renewing prescription

[onward60]

My CPAP script seems to be expired. It is dated July 2022. The script for the machine says 99. The script for the supplies says 12 refills. MyChart says the script is expired.

My original prescriber has retired. The nurse who replaced him is a total jerk (as experienced by me and others who left her online reviews). I'm never going back there. If I could get referred to a different medical system, it would be quite a drive for me.

I have my machine. I'm trying to adjust to the Bleep system right now. My insurance does not cover Bleep. Do I actually need a current prescription to continue? I'm confused that some online suppliers seem to want one and some don't. (I am Wisconsin, USA.)

[jdm5]

I have sent expired scripts with no issues for years (more than 15). If you need supplies / masks upload the expired script and see what happens - I have never had an issue. Worst case they’ll just reject it.

Alternatively I believe there are a few home sleep study tests you can get that will have a remote provider review and provide you with a script. Cpap.com has one - https://www.cpap.com/home-sleep-apnea-test though there are undoubtedly others.

Good luck with Bleep! It’s my favorite “mask(s)” / interface. Both the Dreamports and Eclipse are great - Dreamport a little more difficult to connect but lighter on the nose. Eclipse simple to connect but a bit heavier. The key is skin prep - I wash my face with soap, then wipe down nose, nares, upper lip with rubbing alcohol pad.

[onward60]

I have sent expired scripts with no issues for years (more than 15). If you need supplies / masks upload the expired script and see what happens - I have never had an issue. Worst case they’ll just reject it.

Alternatively I believe there are a few home sleep study tests you can get that will have a remote provider review and provide you with a script. Cpap.com has one - https://www.cpap.com/home-sleep-apnea-test though there are undoubtedly others.

Good luck with Bleep! It’s my favorite “mask(s)” / interface. Both the Dreamports and Eclipse are great - Dreamport a little more difficult to connect but lighter on the nose. Eclipse simple to connect but a bit heavier. The key is skin prep - I wash my face with soap, then wipe down nose, nares, upper lip with rubbing alcohol pad.

Thanks. This is good to know.

I have the Dreamports but have been struggling with them due to hand issues. Fiddling with tiny objects is hard on my fingers/thumbs/wrists. Thinking of switching to Eclipse.

[onward60]

To expand on my question, if I don't need a script, is there any reason to ever go back to a provider for "follow up," as they are insisting I need? They say they want to evaluate my data. If I get Oscar and I have y'all, what do I need them for? I don't want to admit to them that I am still struggling to find a mask that works. The nurse who wrote the second script for a machine was haughty and shaming.

[Pugsy]

If I get Oscar and I have y'all, what do I need them for?

That's a good question.

The nurse who wrote the second script for a machine was haughty and shaming.

That's grounds for immediate dismissal in my book.

The medical profession works for US and they owe us at least respect (besides decent medical care).

if I don't need a script, is there any reason to ever go back to a provider for "follow up," as they are insisting I need?

You will need to jump through the hoops if you want your insurance to pay and your insurance company may have some specific requirements so that they will pay their portion of your cpap stuff. You need to figure out (by talking to your insurance company) what it takes to make them happy so that they will pay. Don't EVER, EVER rely on what a doctor says or the DME says about your particular coverage. Get all information straight from the horses mouth.

BTW who told you that the Bleep wasn't covered by insurance???? Medicare will pay for it and so do most other insurance companies because they follow Medicare guidelines.

All that said about follow up ..... yes, we have this forum and OSCAR but sometimes there are problems that we can fix from here or the data can't point to a fixable problem...sometimes we do need the extra care from the "pros" but good luck getting it. That's when we go doctor shopping...and doctor office shopping as well. I have fired docs that were probably "okay" but their office staff pissed me off.

Remember who they work for....it's us the patients. Not the other way around where we are supposed to feel blessed that they have us a patients.

[onward60]

If I get Oscar and I have y'all, what do I need them for?

That's a good question.

The nurse who wrote the second script for a machine was haughty and shaming.

That's grounds for immediate dismissal in my book.

The medical profession works for US and they owe us at least respect (besides decent medical care).

if I don't need a script, is there any reason to ever go back to a provider for "follow up," as they are insisting I need?

You will need to jump through the hoops if you want your insurance to pay and your insurance company may have some specific requirements so that they will pay their portion of your cpap stuff. You need to figure out (by talking to your insurance company) what it takes to make them happy so that they will pay. Don't EVER, EVER rely on what a doctor says or the DME says about your particular coverage. Get all information straight from the horses mouth.

