Mask purchase problem

Olivia · Post by **Olivia** » Thu Mar 27, 2014 3:38 pm

I have Medicare and have been obtaining my equipment and supplies from Nationwide Medical. My provider has ordered a Quattro Air FFM for me after several mask fit appointments as I continue to have major leak and did well with this when tested. Nationwide does not carry, this mask. I have tried several other DMEs who insist I have to submit all my sleep studies, doctor notes and orders to them along with transferring to them as my DME or they cannot sell me a mask. Is this really true? It seems to me I should be able to just give them my prescription for a mask in order for them to dispense me one. It has been over 6 months since Medicare has paid for a mask so I know I am due. What to do?

ChicagoGranny · Post by **ChicagoGranny** » Thu Mar 27, 2014 3:42 pm

submit all my sleep studies, doctor notes

Sounds damn strange.

ChicagoGramps

chunkyfrog · Post by **chunkyfrog** » Thu Mar 27, 2014 3:45 pm

This may be a Medicare rule or a "rule" of the DME(s) to make it harder to have more than one provider.
If you want to patronize a different DME because they will sell you something the first one won't,
just ask your doctor to send duplicates to the new DME. They are all copies anyway.
My first medicare DME wanted every possible bit of paper--maybe it's the law--maybe just a game.
It doesn't really matter unless you can't "play".

Wulfman... · Post by **Wulfman...** » Thu Mar 27, 2014 3:47 pm

Olivia wrote:I have Medicare and have been obtaining my equipment and supplies from Nationwide Medical. My provider has ordered a Quattro Air FFM for me after several mask fit appointments as I continue to have major leak and did well with this when tested. I have tried several other DMEs who insist I have to submit all my sleep studies, doctor notes and orders to them along with transferring to them as my DME or they cannot sell me a mask. Is this really true? It seems to me I should be able to just give them my prescription for a mask in order for them to dispense me one. It has been over 6 months since Medicare has paid for a mask so I know I am due. What to do?

I'm a little confused as to which provider you're having problems with.
This situation has been discussed frequently before on the forum.

I'm also on Medicare, but have purchased all of my equipment out-of-pocket before going on Medicare as I didn't want to have to jump through any more hoops with Medicare and this therapy.
But, I suspect that if you're switching providers, yes, you have to provide all of that documentation to them.

Den

.

chunkyfrog · Post by **chunkyfrog** » Thu Mar 27, 2014 4:03 pm

I pay enough for my part B and required supplements--PLEASE KICK ME if I pass on any benefit I've PAID FOR!

sleepy guesty · Post by **sleepy guesty** » Thu Mar 27, 2014 4:18 pm

Olivia wrote: I have tried several other DMEs who insist I have to submit all my sleep studies, doctor notes and orders to them along with transferring to them as my DME or they cannot sell me a mask. Is this really true? It seems to me I should be able to just give them my prescription for a mask in order for them to dispense me one.

i would think a mask or supplies script should suffice
you should contact medicare to clear this up tho
if it turns out you also need a copy of a sleep study
and you have more than one i would send them the oldest
you do have your own personal copies right

LSAT · Post by **LSAT** » Thu Mar 27, 2014 5:13 pm

Olivia wrote:I have Medicare and have been obtaining my equipment and supplies from Nationwide Medical. My provider has ordered a Quattro Air FFM for me after several mask fit appointments as I continue to have major leak and did well with this when tested. Nationwide does not carry, this mask. I have tried several other DMEs who insist I have to submit all my sleep studies, doctor notes and orders to them along with transferring to them as my DME or they cannot sell me a mask. Is this really true? It seems to me I should be able to just give them my prescription for a mask in order for them to dispense me one. It has been over 6 months since Medicare has paid for a mask so I know I am due. What to do?

I believe that IF you have your doctor specifically write a prescription for that Quattro Air mask, the DME must supply it if they are an approved Medicare supplier.

StuUnderPressure · Post by **StuUnderPressure** » Thu Mar 27, 2014 6:01 pm

Olivia wrote:I have Medicare and have been obtaining my equipment and supplies from Nationwide Medical. My provider has ordered a Quattro Air FFM for me after several mask fit appointments as I continue to have major leak and did well with this when tested. Nationwide does not carry, this mask. I have tried several other DMEs who insist I have to submit all my sleep studies, doctor notes and orders to them along with transferring to them as my DME or they cannot sell me a mask. Is this really true? It seems to me I should be able to just give them my prescription for a mask in order for them to dispense me one. It has been over 6 months since Medicare has paid for a mask so I know I am due. What to do?

1st of all, YOU should have copies of all of this.
If not, get those copies now & never give out your last one.
Keep a copy of every one of those for yourself forever.

