Question about my DME exchange policy

jabman · Post by **jabman** » Fri Dec 09, 2011 7:47 am

When I went to get a full face mask to try on monday I asked about there exchange policy. The lady told me that I was allowed to exchange the mask within 30 days but but if I wanted to exchange again that they would bill my ins. company the full mask. So I would only be able to exchange once. Does this sound right? I told the lady that it made no sence since it can take some time to find a mask that fits right.
I have been using this DME now for over a year and was not aware of this policy because the mask (the one in my eqipment list) I normally use works great for me but I want to have a full face mask for when I have a stuffy nose and also cause I mouth breath.

b360155 · Post by **b360155** » Fri Dec 09, 2011 8:28 am

From what I've read, it can vary by manufacturer, insurance company and DME. I started my CPAP journey with a ResMed Swift FX and my DME told me the same thing. I could exchange once free of charge within the first 30 days. I'm a mouth breather/leaker as well, so I wanted to try a full face mask so I got a ResMed Mirage Liberty hybrid mask. When I exchanged, I asked what would happen if the Liberty didn't work for me and they said they would hold it for a week. After that time, I would have to decide if I wanted to keep the Liberty or exchange back to the Swift FX. Similar to what you were told, I was told if I wanted to go to a mask other than one of those two, I would have to pay for it on my own. Optionally, my insurance company allows for a new mask every 3 months, so if one of the 2 didn't work, I could then get insurance coverage on another mask after 3 months had passed.

Others have stated that they've been allowed to exchange multiple times within as long as the manufacturer allows for it and that the DME will fill out the required paperwork so that they can get their credit from the manufacturer for the returned mask.

I ended up keeping the Liberty and pieced together a Swift FX on eBay for cheap to have as a backup. Since then, I've also picked up a Quattro FX.

Grand-PAP · Post by **Grand-PAP** » Fri Dec 09, 2011 8:40 am

b360155 · Post by **b360155** » Fri Dec 09, 2011 8:58 am

Grand-PAP wrote:Hi b360155,

CAN I ASK ANYONE WHO RESPONDS THAT HAS EXPERIENCE WITH MEDICARE WHAT THE MEDICARE POSITION WOULD BE ON THIS?

I have the EXACT situation. Through Medicare . . .

11-23-11 DME delivered my first Mask -- ComfortGel Blue Nasal Mask. I had serious proplems with the bridge of my nose, plus mouth breathing issues.

11-28-11 She delivered a Mirage Quattro Full Face mask and said exactly the same thing, "If this doesn't work, then you will have to pay for a third -- Medicare will not pay for it."

Hey Grand-PAP, I like your logon ID, very clever!

I'm not on Medicare but I was told by my DME that as far as machines, masks, parts and supplies reordering schedule, my insurer (Aetna) pretty much followed the same schedule as Medicare.

If the first mask didn't work at all, hopefully your Quattro ffm will. If you do need to go to a 3rd mask, you might want to look into the CPAP Library 1-week mask trial program before buying anything. They will send you a mask of your choice (provided they have it in stock) for a 1-week trial for only $14 to cover shipping. I used it once and it worked very well.

xenablue · Post by **xenablue** » Fri Dec 09, 2011 9:02 am

jabman - it appears it does depend on the manufacturer, DME and insurance what the policy is, however when I was still using my now ex-DME I went in for a mask exchange within the first 30-days after dx, and when I got the 2nd mask, the RT told me if the new mask didn't work, I could bring it back for another exchange and keep doing so for the first 30-days if I wanted to.

Not sure what my new DME's policy is with multiple mask changes is, as I've not had to exchange any as yet - the new masks I've requested have worked well for me.

I do know when I ordered my SleepWeaver they told me it couldn't be exchanged, however that's not quite correct as Circadiance told me the DME can send the mask back if I don't like it, but the DME won't get credit, just a new mask to give someone else.

Cheers,
xena

Pugsy · Post by **Pugsy** » Fri Dec 09, 2011 9:11 am

Grand-PAP wrote: CAN I ASK ANYONE WHO RESPONDS THAT HAS EXPERIENCE WITH MEDICARE WHAT THE MEDICARE POSITION WOULD BE ON THIS?

I have the EXACT situation. Through Medicare . . .

Medicare doesn't care how many times you swap out masks....they only pay for the one they get billed for and won't pay for another one till the replacement time schedule is met. So they pay for one mask to start with. Whether it works or not.