BTW who told you that the Bleep wasn't covered by insurance???? Medicare will pay for it and so do most other insurance companies because they follow Medicare guidelines.

All that said about follow up ..... yes, we have this forum and OSCAR but sometimes there are problems that we can fix from here or the data can't point to a fixable problem...sometimes we do need the extra care from the "pros" but good luck getting it. That's when we go doctor shopping...and doctor office shopping as well. I have fired docs that were probably "okay" but their office staff pissed me off.

Remember who they work for....it's us the patients. Not the other way around where we are supposed to feel blessed that they have us a patients.

Thank you the affirmation. That nurse was really a piece of work. I left feeling shamed for failing my first trial and thinking that since my apnea was "mild" (14.2) the CPAP wasn't going to do me much good. I saw that another patient left a review saying the nurse had shamed her, too.

I don't get Medicare until August. There are only a few DME suppliers here that take Medicaid. I tried every one in the county. They didn't carry it. One in the next county carried only the Dreamport and said there was no applicable code to submit because technically it wasn't a mask, it was a box of many masks.

I hear my medical group plans to hire another sleep nurse. And there is another group with a sleep nurse that is a bit of a drive, but not terrible. That nurse who wrote my second script also wrote some nasty stuff in my medical record (to cover her behind, I wish I had recorded the session or brought a witness) so I am thinking I will change groups entirely when Medicare kicks in.

[chunkyfrog]

. . .
I will change groups entirely when Medicare kicks in.

Don't wait.
There is enough to do when you start Medicare without breaking in a new doctor.
Also, it may be easier to be accepted as a new patient BEFORE Medicare is involved.

[onward60]

. . .
I will change groups entirely when Medicare kicks in.

Also, it may be easier to be accepted as a new patient BEFORE Medicare is involved.

Well, that is something I had not considered. Perhaps I will keep my primary and try to get him to refer me out of the group to the sleep clinic across town. He's a nice guy. He may do it.

[Pugsy]

said there was no applicable code to submit because technically it wasn't a mask, it was a box of many masks.

What a load of bull crap.

The ports fall under the same classification for HCPCS billing codes as any other nasal mask.

The DreamPorts/Halos use the replacement Nasal cushion code.... which is A7032 and 2 per month is allowed and each box is equal to 2 weeks worth so each box is like one replacement cushion and 2 replacement cushions are allowed...so 2 boxes a month are allowed.
The frame/hose part is HCPCS billing code A7034 and you are allowed one per 3 months. It will last a LOT longer than 3 months.

Medicaid huh??? Sigh...you get treated like the ugly stepchild for sure. These idiots won't listen to reason though.

[onward60]

Thanks for this chart, Pugsy. I will use it next time I try calling round. I'm hoping that eventually more places will start carrying Bleep. One place had never even heard of it.

[Pugsy]

Thanks for this chart, Pugsy. I will use it next time I try calling round. I'm hoping that eventually more places will start carrying Bleep. One place had never even heard of it.

Even when they hear of it they don't always want to listen. I had that happen with the DME that I used to use (note the term "used to" )

I fired them when they told me that insurance wouldn't pay for the Bleep. I don't like being lied to and they were unwilling to listen to me. So I haven't been back since March 2019. I wouldn't buy so much as a cheap little filter from them.

I do understand it is harder when the insurance is Medicaid because a lot of suppliers won't accept Medicaid patients because reimbursement rates have been historically low...so shopping around for suppliers isn't so easy.

If you end up really liking and wanting to use the Bleep or the Eclipse you may run into some hurdles but they all pay by the HCPCS billing codes and not by type of mask or name of mask or brand of mask. It's the billing codes only and if you give them the correct billing code and become an annoying squeaky wheel you will have better chance of making them get you what you want.

[onward60]

Even when they hear of it they don't always want to listen. I had that happen with the DME that I used to use (note the term "used to" )

I fired them when they told me that insurance wouldn't pay for the Bleep. I don't like being lied to and they were unwilling to listen to me. So I haven't been back since March 2019. I wouldn't buy so much as a cheap little filter from them.

I do understand it is harder when the insurance is Medicaid because a lot of suppliers won't accept Medicaid patients because reimbursement rates have been historically low...so shopping around for suppliers isn't so easy.

If you end up really liking and wanting to use the Bleep or the Eclipse you may run into some hurdles but they all pay by the HCPCS billing codes and not by type of mask or name of mask or brand of mask. It's the billing codes only and if you give them the correct billing code and become an annoying squeaky wheel you will have better chance of making them get you what you want.

I think I can do squeaky wheel!