Does your DME give you all 3 S/M/L pillows with Swift FX?

[infntyx2]

Greetings all... I've been a CPAP/Swift FX user for about 9 months now. I've been dealing with what appears to be a consistent issue among Swift FX users here. I've been getting about a month's worth of use out of my FX pillows before I struggle with leaks. It seems as time progresses, the material seems to get stiffer. I wash the pillows daily with either a natural mask cleaning wipe or with mild soap and water. I've tried Lansinoh as well as the O ring fix with some success. Originally, my DME started me out with a Medium pillow but in an attempt to address leaks, I've switched over to a Large pillow. I would have the tendency to say that the Large is a larger than necessary (and not as comfortable) but seems to leak less.

Anyway... I have Blue Cross/Blue Shield of Illinois for Insurance and my DME charges it to insurance by "parting out" the entire mask and billing it separately as hose, headgear, pillow, etc. vs one mask. They only give me the one size of pillows I request. They keep the other two. The amount billed back to insurance is around $200. Anyone else have a similar experience with their DME and think this might be a little bit fishy?

[msradar65]

I had BCBS of LA and BCBS anthem and they parted out all the parts. I only get replacement pillows month. The RT let me keep the small and Xsmall pillows but took the medium.

This seems to be standard practice from what I am learning. I am hoping when I am due for new headgear and mask they let me keep the whole thing.

[Pugsy]

Tis fishy.

With the entire mask package (headgear and straps) you should get all three sizes. It is common for DME to bill each item separately as that is the way pretty much everyone does BUT you should still get all 3 if you are getting the whole mask package.
They are splitting it up and selling the others as replacements to someone else.

My DME has always given me 3 sizes of pillows on any of the nasal pillow mask systems I have used.

If getting simply a replacement pillow you can always ask for a different size. I have done this also. All you have to say is that you want to see if there is much of a change with it.

[Blackjackcat]

Same with me, I get the S/M/L pillows with each mask.

Tis fishy.

With the entire mask package (headgear and straps) you should get all three sizes. It is common for DME to bill each item separately as that is the way pretty much everyone does BUT you should still get all 3 if you are getting the whole mask package.
They are splitting it up and selling the others as replacements to someone else.

My DME has always given me 3 sizes of pillows on any of the nasal pillow mask systems I have used.

If getting simply a replacement pillow you can always ask for a different size. I have done this also. All you have to say is that you want to see if there is much of a change with it.

[Janknitz]

DME's charge for individual parts because they make more money than a mask "package" where everything comes together. This is really cheating, but the insurance companies don't seem to see this as a problem.

However, the reality is that they are often providing you with the package deal that they buy from the manufacturers as a package--complete with THREE sizes of nasal pillows, strap covers, and a little carrying bag. If the DME is opening these packages and removing two of the pillows, what they are doing is taking YOUR pillows that your insurance paid for (even though it wasn't priced out for 3 pillows the way they billed it, that's what the DME purchased with your money from the manufacturer) and then turning around and reselling them to someone else for more than $20 EACH. The DME can claim that it's not fraudulent because they only billed for one set of nasal pillows, and you got one set, but it's really SLIMY!!!!!!!!!!!

I would make a lot of NOISE. If you are receiving opened packages with the pillows removed, COMPLAIN. I suggest IN WRITING, and CC it to your insurance company fraud investigation unit and your state agencie that regulate DME's. If you are on Medicare, cc the Medicare fraud investigation unit.

Truthfully, you probably would NOT win in a fight about this because they charged for 1 pillow and supplied 1 pillow, but if you make a lot of noise they may stop stealing your other two pillows if for no other reason than to shut you up. To me, that would be worth it

[infntyx2]

DME's charge for individual parts because they make more money than a mask "package" where everything comes together. This is really cheating, but the insurance companies don't seem to see this as a problem.

However, the reality is that they are often providing you with the package deal that they buy from the manufacturers as a package--complete with THREE sizes of nasal pillows, strap covers, and a little carrying bag. If the DME is opening these packages and removing two of the pillows, what they are doing is taking YOUR pillows that your insurance paid for (even though it wasn't priced out for 3 pillows the way they billed it, that's what the DME purchased with your money from the manufacturer) and then turning around and reselling them to someone else for more than $20 EACH. The DME can claim that it's not fraudulent because they only billed for one set of nasal pillows, and you got one set, but it's really SLIMY!!!!!!!!!!!

I would make a lot of NOISE. If you are receiving opened packages with the pillows removed, COMPLAIN. I suggest IN WRITING, and CC it to your insurance company fraud investigation unit and your state agencie that regulate DME's. If you are on Medicare, cc the Medicare fraud investigation unit.

Truthfully, you probably would NOT win in a fight about this because they charged for 1 pillow and supplied 1 pillow, but if you make a lot of noise they may stop stealing your other two pillows if for no other reason than to shut you up. To me, that would be worth it

Jankitz - I have no doubt that they are "selling" the extras as the "monthly pillow replacements" for someone needing that particular size. And yes, the mask package comes opened with the other two pillows removed. The downfall to me is that I could potentially use both the Medium and Large pillows myself. I'd consider changing DMEs but unfortunately, the warranty on my Resmed S9 is probably tied to this DME for the remaining life of the machine. Based on other people's experiences, I will be questioning why they are removing the extras when the mask is a complete package. The last time I asked mildy, I was told that this is the way insurance prefers to handle it. I will also be checking with another local DME to see how they would handle distribution and billing of the Swift FX.

[jbn3boys]

... my DME charges it to insurance by "parting out" the entire mask and billing it separately as hose, headgear, pillow, etc. vs one mask. ...

My DME will bill separately for the hose, the headgear, and the mask (pillows). But when they gave me my first Swift FX, they gave me the sealed package, with all three pillows. When I have gone back for replacement pillows, I only get the size I need.

Edited to say: the package contained all parts, headgear, hose, pillows, all in one sealed package. I think the individual parts were also individually sealed, within the one, larger package.

(Yep, love my DME!)

...I'd consider changing DMEs but unfortunately, the warranty on my Resmed S9 is probably tied to this DME for the remaining life of the machine...

I would keep my machine with them, then, but I would consider finding a different DME for your "supplies".

[HoseCrusher]

I recently received a replacement Swift FX. The headgear was in one unopened package, the short hose in another, and the medium (only) pillows in a third unopened package. All three were labeled Components/Spare Parts.

[pbach]

I receive the whole unopened package with 3 pillow sizes.

[Janknitz]

You are not obligated to get your supplies from the same DME that provides your machine. Unless your insurance requires you to use a particular provider, you're free to get your supplies from any other providers that your insurance will work with.

[bap40]

This is what happens to me on occasion. It seems to depend on which RT is handing out my gear at the time I go to pick it up. One just gives me the entire set and another one does not. She removes all but the size of pillows I use. They do give me enough replacement pillows for 3 months but of course that is another fee. I know my extra pillows are parted out because the extra ones I get are in little zippy bags, not factory sealed at all.

[sleeplessinaz]

I receive the whole unopened package with 3 pillow sizes.

Carrie

[secret agent girl]

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