Newbie trying to understand the system - masks

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
robpiercey
Posts: 17
Joined: Mon Mar 27, 2017 7:22 am

Newbie trying to understand the system - masks

Post by robpiercey » Tue Apr 04, 2017 8:27 am

I'm about 2 weeks into using my machine. I'm using the nasal pillows and They feel fine. I'm starting to feel pretty comfortable with them.

I see that a lot of posters have multiple masks, and use a full face sometimes because of congestion.

My DME told me they're pretty lenient and that if I was uncomfortable with my pillows I could get a new mask within the first 30 days.

Is that my opportunity to actually get something out of the insurance premium I pay weekly? Do they usually let you keep your pillows because they're used and no good to anyone else?
In essence getting the second mask free?

I believe my mask allowance is every three months, so are most people using that as the time to get a new full mask?

I tried a search for mask and insurance but most results were for Medicaid. I've got HAP.
Thanks.

_________________
Machine: AirSense™ 10 Elite CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: AHI 38, Pressure 7, Pillow Size Medium

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Newbie trying to understand the system - masks

Post by Pugsy » Tue Apr 04, 2017 9:07 am

Insurance normally just pays for one mask within whatever allowance period. Insurance doesn't set the 30 day mask swapping period...it's the DME who makes its own in house rules. They can do this. It's actually the mask manufacturer who offers a 30 day mask return allowance so that DMEs don't lose money dispensing a second or third or fourth mask. That mask manufacturer 30 day return policy applies to each mask but DMEs will often make their own in house rule (and they can) and make it so the patient only has one 30 day time period because they don't want to continually have to do paperwork to get credit so they don't lose money.

Some DMEs require a physical "swap" of the first mask with the second mask so that they can do some paperwork and get credit for the "return" of the first mask and the dispensing of the second mask that insurance won't pay for. Some DMEs don't require that you return the first mask.

Your DME may or may not require the physical swap of your mask in order for you to try another mask.
My DME allows a 60 day swapping period and it goes with any mask...even for me as an 8 year cpap veteran. If I try a mask and don't like it I can bring it back to them and get something else and I can do that as many times as it takes within that 60 day time period for me to find a mask that I like. So they have a fairly generous swapping policy but it does require my physically swapping the mask.
Now we all know that when a mask gets returned that they can't do anything with it and they don't box it up and send it back to the mask manufacturer as proof so they can get credit. It seems like mask manufacturers will take the DME at their word that so and so mask didn't work out for someone and they had to dispense another mask that insurance won't pay for.

You will need to check with your DME as to what their in house rules mean. Do you have to return your current mask in order to get that second mask to try...only they can answer that question. If you don't have to give it up and you don't want to give it up in order to try a second mask...by all means request a second mask. Make use of whatever in house rules your DME may have chosen to use.
But it is not your insurance paying for that second mask...it will be the mask manufacturers who are backing any additional masks that a DME dispenses beyond what insurance will pay for.

If your DME requires a physical swap...and you don't want to give your mask up because it is working well for you...then you might wait until your insurance will may per the allowance period to get that second mask to have on hand in case you might want or need a full face mask during times of nasal congestion.
Or watch the forum...people give away or sell real cheap there own failed mask experiments. It's a good way to get a mask to try without burning an insurance allowed and paid for mask.

_________________
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.

robpiercey
Posts: 17
Joined: Mon Mar 27, 2017 7:22 am

Re: Newbie trying to understand the system - masks

Post by robpiercey » Tue Apr 04, 2017 9:25 am

Very helpful Pugsy. Thanks.

_________________
Machine: AirSense™ 10 Elite CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: AHI 38, Pressure 7, Pillow Size Medium

D.H.
Posts: 3467
Joined: Sun Sep 04, 2016 7:07 pm

Re: Newbie trying to understand the system - masks

Post by D.H. » Tue Apr 04, 2017 12:45 pm

You have to make sure in the beginning that you have the correct interface device for you.

They just gave me a mask and I used that model mask for several years. Then the Sleep Lab suggested another one and I've been using it ever since. The new one fits at 99% or 100% almost every night. I don't know about the old one, since the machine I had at the time was a "brick."

However, many patients just can't stand the mask that they're given and fail to comply with therapy! Please make sure that you have the right one, as my experience does not appear to be typical!

_________________
MachineMask
Additional Comments: Auto PAP; 13.5 cmH2O min - 20 cmH2O max

robpiercey
Posts: 17
Joined: Mon Mar 27, 2017 7:22 am

Re: Newbie trying to understand the system - masks

Post by robpiercey » Tue Apr 04, 2017 1:18 pm

Thanks DH. I'm comfortable in the pillows I have now, but as I read through the forum here, I see a trend... Use your machine every night no matter what!!!! Actually, I think it's sound advise and I intend to adhere to it. So I almost feel as if I'm doing myself a disservice by not having backups at this point.

I was thinking last night after waking up at 2am again, I'm comfortable, why am I awake?

_________________
Machine: AirSense™ 10 Elite CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: AHI 38, Pressure 7, Pillow Size Medium