Most of the major mask manufacturers offer the 30 day thing (swap it out if it doesn't work) so they will replace a mask that gets used (and DME can't bill Medicare for because they already likely billed for the first mask).

This 30 day rule where DMEs say one mask in 30 days is a DME house rule. They could be reimbursed for 20 masks utilizing the manufacturer's 30 day policy if they were willing to do the paperwork needed.

Lizistired · Post by **Lizistired** » Fri Dec 09, 2011 9:15 am

Thanks Zena, I had forgotten about the sleepweaver. I want to get a full face for stuffiness too. Glad to hear you are happy with it. I don't think I have heard of anyone who didn't like it.

jamiswolf · Post by **jamiswolf** » Fri Dec 09, 2011 9:51 am

Hi all,
Do DMEs have a different exchange policy for new cpap users vs old customers wanting to try a different mask? I just pose that question since it may be related and I don't know the answer.

With my DME, I was allowed to try out 4 different masks and my RT would have given me more...if needed. They aren't charged...it's a manufacturer's program.

Another issue that I hear people comment on, is that they have to return the unacceptable mask. My DME didn't want them back. It was just a disposal issue for them. So I had 4 masks at the end of the 30 days. Later, as my mask adjusting skill improved, I was able to wear some that didn't work at first. So depending on your relationship to your DME and their attitude, don't return the old ones unless they ask for them. Just a thought...
Jamis

chunkyfrog · Post by **chunkyfrog** » Fri Dec 09, 2011 10:13 am

I wish there was a full-face sleepweaver; but it's probably not possible.
Maybe a fabric cushion for a hard frame mask?
Oh, well, there's mask liners--especially Pad-a-cheek.

jabman · Post by **jabman** » Fri Dec 09, 2011 11:38 am

I is kind of upsetting to me that I can only exchange once only because I want a full face mask.and if this one that i am trying now does not work then I have to wait six months to try another one. But I am thankful that I do have a nasal mask that works well for me. But for anyone who is new or trying to find a mask that works for them MyDMe's exchange policy is crap.

archangle · Post by **archangle** » Sat Dec 10, 2011 1:21 am

Pugsy wrote:Most of the major mask manufacturers offer the 30 day thing (swap it out if it doesn't work) so they will replace a mask that gets used (and DME can't bill Medicare for because they already likely billed for the first mask).

This 30 day rule where DMEs say one mask in 30 days is a DME house rule. They could be reimbursed for 20 masks utilizing the manufacturer's 30 day policy if they were willing to do the paperwork needed.

Someone posted one manufacturer's web site link to their mask exchange policy and it was ONE exchange per patient. Lots of people have gotten more exchanges from their DME. I don't have the link, but I THINK it was ResMed.

Pugsy · Post by **Pugsy** » Sat Dec 10, 2011 8:55 am

archangle wrote:Someone posted one manufacturer's web site link to their mask exchange policy and it was ONE exchange per patient. Lots of people have gotten more exchanges from their DME. I don't have the link, but I THINK it was ResMed.

I thought ResMed didn't have a one limit exchange policy. I could be wrong but I couldn't find anything on their website just now. Perhaps someone could clarify this.

According to my DME (who supplies ResMed masks) he will exchange/swap out as many masks as it takes to find the right one .....for 60 days. This is a House rule and only pertains to newly diagnosed cpap users.

So the end result of any exchange policy is really whatever the DME is willing to do and in some cases the DME bends over backwards and allows multiple trials even for established patients. Those DMEs are rare.

jabman · Post by **jabman** » Sat Dec 10, 2011 11:29 am

since I am only allowed one exchange, I will give the Mirage Quattro one more week, ( my l/h last night was 38) and if i can't get it to work I will exchange it for my usual set up then try a different FFM in 6 months or a year.

jamiswolf · Post by **jamiswolf** » Sat Dec 10, 2011 12:12 pm

Jabman,
Don't forget that there is a sort of "black market" which is the entire Craigslist network. I personally abandoned my DME and MD and now plan on purchasing exclusively from that market. I returned my rental machine and bought my current machine new from a Craigslist advertiser. I recently bought a unused but opened package Quattro...for $40. Those deals are available all the time. So consider that as a fall-back option.
Jamis

Pugsy · Post by **Pugsy** » Sat Dec 10, 2011 12:18 pm

If I didn't want to "spend" my once in 6 months new mask via insurance and I wanted to experiment with different masks, I would go to the mask trial program. Cheap way to find out if something that caught my eye would work or not.
http://www.cpaplibrary.com/mask-trials.html

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