New Mask Every 6 months.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
pratzert
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New Mask Every 6 months.

Post by pratzert » Thu Oct 23, 2014 3:51 pm

Hi All.

I have CIGNA and use Crapria as my supplier.

I got a new mask about 4 1/2 months ago and know I am allowed a new one every 6 months.

I went to my Sleep Doc a couple of days ago and he wanted me to try a FFM.

I tried several years ago but it wasn't good for me. It was a Quatro ( Not the FX ) but I could not get it to stop leaking so I went back to the Activa.

My Doc wanted me to try the "FX" and said it was less prone to leaks. I explained I was due for a new mask in a month and a half and he said he would order me the Quatro FX. I "Assumed" he would order it in in a coupl eof months, but he apparently ordered it that day from Crapria.

When I got home today, there was a package from Crapria that had a new Quatro FX in it.

They sent me a "Medium" size. Now.... how in the heck did they know what size to send? I can only think it was Monkeys throwing darts at the proverbial dart board to choose a size.

I plan to send it back so I don't get charged for it.

But, since it's a different type of mask, am I allowed to get it in less than 6 months? Are all types of masks considered to be a mask regardless of whether it's a FFM, Nasel mask, Plugs etc ?

Anyone have any experience/knowledge on a situation like this ?

I don't trust this DME whatsoever and am inclined to return it.

I am still perplexed about how they figured I needed a Medium and not a large size.

Thanks for the help.

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LSAT
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Re: New Mask Every 6 months.

Post by LSAT » Thu Oct 23, 2014 3:59 pm

Your questions can only be answered by your insurance company...they are all different.

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englandsf
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Re: New Mask Every 6 months.

Post by englandsf » Thu Oct 23, 2014 4:04 pm

Try to get your RX amended to show a new mask every three months. And pillows every month. That might help...

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tortoisegirl
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Re: New Mask Every 6 months.

Post by tortoisegirl » Thu Oct 23, 2014 8:28 pm

Agreed to call your insurance and ask specifically what the DME policy is for your plan. Might it be possible you can get DME as medically required, and it was only Apria who incorrectly said a mask every 6 months? Before opening it, I'd check if it is covered by insurance. It would be pretty ridiculous if they sent it out to you knowing it wasn't covered by insurance and didn't tell you, but you never know. If your insurance covers 1 mask every X months, it should be regardless of the type.

Sometimes doctors can appeal to have them cover one early for medical reasons, such as if you need a different type, but that should have required extra paperwork & time. I wouldn't expect it to show up in a couple days if that was the case. Interesting your doctor places an order for you through Apria and Apria doesn't even call first to ask if that is what you want and if you want a mask fitting or anything? I would not be happy with that, but I wouldn't have let my doctor order something specific for me in the first place, just write a prescription and send it over. Even if he sent a prescription over for the specific mask type & size, I would have expected they would have to interact with you, even being an existing patient with them. Did your doctor have a mask size on file for you from a previous sleep study or prescription?

Also, I thought I'd throw it out there that the Resmed Airfit F10 is considered by a lot of folks to be an upgrade to the Quattro FX. It only came out this Spring so maybe your doctor isn't aware of it somehow? Although I like the idea of the Airfit F10, in practice, the Quattro FX works better for me. You might want to make an appointment for a mask fitting and try some on (and get properly fitted for whatever size you need) vs. having to question if you are settling or not. Best wishes.

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pratzert
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Re: New Mask Every 6 months.

Post by pratzert » Fri Oct 24, 2014 6:43 am

Thanks for the feedback everyone.

I don't know exactly what the Rx said that the Sleep Doc sent. I guess it's possible he indicated a size.

But even if it did, it's exceedingly bad that Crapria didn't consult with ME about sizing. Especially since it's an entirely new mask for me.

Thankfully, I have become used to Crapria not doing what is correct no professional so it didn't totally surprise me that they sent me a mask without talking to me first about getting sized for it. It's their M.O.

Their main objective is to push out machines and supplies at the fastest pace possible so they can bill someone for them.

They business has absolutely nothing to do with honest to goodness patient care.

I'll try to get a definitive answer about the time frame between masks from Cigna. I do vaguely recall Crapria telling me the allowance was now 3 months between masks, but I want to clarify it before I open the new mask in case I have to send it back to Crapria. I don't have much faith in goign to their office for a fitting either. The last time I went to get fitted for a mask, the guy in the office grabbed a mask from the shelf (still in the plastic bag) and held it up to my face and said "Ya, this will do." Never strapped it on. I was like WTH.... this can't be real. Of course it was NOT the correct size and I had to go thru an extremely painful process to return that wrong sized mask and get the correct size.

Crapria's automated dialers continue to call me every other day and leave a message that they are trying to "Check on their patient".

Hey Crapria ! I am NOT your "Patient"... I am your "Customer". (JERKS!).

They know nothing about Customer Service, let alone Patient Care.

Thanks Again Everyone.

