I have used it for only one night....who knows how I will feel after a few nights.

Anyway.....Can I go to a local DME to get masks thru the insurance? Just thinking I might be able to actually get something free since we have already met our out of pocket part and everything else is covered at 100%.

Thanks
If you've got a prescription, yes.

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chartle
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Re: Can I still get a mask

Post by chartle » Thu Apr 19, 2018 7:55 am

You can probably get one mask but for replacements insurance is going to use some sort of schedule. In my case its something like a new cushion ever 90 days, frame every 6 months, straps every 6 months, hose maybe every year, machine every 5 years.

They are not going to cover say 6 masks only one so the DME will sell you 6 masks but insurance will only pay for 1.

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gwc2795
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Re: Can I still get a mask

Post by gwc2795 » Thu Apr 19, 2018 8:03 am

I hope this helps.
https://www.bonanza.com/booths/Best_Savings_CPAP
We have to pay for my wife's cpap supplies out of pocket and I use Bonanza.com for some things. The link above has very good prices and free shipping. When I pay I use the Paypal option for added assurance of receiving what I have ordered.

Gerry

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Pugsy
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Re: Can I still get a mask

Post by Pugsy » Thu Apr 19, 2018 8:18 am

From another thread from the OP in this one.
She has been able to get the RX and is going to take it to the DME and get a mask using insurance (while she has it) and will be able to try on several masks to make sure it works decently for her.

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Pugsy
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Re: Can I still get a mask

Post by Pugsy » Thu Apr 19, 2018 9:30 pm

I found a machine that she can have. It was donated by someone. It came today and will go out tomorrow.
It's the PR S1 60 series Auto Bipap....high hours but still have 2 or 4 years left. It's essentially silent only noise I could ear was with my ear laying on the machine with it on and me breathing. Humidifier included.
It isn't set up for heated hose at this time but later if it needs to be changed then it can be done later. Probably won't even be needed until next fall/winter.

If anyone has any white fine filters for the Respironics models...I only had 2..put one in after washing the foam filter and she has 1 left.
It's all I had that I could find......if anyone has any PR S1 white filters...that you don't need...she could use them. Get them out of your hair if you won't use them again.

She has to meet compliance right from the moment she gets it so that she can then start CDL driving school....and get this she will be close to where I live. Eventually hope to meet her and give hands on help with the machine if she needs it.

To make it easy we are just doing cpap mode at fixed 8 for now and then if we have to do the other I can walk her through it.
Right now her eyes will glaze over with all the options. 8 was what they came up with at the titration study.
She Needs a SD card. I couldn't find my spare.


Oh...to OP here...you need to go get SleepyHead
https://sleep.tnet.com/equipment
There is some data on the screen but it is so limited it's pretty much useless.

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smith972
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Re: Can I still get a mask

Post by smith972 » Fri Apr 20, 2018 11:38 am

Pugsy wrote:
Thu Apr 19, 2018 9:30 pm
I found a machine that she can have. It was donated by someone. It came today and will go out tomorrow.
It's the PR S1 60 series Auto Bipap....high hours but still have 2 or 4 years left. It's essentially silent only noise I could ear was with my ear laying on the machine with it on and me breathing. Humidifier included.
It isn't set up for heated hose at this time but later if it needs to be changed then it can be done later. Probably won't even be needed until next fall/winter.

If anyone has any white fine filters for the Respironics models...I only had 2..put one in after washing the foam filter and she has 1 left.
It's all I had that I could find......if anyone has any PR S1 white filters...that you don't need...she could use them. Get them out of your hair if you won't use them again.

She has to meet compliance right from the moment she gets it so that she can then start CDL driving school....and get this she will be close to where I live. Eventually hope to meet her and give hands on help with the machine if she needs it.

To make it easy we are just doing cpap mode at fixed 8 for now and then if we have to do the other I can walk her through it.
Right now her eyes will glaze over with all the options. 8 was what they came up with at the titration study.
She Needs a SD card. I couldn't find my spare.


Oh...to OP here...you need to go get SleepyHead
https://sleep.tnet.com/equipment
There is some data on the screen but it is so limited it's pretty much useless.
I can't thank you enough. I also can't wait till I can pay this forward and be a blessing to someone else. I am so excited to get on with this next chapter in my life. I am excited that I will be able to see more than the east coast. I currently eat, breath and sleep truck driving.

Thank you again.....over and over again. Once I upgrade to my own truck I will make it my business to meet you in person and give u a hug....yes I am one of those folks that loves to hug.

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smith972
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Re: Can I still get a mask

Post by smith972 » Fri Apr 20, 2018 4:10 pm

Lincare called me today about getting a mask and heated tube thru the insurance company. She told me the Dr has to write out a new RX that specifically says full face mask and heated tube. She also said she needs my chart notes????

