Advice on DMEs

[Leadhead]

I presently get my supplies through the VA. They contract with a local DME who delivers to my home and checks my machine for proper pressure and compliance. The VA schedule sets a limit of 2 masks with associated tubing, headgear, and filters per year. I put an average of 1600 hours on a mask in 6 months.
At about 800 hours the oral cushion begins to leak...at about 1200 hours the hard plastic parts on my Mirage Ultra often break. I have glued them together in the past to get by. I arrived at the Mirage Ultra through much trial and error and it works for me, so I'm not really willing to try a different mask that may last longer. I have requested 3 masks per year from the VA but with no success.
Medicare provides masks and oral cushions on a more frequent basis. I asked the DME to supplement my VA schedule with one extra mask per year through Medicare. They were not willing to do that for whatever reasons they have.
So, I have decided to try to get one mask per year from an internet DME who takes Medicare. I have a sleep study and an RX so that should be no trouble.
Does anyone use a mail order DME who takes Medicare and would recommend their service. I was thinking of Liberty Medical...anyone use them?

[Julie]

Cpap.com (who sponsors this forum) may take Medicare and have an 800 # on their site (but I never asked as I'm in Canada). I use the same mask as you and it is terrible about breakage. I spent $30 on some Loctite 4011 special glue (cost more to get here from there) but have had to pay for parts a lot. I've tried other masks but they all have some problem that makes them less wearable. Good luck!

[Pugsy]

May I suggest on adding "online" to your topic title...Online DMEs
We do have a few members who utilize online suppliers.
Cpapcareclub.com was recently mentioned and comes to mind.
website is called Verus Healthcare
http://verushealthcare.com/

I can't think of any others at the moment.

cpap.com does NOT accept Medicare in lieu of payment and Medicare won't reimburse for items purchased from them either.

[Wulfman...]

What on earth are you doing to your masks?
I've been using the very same Ultra Mirage Full Face for nearly nine years (started in 2005). The only things I've replaced were the forehead support (because it dropped it on a hard floor and it broke) and after a number of applications of Krazy Glue, I finally broke down and got a replacement.......two sets of headgear and one seal/cushion. I've got over two years on the current headgear and about three years on the current seal/cushion (I used the first one for six years).
I find the mask seals actually seal better the longer I use them.

I've purchased almost all of my supplies (out-of-pocket) from online sellers (mostly CPAP(dot)COM) and some from individuals. I've never used a brick & mortar DME.


Den

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[StuUnderPressure]

Through Medicare, you can get an entire mask every 3 months, 2 cushions every month, & new headgear every 6 months.

Using the link below, find a DME in your area.

http://www.medicare.gov/Supplier

[xyz]

I don't know anything about the VA. But because they're a part of the federal government, I would be surprised if they use different guidelines than Medicare does.

The last time I checked, which has been a while, the replacement schedule was:

a complete mask, 6 months
a mask without headgear, 3 months (yeah, that's crazy)
headgear by itself, 6 months
non-disposable filter, 6 months (the dark foam filter)
disposable filter, 2 per month (the white, soft filter)
hose, 3 months
cushion/seal for FF mask, 1 per month
humidifier chamber, 6 months

What your insurance company, DME, or the VA _actually does_ is, more or less, irrelevant. That is NOT the question.

The question is what they are supposed to be doing! In my experience those are different much of the time.

SA patients, especially new ones, don't know what the rules are.

DMEs, especially those on capitated plans, increase their profits by denying products and services (not following the rules).

With regard to sleep apnea, the old saying "what you don't know won't hurt you" (aka "ignorance is bliss") is wrong.

Here are a couple of questions to ask your VA contact.

1. Are the VA's sleep apnea supplies replacement guidelines the same or different than Medicare's?

2. What is the source of your answer? I'm not asking what _you believe_ to be true. I want a copy of the page out of the guideline document that shows the replacement schedule. (Or a url to a webpage that shows it.)

You cannot accept anything that they say (verbal only) to necessarily be true. DME issues are usually a small part of all the issues that a typical customer service rep handles. Really small part. The worst thing they can do is guess and give you the wrong answer.

[Julie]

Den - Unless you sleep on your back all night, or never inadvertently tweak the mask the 'wrong' way, the UM FF's are very prone to breakage - whether the forehead 'ladder' adjustment, the tiny struts inside the valve ring near the elbow, or somewhere on the mask itself, I've had loads of breakage. I don't sleep on my back (not a good idea, cpap or otherwise) but how I sleep is not really the problem anyway... it's just that the parts are fiddly and if handled wrongly even for a minute, will break easily.

[FoxNewsFan]

I presently get my supplies through the VA. They contract with a local DME who delivers to my home and checks my machine for proper pressure and compliance. The VA schedule sets a limit of 2 masks with associated tubing, headgear, and filters per year. I put an average of 1600 hours on a mask in 6 months.
At about 800 hours the oral cushion begins to leak...at about 1200 hours the hard plastic parts on my Mirage Ultra often break. I have glued them together in the past to get by. I arrived at the Mirage Ultra through much trial and error and it works for me, so I'm not really willing to try a different mask that may last longer. I have requested 3 masks per year from the VA but with no success.
Medicare provides masks and oral cushions on a more frequent basis. I asked the DME to supplement my VA schedule with one extra mask per year through Medicare. They were not willing to do that for whatever reasons they have.
So, I have decided to try to get one mask per year from an internet DME who takes Medicare. I have a sleep study and an RX so that should be no trouble.
Does anyone use a mail order DME who takes Medicare and would recommend their service. I was thinking of Liberty Medical...anyone use them?