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pratzert
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Re: New Mask Every 6 months.

Post by pratzert » Fri Oct 24, 2014 8:43 am

I just spoke to the Manager of the local Crapria office who informed me that CIGNA insurance covers a new "MASK" every 3 months, but NOT the headgear.

The headgear is covered once every 6 months.

So I will be returning the mask to Crapria and re-ordering it in another 5-6 weeks when my 6 months have passed.

Geez.... this is painful.....

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andy5805
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Re: New Mask Every 6 months.

Post by andy5805 » Fri Oct 24, 2014 11:18 am

here is a tip some may criticise me for and others may think great idea. but either way the explanation is that It is bourne of self preservation and the fact that I work very hard and pay my taxes which include funding of the NHS in the UK

if a piece of kit nacks up and I do not have backup, my job is written off until I get backup. I refuse to let sleep apnoea stop me working

if something breaks and if I get both the broken thing back and the un broken thing back when I go in and complain, guess which piece I bring back in 3 months time and say is broken?

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cathyf
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Re: New Mask Every 6 months.

Post by cathyf » Fri Oct 24, 2014 1:29 pm

I have an AirFit 10 FFM (in a size small) and one of the things that I have mused about while trying to fall asleep* is that there are spots all around the mask that work well because they fit just right. At the cheeks, for example, it presses in a bit and keep my mouth from puffing up at higher pressures. The bottom just fits in the indentation on my chin, while the top of the nose is in the right place to seal. Actually the mask is ever-so-slightly too tall for me in that the slightest up/down movement gives me a leak at top or bottom, and if it were a shade less tall it would have a little more tolerance for me bumping it. It curves the right amount from side to side that I basically never get leaks that direction unless I really just knock the mask off. All of that is not just size, but more subtly the shape of my face, and I lucked out that the mask being pushed by my dme seems quite well suited to me.

But, anyway, the upshot is that size *does* matter, and Crapria are idiots!

*(note that successfully falling asleep is easier if you think about boring wonky things.)

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teachcsg
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Re: New Mask Every 6 months.

Post by teachcsg » Fri Oct 24, 2014 4:46 pm

'Crapria' LOL. First time I've heard that and I work in the industry. Very fitting (unfortunately)
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renatae
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Re: New Mask Every 6 months.

Post by renatae » Sat Oct 25, 2014 1:15 am

andy5805 wrote:here is a tip some may criticise me for and others may think great idea. but either way the explanation is that It is bourne of self preservation and the fact that I work very hard and pay my taxes which include funding of the NHS in the UK

if a piece of kit nacks up and I do not have backup, my job is written off until I get backup. I refuse to let sleep apnoea stop me working

if something breaks and if I get both the broken thing back and the un broken thing back when I go in and complain, guess which piece I bring back in 3 months time and say is broken?
I'm with you. When I first started CPAP and had no backup supplies, I did say I needed a new hose when I probably didn't, and a new mask as well, because I realized if something went wrong, waiting six months for a new mask wasn't going to cut it. Now that I have backups, I no longer do this.

LOL @ Crapria.

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sleepstar
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New Mask Every 6 months.

Post by sleepstar » Sat Oct 25, 2014 5:06 am

New mask every 6 months? That's pretty amazing.

(Off the topic, sorry, but I wish we had that here!!!)

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andy5805
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Re: New Mask Every 6 months.

Post by andy5805 » Sat Oct 25, 2014 8:19 am

renatae wrote:
andy5805 wrote:here is a tip some may criticise me for and others may think great idea. but either way the explanation is that It is bourne of self preservation and the fact that I work very hard and pay my taxes which include funding of the NHS in the UK

if a piece of kit nacks up and I do not have backup, my job is written off until I get backup. I refuse to let sleep apnoea stop me working

if something breaks and if I get both the broken thing back and the un broken thing back when I go in and complain, guess which piece I bring back in 3 months time and say is broken?
I'm with you. When I first started CPAP and had no backup supplies, I did say I needed a new hose when I probably didn't, and a new mask as well, because I realized if something went wrong, waiting six months for a new mask wasn't going to cut it. Now that I have backups, I no longer do this.

LOL @ Crapria.
yeah I'm not mad about it, I just want a "Plan B" - I find that in life you do better that way - it doesn't even to be about OSA, generally if you have a "Plan B" life goes well - and regarding OSA my "Plan B" includes a machine I bought myself from the US as a backup to the one I have on the NHS here plus hoses etc, I don't get greedy with it, I just want to be able to say " if this all goes tonight, I can still get to work" - as my job is important to me

of course that doesn't cover electric -that's my next project, a 12v car battery backup - but I've not got round to that, mainly because the grid is so reliable where I live and hasn't gone once yet. If/when it does a mobile phone powercut sensor alarm will go off, and that's my none finished plan b on that one. At least I get woken up even if I then have to sit and wait for them to fix the power lines!

cheers

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Additional Comments: over the moon to have finally got there with therapy!