The DME is trying to hook you into being a "permanent" patient, as opposed to just passing through & buying just that 1 mask.

All they really need is the Rx.

But, if they have what you want, I would pacify them & give them all that they want. It is a game they like to play. But, if it will get you what you want, "I" would play that game.

If that is the only thing you want to buy from them, you do NOT have to buy anything else from them. Simply return to buying from Nationwide Medical.

But, if that DME can provide you with everything you need & Nationwide Medical canNOT, "I" would be tempted to switch to this DME for my future purchases anyway.

jencat824 · Post by **jencat824** » Thu Mar 27, 2014 6:05 pm

LSAT wrote:
Olivia wrote:I have Medicare and have been obtaining my equipment and supplies from Nationwide Medical. My provider has ordered a Quattro Air FFM for me after several mask fit appointments as I continue to have major leak and did well with this when tested. Nationwide does not carry, this mask. I have tried several other DMEs who insist I have to submit all my sleep studies, doctor notes and orders to them along with transferring to them as my DME or they cannot sell me a mask. Is this really true? It seems to me I should be able to just give them my prescription for a mask in order for them to dispense me one. It has been over 6 months since Medicare has paid for a mask so I know I am due. What to do?
I believe that IF you have your doctor specifically write a prescription for that Quattro Air mask, the DME must supply it if they are an approved Medicare supplier.

Correct - if they are a Medicare approved provider, which Nationwide is, and your Dr. writes the prescription specifically for the Quattro Air, then that's what they have to provide. Also, Nationwide is feeding you a line of bull, my hubby had previously used the Quattro Air & it was supplied by Nationwide. I'd call Nationwide Medical back & tell them you know they carry this mask because you know someone they have supplied it to. I've never had trouble with Nationwide until the beginning of this year, they made a few mistakes, but I knew they had the extra influx of Medicare patients, so I thought it was just due to that. Then we had a mix-up with my hubby's order, so I'm beginning to think they bit off more than they were prepared to chew with the Medicare contract.

Either way, I'd call them on it using both points - RX & someone else got this mask from them.

Good luck & let us know how it goes,
Jen

Edit - if you have to go to another DME then yes, I think Medicare has a clause about needing your sleep study copies. I ran into that in a strange way I won't bore you with.

chunkyfrog · Post by **chunkyfrog** » Thu Mar 27, 2014 6:30 pm

I would guess the other DME's would like all your business;
but I don't believe Medicare restricts us to one DME at a time.
If you have an "advantage" plan, it's more like an HMO, which could be more restrictive.

Olivia · Post by **Olivia** » Thu Mar 27, 2014 10:25 pm

Thanks for all the advice. Of course, I have all my sleep studies and orders. I think I will call Medicare and see what the story is really. Nationwide told me that they have this mask on back order and that may be several months. Actually one person told me they don't make enough money off of this mask! Of all the DMEs I spoke with, Apria was the most polite and professional. go figure.

Pugsy · Post by **Pugsy** » Fri Mar 28, 2014 4:40 am

Olivia wrote:Actually one person told me they don't make enough money off of this mask!

You probably got the truth with this statement. The profit margin is likely not as large as they would like to see and so they aren't very agreeable to supplying it unless they are forced to. They might not sell enough of them to be able to buy in bulk to get a better deal. I don't know if bulk buying discounts pertain to brand or mask models...or even if there is such a thing.
My DME (small town) is honest and just tells me that they can't stock every mask available in the whole world and so they stock the ones that are most popular and they get the best deals on.

Medicare pays a certain rate for a full face mask and headgear no matter how much it costs wholesale. Brand and model doesn't matter either.

Hang Fire · Post by **Hang Fire** » Fri Mar 28, 2014 5:36 am

Olivia wrote: Actually one person told me they don't make enough money off of this mask!

Why the exclamation point? Do you think you could run a business selling things at no profit? Did you not like to hear the truth from this person?

Wulfman... · Post by **Wulfman...** » Fri Mar 28, 2014 11:15 am

Hang Fire wrote:
Olivia wrote: Actually one person told me they don't make enough money off of this mask!
Why the exclamation point? Do you think you could run a business selling things at no profit? Did you not like to hear the truth from this person?

If the DMEs can't make a profit, maybe they need to get out of the business. They can make a profit on the items......or they can make it up on something else. Sometimes you lose money on one item and chalk it up to keeping or getting a customer.

Den

.

Hang Fire · Post by **Hang Fire** » Fri Mar 28, 2014 3:44 pm

If the DMEs can't make a profit, maybe they need to get out of the business.

Oh, that would be great for us CPAPers. Let a bunch of the DMEs go out of business and see how high the prices will go and how low the service will go.

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