Lead,
I have used cpap.com and have been very happy. They are a quality company but alas, they don't take insurance.

I used Liberty medical for the last 5 years and was very happy because they did ALL THE WORK re ins., contacting the doctor, etc., (I did nothing except open the box from UPS every 3 months), but alas they did not win the competitive bid for medicare which started last July 1st.

I used the website that Stu gave you and found American Home Patient. After a few glitches I now get my supplies with them. One of the regulations which was new to me was- Medicare requires the doctor to fax face-to-face office notes from a visit you made 6 months or less from the time you want something for them to pay for, at least for a new machine. My doctor would have faxed them the script but now Medicare forced me to make an unnecessary visit to my doctor and waste his time, my time and my co-pay.

Amer. Home Pat. will call me every three months and tell me what I qualify for and what I need.

I just got a new machine from them and was concerned about proving compliance because I travel around the world a lot. They put me at ease because all I have to do is call them and read the numbers off my machine.

Go to Pad-a-Cheek and get a cushion liner. IT STOPS ALL MY LEAKS AND ALSO PRESERVES THE CUSHION BECAUSE YOUR FACE/LIPS ARE NOT TOUCHING THE CUSHION. Sorry, didn't mean to yell but sometimes it's necessary.

Good luck,

Ed

[Wulfman...]

Den - Unless you sleep on your back all night, or never inadvertently tweak the mask the 'wrong' way, the UM FF's are very prone to breakage - whether the forehead 'ladder' adjustment, the tiny struts inside the valve ring near the elbow, or somewhere on the mask itself, I've had loads of breakage. I don't sleep on my back (not a good idea, cpap or otherwise) but how I sleep is not really the problem anyway... it's just that the parts are fiddly and if handled wrongly even for a minute, will break easily.

Julie,

I can't sleep on my back (in bed) if I want to.......I'm a dedicated side-sleeper. Like I said, the only time I've broken a part on mine is when it slid out of my hand and hit on the hard floor (the forehead support hit first)......and it was still attached to the hose.
But, I use a water-based pillow and that keeps my head from sinking into the pillow. Maybe that's one reason, but I've never had a problem from "normal" use. From my experience, I've considered them to be pretty durable. I've also never (completely) disassembled any of mine, either. I've always washed them while (mostly) assembled......never felt the need to take it apart.......especially the anti-asphyxiation valve/assembly.


Den

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[Sheriff Buford]

What on earth are you doing to your masks?

Den: I have admired and respected your responses over the years, but I can only get about 3-4 months on my mask, but I had one that lasted 6 months. When a mask is about to get drop-kicked into the next county... it will start leaking around my temples and there is nothing I can do to remedy it. I've tried pad-a-cheek liners, Remzzz liners, mask adjustments and a few choice cuss words with no avail. I have resorted into thinking the structure of our faces and maybe how each mask fits the differing facial structures, along with the different pressure-points a mask will have and possibly the breakdown of the silicone mask and sealing areas will be different for each face. My face may be beeeeuuuutiful.... , but that dang mask don't like to be next to it. It appears your mask loves your mug and probably was a match made in Heaven.

Sheriff

[FoxNewsFan]

What on earth are you doing to your masks?

Den: I have admired and respected your responses over the years, but I can only get about 3-4 months on my mask, but I had one that lasted 6 months. When a mask is about to get drop-kicked into the next county... it will start leaking around my temples and there is nothing I can do to remedy it. I've tried pad-a-cheek liners, Remzzz liners, mask adjustments and a few choice cuss words with no avail. I have resorted into thinking the structure of our faces and maybe how each mask fits the differing facial structures, along with the different pressure-points a mask will have and possibly the breakdown of the silicone mask and sealing areas will be different for each face. My face may be beeeeuuuutiful.... , but that dang mask don't like to be next to it. It appears your mask loves your mug and probably was a match made in Heaven.

Sheriff

Sheriff,
I have a face similar to the one in your avatar. I was using the Mirage Quattro FFM in medium and had some trouble with leaks. One day my DME sent me a small by mistake. I tried it and lo and behold my leaks went way down and when I added the liner, they stopped altogether. Maybe you need a different size.
Ed

[Sheriff Buford]

What on earth are you doing to your masks?

Den: I have admired and respected your responses over the years, but I can only get about 3-4 months on my mask, but I had one that lasted 6 months. When a mask is about to get drop-kicked into the next county... it will start leaking around my temples and there is nothing I can do to remedy it. I've tried pad-a-cheek liners, Remzzz liners, mask adjustments and a few choice cuss words with no avail. I have resorted into thinking the structure of our faces and maybe how each mask fits the differing facial structures, along with the different pressure-points a mask will have and possibly the breakdown of the silicone mask and sealing areas will be different for each face. My face may be beeeeuuuutiful.... , but that dang mask don't like to be next to it. It appears your mask loves your mug and probably was a match made in Heaven.

Sheriff

Sheriff,
I have a face similar to the one in your avatar. I was using the Mirage Quattro FFM in medium and had some trouble with leaks. One day my DME sent me a small by mistake. I tried it and lo and behold my leaks went way down and when I added the liner, they stopped altogether. Maybe you need a different size.
Ed

Jackie... er... Sheriff Buford T. Justice died a few years back. My mug is no where near Jackie's... er... Sheriff Buford's! I like to think I much handsomer!! Well.... least my dog loves me!!