Has anyone had this experience before. Is this normal.

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LSAT
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Re: Can I still get a mask

Post by LSAT » Fri Apr 20, 2018 4:50 pm

The chart notes are to confirm that you have been seeing your doctor to review your CPAP progress. Normal for some DME/Ins Companies. Heated hose and masks are available on Amazon.....no prescription.

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DavidY
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Re: Can I still get a mask

Post by DavidY » Fri Apr 20, 2018 5:04 pm

If one is in Canada, no prescription is required for masks and any accessories. Only a CPAP unit requires a prescription.

Dave

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Pugsy
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Re: Can I still get a mask

Post by Pugsy » Fri Apr 20, 2018 5:18 pm

Don't worry about the heated hose thing...they are specific to the brand unless you get the stand alone heated hose like the Hybernite.

And you don't need a RX for the heated hose anyway...that's bull shit.

The machine I am sending you...isn't heated hose capable unless we change out the power supply and then the kit comes with a heated hose.

If you want or need a heated hose....you first need a machine and the one I am sending is capable only if we do the upgrade kit thing...which can be done and is easy to do...I did it myself with my machine.
This...
https://www.cpap.com/productpage/pr-hea ... e-kit.html

We can find you some masks to try...I need to have a chat with you first though..
Will send you a PM in a bit..phone call is easier than typing so much. I know some people who want to help you with a mask but I need some info from you about sizing first.

And...a RX for a cpap machine is usually sufficient for any other equipment supplies and that includes masks.
My RX doesn't mention a mask at all...just says cpap with heated humidity at so and so pressure...and I have been getting masks for over 8 years with that RX.
More typical DME bullshit...that's what you are hearing.

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smith972
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Re: Can I still get a mask

Post by smith972 » Fri Apr 20, 2018 5:21 pm

LSAT wrote:
Fri Apr 20, 2018 4:50 pm
The chart notes are to confirm that you have been seeing your doctor to review your CPAP progress. Normal for some DME/Ins Companies. Heated hose and masks are available on Amazon.....no prescription.
Since we have reached our out of pocket max for the year...it's just April...and I will be dropped off the insurance at the end of the month, I was hoping to get something free from Cigna. I am being dropped at the end of the month because COBRA kicks in and to cover my husband and I it will cost 1300 a month. So we will just pay his COBRA 600 and keep his coverage as he is sicker than me.

Our yearly out of pocket is 4899

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Additional Comments: I dont have the bluetooth nor the heated features with my machine but there was no option without it

smith972
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Re: Can I still get a mask

Post by smith972 » Fri Apr 20, 2018 5:24 pm

Thank u pugsy....I watched a video today and a lady brought a sleeve to go over the hose. I am going to pull out the sewing machine and make me one. What kind of fabric are those sleeves made from.

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prodigyplace
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Re: Can I still get a mask

Post by prodigyplace » Fri Apr 20, 2018 5:40 pm

The pad-a-cheek hose covers are micro fleece.

http://padacheek.com/PAC_Hosecover.html

There is a user here that knits hose covers using yarn, I believe.

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Pugsy
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Re: Can I still get a mask

Post by Pugsy » Fri Apr 20, 2018 6:51 pm

Okay...here's the updated version.

DME wants what they want and the doctor will provide whatever they request and want to blame it on insurance. May be the DMEs own in house rules or whatever but there's insurance available only until the end of the month...might as well use it for mask or whatever since out of pocket expense right now is 0 since max out of pocket for this year has been met.

DME is aware that a machine is coming and they want to see it...that's fine..that way they can do whatever they want and make sure filters work...blah, blah, blah. I set the BiPap for cpap mode for the time being so that should make the DME happy.

If they do have the upgrade kit for the 60 series machine in stock..might as well let insurance buy it.

The mask she came home with from the titration study was the Medium Amara View and she likes it.
I suggested that she look at the DreamWear FFM if the DME has it...she might like it and it would be a good mask to try since she likes the Amara View. If insurance is going to buy a mask...might as well be an expensive one. :lol:

Nose works okay most of the time so a nasal pillow mask wouldn't be totally out of the question to try maybe at some point but she is a life long mouth breather out of habit if nothing else. So at some point I do think it would be worth trying nasal pillow but it's on the back burner for now.

She should get the machine Monday as long as the USPS keep up their end of the bargain.
She can take it to the DME and get what she can get to go along with it using her insurance while she can.
I did include a generic 22 mm white performance hose that was used but used very little. Wouldn't hurt to get another hose anyway.
At least it's not the cheap generic non flexible gray non heated hose.

If anyone wants to donate other masks for her to try that you don't want...send me a PM or her and get her address.

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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.