How often does your Ins. Co.

Debjax · Post by **Debjax** » Thu Mar 05, 2009 10:44 pm

Mother Goose wrote:OK, I guess my insurance co (Tricare Standard) is on track. I got my initial set up last year when I had reached my out-of-pocket, so it was covered 100%. They paid for the machine in total, not rental. I get a package from them once every three months. It contains:

Tricare Prime requires a 13 month rental, at least on our first machines....I'm going to try to remember (like i have been trying to remember for 3 months now) to call them and get their version of the replacement schedule, and find out for sure what my copay amounts are.

TheDreamer · Post by **TheDreamer** » Fri Mar 06, 2009 11:12 am

IIRC, I was told white filter monthly, hose 3 months, mask and foam filter 6 months. I think mask pillows can be once a month....but it hasn't been a month yet on any one mask....

I have BlueCrossBlueShield of Kansas.

The machine was purchased outright, and I had a $50 in-network deductible...which I had already met last year when I got the machine (and initial mask) on December 29th. But, I incurred the $50 deductible when I exchanged masks on January 14th (they billed for that mask, and resubmitted the previous bill corrected to remove the mask charges).

I was under the impression that the DME has these things scheduled and that I would get reminders or something about when to get replacements. But, the only call I ever got from the DME was the morning after my first night to make sure that I was using the machine. I asked about getting my replacement white filter when I was there last. She did say next time I'm in for my download, I'll be eligible for a new hose.

My doctor mentioned something about my compliance reporting for my next appointment....on March 30th....just over the 90 day mark of when I started (though not in usage).

The Dreamer.

NeurosurgeryNP · Post by **NeurosurgeryNP** » Fri Mar 06, 2009 11:55 am

Mother Goose wrote: What do you do with your old (month old) hoses and masks?

Thanks for the feedback

Keep them for spare parts - if a piece breaks one one or a head gear clip falls off and we can't find it, - we will alwyas have a sprae.

NeurosurgeryNP · Post by **NeurosurgeryNP** » Fri Mar 06, 2009 12:04 pm

From what I was told by DME -

Machine - every 5 yrs
Mask and headgear - every 6 mos, cushion for mask - every 3 mos, chin strap every 6 mos; they send filters with the new mask.

I have had stuff break before the time frame (head gear clips, mask cushion ripped), and they have given it to me without a problem. I have not otherwise asked for things to be replaced sooner.

When my machine stopped working, I got a brand new one (almost 4 yrs after the original) without issue - the DME had me get a letter of medical necessity in case it was needed - but they replaced it without issue. I get everything 10% covered through Empire BC/BS using a DME affiliated through my health system I work for - it is private (not a chain). I love my DME. They go above and beyond.

sleeplessinaz · Post by **sleeplessinaz** » Fri Mar 06, 2009 1:30 pm

I was just told today that I can get a new water chamber for my humidifier every 6 Months!! DID not know that!! So I guess I NEVER have to clean it if I can get a new one every 6 months--LOL!

6PtStar · Post by **6PtStar** » Fri Mar 06, 2009 2:28 pm

Mine says I can get a mask every 3 months but the headgear is only replaceable every 6 months. The problem is that I have not found a DME that will sell the mask without the headgear so it basicly limits me to a mask every 6 months. Machine replacement is every 5 years unless it is over 2 years and it breaks and the factory says it can not be repaired. One black filter every 6 months, 2 white filters every month (if I remember to go get them). A hose every 3 months.

Jerry

Mom of a girl · Post by **Mom of a girl** » Fri Aug 14, 2015 7:46 am

My daughter is in desperate need of a mask. Hers got a hole, which she picked at (she's 6) and now there's a huge huge and crack. Insurance says they replace it only once a year. I've been waiting for weeks and called the provider of the equipment several times as well as her doctors office. The provider is waiting because of insurance. The doctor said to call if we had a problem but then referred us back to the provider of the supplies. She has about 6 months before it's covered I believe. So frustrating. I asked if they'd like to pick up her machine as it's not useable or should we store it somewhere. They said she should continue using it lol. Took a mont for her to stop crying when she first got it while she got used to it now she cries because it doesn't work and blows air everywhere and she wants it and by the time we get a replace my she'll be used to not using it again. Think it's ridiculous how tightly they hole onto these little plastic and rubber pieces that probably cost pennies to make.

