I need a mask supplier that is in the BCBS network

[BusyLyn]

I've finally determined that the PR ComfortGel FFM is my mask of choice, but I've found that I need to replace the cushion every 4-5 weeks to maintain effective therapy and that causes a problem with my DME.

My current DME is in-network to BCBS, but they've chosen to only stock complete mask w/ headgear kits and they will not special order replacement parts. When I asked about replacement pillows for those who use pillow masks, I was told that this would be a different story as the DME has spare pillows (they only send one pair with each new mask, and keep the 2 unused pairs (my further thoughts are censored!)).

Anyway, I am now looking for a new mask supplier that stocks parts. The supplier must be in BCBS's network because I have an exclusive provider (EPO) BCBS plan and I cannot get reimbursement for items ordered from suppliers like our host. I'm located in northeastern PA, but as my insurance is considered to be a nationwide plan the supplier can be anywhere in the US if they will ship. Who do you recommend? Can anyone recommend Lincare or Apria? What about online suppliers like Liberty Medical?

Thanks!
-Lyn

[Janknitz]

You need to contact BCBS for a list--it may vary by plan and each plan may have a different type of contract with suppliers.

Once you find one willing to work with you, call BCBS again and confirm that they are really on the plan to avoid any nasty surprises.

[chunkyfrog]

Our former DME was willing to provide the cushions for full-face masks; but insisted on coding them as the MASK --less headgear;
thus limiting replacement to 90 day intervals. I notified BCBSNE, and they said that was OK! I notified our union president--a couple of months ago. No news. Note, I stated they were our FORMER DME! Screw me once-shame on you; screw me twice, shame on me.
I may have to submit incriminating emails to the state regulatory board. I have them! I hate to be a meanie--but they shouldn't be allowed to do this to people. Go ahead--sic me on them.

[sleepycarol]

Check with BCBS to make sure that they will reimburse for the cushion that often. Many will replace the cushion every three months (or according to the Medicare guidelines). I know on my 431 I could get a cushion every 3 months (at least to the old policy we had with BCBS) but I could get nasal pillows every month.

I would think the cushion would last longer. How are you cleaning it? Do you use facial creams or lotions that could be contributing to the break-down?

Look on eBay -- although you won't get reimbursed many times cushions can be purchased alot cheaper than using a DME.

I have purchased only 2 masks through insurance. Although I could get reimbursed if I used a DME I chose to purchase outright and not deal with the insurance. I have also purchased back-up machines without reimbursement.

[BusyLyn]

I've both called Empire BCBS (the administrators of my national insurance plan in this area) and searched their provider database online. Either way I have a list of DME providers, but without calling each one I don't know whether they even carry cpap supplies, nor what their policies are if they do.

The national suppliers Lincare and Apria are on the list and have at least 1 office each within a 50 mile radius of my house. Some members here do not have good words to say about Apria; I haven't seen any remarks about Lincare. I'd like to know what others here have experienced about either company, even if it's merely to say that the experience varies on a location by location basis. I hope that by being a nationwide chain one or both would be more likely to stock parts and not merely the complete kit. Why should I (via insurance) be forced to buy the whole expensive unit when all I need is 1 replaceable part?

Liberty Medical is an online DME who claims to work with most insurance on a wide range of durable medical items and diabetic supplies. A friend who also wears the ComfortGel FFM just signed up with them but hasn't yet gotten anything. They don't show up on my list (not within 50 miles, even though they show up in my browser window in my home office ). Has anybody used them? Good experience, or not?

Thanks!
-Lyn

[sleepycarol]

I used Lincare. My initial visit with them was positive ----- but in my region they have very limited choices and limited knowledge apparently. When I have talked to them about a couple of different masks I have wanted to try they hadn't heard of them. They carry one nasal pillow mask -- the Optilife and the F&P 431 and the UltraMirage Full Face Mask and one type of nasal mask. As well all know here that there isn't a one mask will work for everyone -- so was very disappointed that they had such limited choices. I signed up for automatic supplies (this was before I was aware that you don't need supplies that often). Never received them -- except one time at about the nine month mark.

