Is my DME right?

[Pugsy]

*pugsy not pigsty. Stupid phone.

I thought maybe you could see my kitchen.
Actually, didn't even notice till you mentioned it.

[chunkyfrog]

The swamp is not a lot better (maybe worse)

[StuUnderPressure]

Medicare and my BC/BS Secondary will replace an entire mask every 3 months.

They will replace just the cushions monthly & you can get 2 of those every month. A 3 month supply of cushions (6 cushions) can be purchased all at 1 time.

In my 14 years on CPAP / APAP, I have only exchanged a mask 1 time & that was when I got my current ResMed S9 AutoSet in December 2011 - & that was only to get a different sized cushion. But, the DME gave me an entirely new mask instead.

I just bought a new mask in January 2013 & specified to the DME that I wanted the 30 day trial period just in case. They agreed immediately.
But, I did not have to exchange anything.

Everytime you buy a mask that insurance will be paying for (at least in part), insist that you have 30 days to try it out.
I doubt that any DME will tell you no.
But, if they do say no, tell them because of that policy you may need to go to another DME who will honor your request.
My guess is they will honor your request to keep you as a customer / patient.

[melindy]

Every DME I've spoken to will not take back any mask they've had to special order.
Maybe that's why I have hardly any masks from local sources.
Sleeping with a mask is the only way to determine if it will work/fit/not hurt.
I have tried at least 20 masks, because my face does not match anybody's idea of a face should look like.
(I guess they simply couldn't fathom anything so gorgeous!)
I knew the DME's are completely useless, so I decided to hurry up and find my best fit while I still have the opportunity.
The mask I find most comfortable (elan) is not one most DME's carry, or are even willing to order.
I may have to schedule road trips after retirement just to get what I need.

Ha!

Currently I have extensive medical bills due to cancer and neurological issues so I can't afford to buy the masks outright without insurance. Also my DME says they have to order all masks, they don't have any masks there to give me so that would mean they wouldn't take back any masks correct?

I will have the Wisp and the Mirage that I can switch back and forth I guess. I tried the Mirage on and found it to be very comfortable so I'm hoping it's just as comfy in bed!

[zoocrewphoto]

I'm not sure how my DME works. The first DME gave me the mask I asked for. A month in, I asked about getting a second mask as I wanted to try a hybrid. I was not exchanging the mask as the first one was mostly working well, as long as I got it fitted just right.

The DME told me that once it left the building, I could not return it. I didn't know about 30 day returns, so I never questioned it. I fired them a couple weeks later anyway due to their refusal to order smaller headgear. Actually, they told me it did not exist, even though it is easily viewed online.

I have never asked my new DME their policy, as once they ordered my smaller headgear, the mask has fit very well, and I am happy with it. I did get 2 full face masks within one month, covered by insurance (well, 80%, my normal coverage).

[StuUnderPressure]

Also my DME says they have to order all masks, they don't have any masks there to give me so that would mean they wouldn't take back any masks correct?

I would not make that assumption.

In the last year or so, I am seeing that the DMEs are "ordering" pretty much everything & no longer keep much in stock.

In fact, my last 2 DME orders that I usually just pick up in person were "ordered" & drop shipped directly to me (from another state, but with the name of my DME).

It looks to me that this practice seems to becoming the norm.
I assume they are doing it because they can get cheaper prices that way.

Just tell them you are still trying to find a mask that works for you & that a 30-day return policy is crucial to you if you are to do business with them.

I have not found that a DME having to order a mask will keep them from honoring the 30-day return.

[Wulfman...]

Good for you. I find your input not helpful at all as its coming across that you're superior. Again good for you. I'm still new to the sleep apnea thing and have found the sleep lab and dme not helpful at all.

We were ALL "new to the sleep apnea thing" at one time. I had never heard of it before January of 2005. I actually thought I had narcolepsy, based on the symptoms I had. But, as soon as the words Sleep Apnea came out, I started doing research on the "condition" and what was required to treat it. Within a very short time (and before my sleep study), I found this forum and kept reading. I finally had my sleep study in late March of '05 and got my prescription and equipment in early May of '05. After a number of months of lurking and reading, I finally joined in July of 2005.

I AM NOT "SUPERIOR"!!! (yes, you can read that as "yelling") I'm just another schmuck who has had this condition for many, many years and has TRIED to help others with their learning curve.


Den

.

[melindy]

Good for you. I find your input not helpful at all as its coming across that you're superior. Again good for you. I'm still new to the sleep apnea thing and have found the sleep lab and dme not helpful at all.

We were ALL "new to the sleep apnea thing" at one time. I had never heard of it before January of 2005. I actually thought I had narcolepsy, based on the symptoms I had. But, as soon as the words Sleep Apnea came out, I started doing research on the "condition" and what was required to treat it. Within a very short time (and before my sleep study), I found this forum and kept reading. I finally had my sleep study in late March of '05 and got my prescription and equipment in early May of '05. After a number of months of lurking and reading, I finally joined in July of 2005.

I AM NOT "SUPERIOR"!!! (yes, you can read that as "yelling") I'm just another schmuck who has had this condition for many, many years and has TRIED to help others with their learning curve.


Den

.

Ok, whatever.

[khauser]

*pugsy not pigsty. Stupid phone.

I bet she's been called worse.

I'm happy calling her "friend".

I'm not liking your DME one bit, but I haven't seen one I like yet, at least not a local DME. I second the idea of sending your prescription to CPAP.COM. Prices are very reasonable and you can purchase return insurance for any masks where the manufacturer doesn't provide that option.