Julie · Post by **Julie** » Fri Aug 14, 2015 8:26 am

Why are you posting on a 7 yr old thread about someone else's insurance?

Anyhow, you can buy a new mask either outright (see Cpap.com and look at all the ones available, both 'nasal' and full face) if you want to, though you'll need a prescription to do it. Or ask your insce. co. if they'll cover it or not.

If you give us the name and size of the mask, someone here might have one or know where to get it (sometimes without a script).

chunkyfrog · Post by **chunkyfrog** » Fri Aug 14, 2015 8:46 am

Momofagirl; talk to your daughter's doctor.
A letter of medical necessity should trump the insurance "guidelines",
ESPECIALLY when a child's health is an issue.

Janknitz · Post by **Janknitz** » Fri Aug 14, 2015 12:02 pm

Mother Goose wrote:OK, I guess my insurance co (Tricare Standard) is on track. I got my initial set up last year when I had reached my out-of-pocket, so it was covered 100%. They paid for the machine in total, not rental. I get a package from them once every three months. It contains:

1 Full face Quadro with head gear
Three hoses
six filters

But I have to pay a co-pay. I wonder if I really need a replacement mask that often. My original looks the same as the one I'm about to replace and the new one. I haven't trown any away. What do you do with your old (month old) hoses and masks?

Thanks for the feedback

Your insurance company is not sending you those supplies, the DME is. They are taking advantage of Tricare's replacement schedule. Medicare and many states have outlawed automatic shipping of supplies because they are often not needed with such frequency. In most cases you are required to ASK for the supplies you need, which will not be covered more frequently than your insurer allows.

You can contact your DME and tell them you want to stop automatic shipping and if they persist you can report them to Tricare.

MarylandCPAPer · Post by **MarylandCPAPer** » Fri Aug 14, 2015 6:15 pm

You may be able to find the mask or part you need on Ebay. It has to be really frustrating for your daughter, now that she has adjusted to CPAP. If you post the model of the mask and the size she uses, someone here may have a spare or some spare parts that might help.

Wulfman... · Post by **Wulfman...** » Fri Aug 14, 2015 6:32 pm

Mom of a girl wrote:My daughter is in desperate need of a mask. Hers got a hole, which she picked at (she's 6) and now there's a huge huge and crack. Insurance says they replace it only once a year. I've been waiting for weeks and called the provider of the equipment several times as well as her doctors office. The provider is waiting because of insurance. The doctor said to call if we had a problem but then referred us back to the provider of the supplies. She has about 6 months before it's covered I believe. So frustrating. I asked if they'd like to pick up her machine as it's not useable or should we store it somewhere. They said she should continue using it lol. Took a mont for her to stop crying when she first got it while she got used to it now she cries because it doesn't work and blows air everywhere and she wants it and by the time we get a replace my she'll be used to not using it again. Think it's ridiculous how tightly they hole onto these little plastic and rubber pieces that probably cost pennies to make.

What mask and what specific part has a hole?
It's easy to buy replacement parts for many masks and much cheaper than to buy complete masks.
And, buying them out-of-pocket wouldn't be all that expensive, either.
Also, depending on where the hole is, it's also possible that it could be repaired or patched to get through the time when it can be replaced.
In all honesty, your post borders on the ridiculous.
Why would you deprive your daughter of her therapy for a mask part that's probably pretty cheap.

Den

.

Goofproof · Post by **Goofproof** » Fri Aug 14, 2015 6:33 pm

sleeplessinaz wrote:I was just told today that I can get a new water chamber for my humidifier every 6 Months!! DID not know that!! So I guess I NEVER have to clean it if I can get a new one every 6 months--LOL!

How many months before you can get a new landfill? Jim

SewTired · Post by **SewTired** » Sat Aug 15, 2015 8:43 am

I have Medicare, so I get the replacement schedule that Guest listed. It looks like my nose pillows seem to only work best the first 3 weeks, so I'm glad I will be able to get them twice a month. Otherwise, once I have a backup supplies, I'll just be calling as needed.

How often does your Ins. Co.

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Machine	Mask

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