replacement schedule

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kit15
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Joined: Fri Apr 10, 2015 1:22 pm

replacement schedule

Post by kit15 » Tue Apr 28, 2015 1:40 pm

I am one month in to therapy, and my filter is starting to look a little gray-ish, but I'm not sure when I am covered for a replacement.
I am wondering what kind of replacement schedule people have. I have been trying to figure out how often I am covered for, but I haven't had much luck. The DME says to ask the insurance company, and my insurance company says that the DME determines the schedule and that they have to follow Medicare rules (even though I'm not covered by Medicare). Does that sounds right? Maybe there is some kind of universal replacement schedule that is based on Medicare? Does anyone know where I could find a copy? Thanks!

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Pugsy
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Re: replacement schedule

Post by Pugsy » Tue Apr 28, 2015 1:50 pm

A good many insurance plans mimic Medicare's replacement schedule.
Your Respironics machine uses the gray filter which is considered the "non disposable" filter and the optional white fine filter which is considered the "disposable" filter and probably what you are referring to when you say it looks gray. Whether your DME and/or insurance goes by this schedule...you will have to ask.
I buy my filters in bulk...saves money. I can get 6 filters for what my insurance co pay would be for 2 filters. I usually buy in bulk of 12 or 24.

http://www.cpapsupplyusa.com/CPAP-BiPAP ... edule.aspx

Item (number) HCPCS Code Replacement Frequency
CPAP Mask A7034 Every 3 months
CPAP Headgear A7035 Every 3-6 months
CPAP Tubing A7037 Every 3 months
Disposable Filter A7038 2 new filters every month
Non-disposable Filters A7039 2 new filters every 6 months
CPAP Chin strap A7036 Every 6 months
Full Face Mask A7030 Every 3 months
Oral CPAP Mask A7044 Every 3 months
Humidifier Chamber A7046 Every 6 months
CPAP Machine E0601 Generally, every 3-5 years, or as necessary

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Nick Danger
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Re: replacement schedule

Post by Nick Danger » Tue Apr 28, 2015 2:14 pm

Same here - I buy filters for my Resmed S9 in bulk. They are so cheap, I don't even worry about insurance (I think I paid under $20 for 12 of them).

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kit15
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Re: replacement schedule

Post by kit15 » Tue Apr 28, 2015 2:17 pm

Thank you both for your replies. If I am interpreting the insurance EOB correctly (which it's possible that I may not be), my 20% for 1 disposable filter was $27 so it sounds like I would definitely be better off not going through insurance.

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Nick Danger
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Re: replacement schedule

Post by Nick Danger » Tue Apr 28, 2015 2:24 pm

I didn't do a detailed search, but CPAP.com sells 6 disposable filters for the 60 series for $11.95. Oh, and I found these through a quick EBAY search: http://www.ebay.com/itm/12-Respironics- ... 0339673211 for $15 with free shipping.

Not sure which of those fit your specific machine (I don't really know much about the Respironics machines)

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Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
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kit15
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Re: replacement schedule

Post by kit15 » Tue Apr 28, 2015 2:28 pm

Thank you! This is a steep learning curve.

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Krelvin
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Location: Metro Phx Area - Dry Heat!

Re: replacement schedule

Post by Krelvin » Tue Apr 28, 2015 2:41 pm

kit15 wrote:Thank you both for your replies. If I am interpreting the insurance EOB correctly (which it's possible that I may not be), my 20% for 1 disposable filter was $27 so it sounds like I would definitely be better off not going through insurance.
WOW what an absolute rip off.

When I got my new machine in Sep from the DME, I paid for 2 filters (despite the fact the machine should have come with them)...

My copay is on the right. Allowable is on the left.

Image

The $10 was for no insurance.

I use the Hypoallergenic filters now which they say they can't get. So I buy the 6pk Hypoallergenic filters now from cpap.com and order them when they have no shipping cost specials.
Current Settings PS 4.0 over 10.6-18.0 (cmH2O) - Resmed S9 VPAP Auto w/h5i Humidifier - Quattro Air FFM
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kit15
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Re: replacement schedule

Post by kit15 » Tue Apr 28, 2015 3:09 pm

My statement is not quite so easy to read. I could be wrong, but only 2 items were marked as "purchase" and the cheaper one is $27 and is called "F STR Kit", which I thought might mean "filter starter kit." I guess it's possible that it is billing for both the disposable filter and the reusable filter? Although it does seem like those should come with the machine. Hopefully I'll be able to get more clarity from the insurance company at some point.

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Nick Danger
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Re: replacement schedule

Post by Nick Danger » Tue Apr 28, 2015 3:24 pm

The EBAY link included 2 of the gray filters and 12 of the white filters for $15.

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Woody
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Re: replacement schedule

Post by Woody » Tue Apr 28, 2015 5:44 pm

Thanks for posting the replacement schedule. So if you can get a hose every 3 months
I guess I can't complain that mine is just about shot after only 6 years of use ! I really
hate to get rid of it, it's been my friend for so long. But 30 min. ago I retired it from
6 years of trusty service.

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Deep Sleep
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Location: SW Ohio, USA

Re: replacement schedule

Post by Deep Sleep » Tue Apr 28, 2015 6:24 pm

If car dealers operated like DMEs, you'd be billed for a list of every part in the car with the replacement cost and a Honda Civic would cost over $100,000.

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englandsf
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Re: replacement schedule

Post by englandsf » Wed Apr 29, 2015 7:01 am

Ask your sleep doctor to specify all your parts replacement schedules on the RX. It cuts out a lot of insurance issues I have found.

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kit15
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Re: replacement schedule

Post by kit15 » Wed Apr 29, 2015 1:12 pm

englandsf wrote:Ask your sleep doctor to specify all your parts replacement schedules on the RX. It cuts out a lot of insurance issues I have found.
Thanks for the suggestion. Sounds like a good next step

tedburnsIII
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Re: replacement schedule

Post by tedburnsIII » Wed Apr 29, 2015 1:50 pm

Could someone please respond to OP's inquiry? Oh, thank you, Pugsy, above!
Last edited by tedburnsIII on Wed Apr 29, 2015 1:54 pm, edited 1 time in total.
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Krelvin
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Re: replacement schedule

Post by Krelvin » Wed Apr 29, 2015 1:54 pm

tedburnsIII wrote:Could someone please respond to OP's inquiry?
Several people have already.

If insurance is paying then it is up to them to provide the schedule regardless of what the DME says. If he is buying without insurance he can replace whenever he wants to. we are talking about a very inexpensive part.
Current Settings PS 4.0 over 10.6-18.0 (cmH2O) - Resmed S9 VPAP Auto w/h5i Humidifier - Quattro Air FFM
TNET Sleep Resource Pages - CPAP Machine Database
Put your equip in your Signature - SleepyHead v1.0.0-beta-1
Kevin... alias Krelvin