[khauser]

Currently I have extensive medical bills due to cancer and neurological issues so I can't afford to buy the masks outright without insurance. Also my DME says they have to order all masks, they don't have any masks there to give me so that would mean they wouldn't take back any masks correct?

Depending on your insurance you might well be able to use CPAP.COM and file for reimbursement. There's also the option of an online DME that accepts insurance assignment. I know there are some, not sure who they are.

Lastly, perhaps a local DME is available that has a clue on how to run their business? Even the sucky DME I first worked with had a wide array of masks in stock to try.

[melindy]

Currently I have extensive medical bills due to cancer and neurological issues so I can't afford to buy the masks outright without insurance. Also my DME says they have to order all masks, they don't have any masks there to give me so that would mean they wouldn't take back any masks correct?

Depending on your insurance you might well be able to use CPAP.COM and file for reimbursement. There's also the option of an online DME that accepts insurance assignment. I know there are some, not sure who they are.

Lastly, perhaps a local DME is available that has a clue on how to run their business? Even the sucky DME I first worked with had a wide array of masks in stock to try.

There were 2 options in my area so I will check into that after I get the Mirage mask and check into the reimbursement option too. Maybe I can call the insurance company and actually get an answer from them but I'm not loving them currently either - they just denied me inpatient treatment that my Neurologist is recommending for me and I'm on my 3rd appeal.

But really I'm still hoping the Mirage is the answer lol. That would make it less stressful for me, I have too many other things going on!

Also they did my checkin today to see how compliant I am and they saw I'm 100% compliant. The DME rep was surprised, she said she doesn't usually see that high with newbies. I guess I'm very lucky that I'm not having issues with sleeping with the masks at all, although I think that's because I sleep with the help of ambien.

[archangle]

My understanding is that most manufacturers will reimburse the DME for ONE mask change per patient. The DME has to do some paperwork to get the reimbursement. The manufacturer may actually require the DME to be willing to do this if you follow it up.

Many DMEs are more generous than that. Some simply refuse to participate or feign ignorance of the manufacturer's policies.

[msla]

Mask return insurance can be bought with mask pruchases from our host.

[StuUnderPressure]

My understanding is that most manufacturers will reimburse the DME for ONE mask change per patient. The DME has to do some paperwork to get the reimbursement. The manufacturer may actually require the DME to be willing to do this if you follow it up.

Many DMEs are more generous than that. Some simply refuse to participate or feign ignorance of the manufacturer's policies.

I have talked to 3 different DMEs about this.
They all say the same thing.

They do NOT bother with the manufacturer's reimbursement.
They simply throw the used mask away (or give it back to you if you want it) & just give you a different mask.

They have to do it so few times that they just take the loss on the mask you bring back. That loss is more than offset by the numerous other mask sales that do not get returned.

I think that is why some DMEs are only willing to do it once per patient.

Yes, you can buy your masks from cpap.com & get the return insurance.
But, most insurances won't reimburse you at all & if they do, they will do it at a lower reimbursement as an out of network provider.

When I was just on BC/BS, I could not buy anything from cpap.com & get it paid at all by BC/BS because BC/BS will not accept a claim from a person. It has to be a medical provider - even if that medical provider is an out of network provider & BC/BS pays at a lower %. Since cpap.com would not file any claim for me, I just could not use them.

[Janknitz]

I think Crapria in particular drop ships everything, so the local Crapria stores don't keep much if any stock. OP's mask was probably not really a special order. I get my office supplies the same way, from a company that has an extensive catalog, but no brick and mortar store. I call one day, it's waiting in my office the next morning. Amazon does this sort of thing too, with some regional warehouses, though not overnight.

It's manufacturers who have the 30 day return policy. They don't really want the mask back (probably costs them more to clean it than to manufacture a new one), but there is paperwork the DME has to fill out, and many DME's don't want to spend the time. So as said above, they'll just eat the profit off one or two masks, but after that it gets iffy.

We do encourage people to check out their DME's mask return policy BEFORE using a DME, but many newbies don't have that opportunity, either because their insurance limits choices or they just don't learn that they can consider that before it's too late. (That's why "What you need to know before you meet your DME" is important!).

And I can totally sympathize with the OP. I was given a Mirage Quattro by the sleep department for my in home titration, but it wasn't working well for me. I got to order the mask of my choice (limited by the Kaiser formulary) with my new machine, but the ONE I heard about which seemed like it was going to work best for me was one Kaiser didn't have as a sample, so I couldn't try it out beforehand. And, of course, Crapria shipped me the wrong size. When I finally got that all straightened out, it ended up I hated the mask I wanted so badly . Grrr! And I was stuck for 3 months from getting something else from Crapria (they don't have to do the manufacturer's thing at all for Kaiser patients, and Kaiser patients have NO choice of DME's whatsoever unless you pay out of pocket).

The saving grace is that Kaiser really, really, really wants you to use your CPAP (saves them money!), so the sleep lab will let you try out as many samples as you need to find the right mask (as long as it's on Kaiser's formulary) and you can keep the samples. Otherwise I may not have been able to find a comfortable mask and stay with CPAP in the long run.

I think being able to actually try out during sleep as many masks as you need to find one that works for you is crucial for a newbie to be able to stick with CPAP. And a good DME will trouble themselves to help with this, to make a lifelong repeat customer. But good DME's are getting fewer and farther between.