In my opinion, I would get on the phone and call the DME's listed in your area and find out what their policy is -- it may be well worth your time to find one willing to work with you.

[Someone in NY]

I am with BCBS also, in NY. My DME (out of network) does the same thing...counts any mask part (pillows) as a new mask. Maybe I should look for a new in network DME and see if there is a different policy of replacement parts ? However, this DME went to bat for me when I needed a new machine.

[rubymom]

I've used Apria for almost two years now. I can't really complain about them. There was a small amount of confusion on one re-order and a small billing dispute, but it was all cleared up with a few phone calls. I'm not real needy though and haven't asked for anything special.

[BusyLyn]

Thanks sleepycarol and rubymom for your comments about Lincare and Apria.

With very low expectations, I started calling around to the various suppliers. My friend who has just switched to Liberty Medical was using the closest DME, so I didn't bother to call them.

I was quite surprised at the response when I called a supplier that is affiliated with one of the community hospitals in the local area (I live in a rural area so 'local' usually means within a 45-60 minute drive ). I had a nice long talk with the respiratory therapist who immediately said without any prompting on my part that the Medicare guidelines which many insurance plans follow allow for a liberal replacement of parts rather than only the entire mask kit. He seemed surprised at the policy of my (now former) DME to not stock parts. This supplier stocks most parts, and can get out of stock parts quickly. He knows that my first order will be for something small - a new cushion - but he seemed happy that they could be of service to me. He has also been a cpap user for more than 10 years.

What a difference between the 2 DMEs! I guess it does pay to shop around. I probably wouldn't have found this DME immediately when I was first diagnosed last October as my first choice would probably have been the DME my friend left. Back in October I was dealing with a new diagnosis and everything was strange and confusing. Almost 5 months later I know that my therapy works and I'm feeling better. And I'm not crazy or washing my mask improperly -- it's normal wear and tear of a simple replacement part.

Someone in NY -- pull the list of DMEs from the Empire website and start calling! You'll find a good DME too.

-Lyn

[DannyPh]

I have been using American Home Patient for three years now and they are very up to date on cpap masks and supplies. They are based all over the United States. Google them for an office close to you but they have shipped my Mask from all over the U.S. with no Problems. I have BCBS also so they accept BCBS.

[sleepycarol]

Glad you was able to find one that was able to help you Lyn.

It pays to ask questions and spend some time shopping around.

[someone in ny]

BusyLyn, I got lost in the BCBS web sit. How do I get the NY DME in-network list? Calling BCBS is another exercise in frustration.

[BusyLyn]

You don't have to log in to do this! From the Empire website (http://www.empireblue.com), click on the 'Enter' button to get to the member home page. From there, select 'Learn More' in the 'Find a Doctor' box on the left. On the next page you come to, click on the link to find a doctor or hospital in Empire's local area network. Then, on the next page, select your plan type from the first dropdown list, and from the provider type dropdown select 'Hospitals, Facilities, Services and Equipment '. Once you've made this selection, a third list will be displayed to select a specialty category. Scroll this list and select 'Medical/Surgical Suppliers - Durable Medical Equipment', then click on the 'Next' button to go to yet another page. Enter your location information, the mileage radius, then select 'View Results'. And there's your list!

-Lyn

[LinkC]

Looks like you've found a source. I just changed DMEs for that very reason. My old brick-and-mortar stopped stocking parts. I am BCBS-Federal. Lincare will send me mask parts AND they accept the Ins in full. They waive the co-pay. My version of BCBS replaces Hybrid cushion and pillows twice a month (I don't get them that often). And no shipping fee, of course. Lincare calls me every month to see if I need anything. Or I can call them if I need something right away.

[someone in ny]

BusyLyn, Thanks for the info. I have a "list" of one, about 27 miles away.