Abusing the system?

[akcpapguy]

I have asked this question because I have about 20 or so patients who bring their Respironics mask back without fail at around the 25-30 day mark. All of these patients have been doing this for over 24 months (Long before I started at this job), and some of them have been doing it for as long as 4 years.

This week my Manager asked me for a recommendation for a timeframe on an acceptable use policy. I told her I would give her an answer on Tuesday after i talked to some other DME RT's and ofcourse polled you folks here at cpaptalk.

These folks don't really switch mask either, they just simply change the size they ask for from month to month. None of them have ever had to pay for a mask, since they are returned before the billing cycle is reach.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, DME

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, DME

[Babette]

OY! Totally abusing the system. Getting a completely different mask or switching due to serious fitting issues; i.e., rashes, blisters, headaches, etc. I can understand, but this seems like blatant abuse.

My DME headed me off at the pass - told me I had 7 days to decide if I liked it or not or it was SOLD. When I got my second mask, after three days, I was only given 2 days to decide on that one. Needless to say, I'm not continuing to do business with them... BTW, they HAVE billed my insurance for that second mask. Like, the next day. I called to find out.

You're clearly getting abused.

Good luck!
B.

[Goofproof]

Mine told me to like mine for 6 months, after that I could try to like another one, for 6 months. Jim

[Guest]

My 02 DME has begun providing my CPAP supplies since my CPAP DME is such a lousy ..... anyway, my 02 DME has been extremely lenient in letting me try masks they have in their supply.

I've found I can often tell the minute I put them on my face which ones to not even bother trying w/pressure. For those that feel promising I've been able to tell w/in 7-10 days. Some I thought would work well did at first, but w/in 7-10 days I either had a tender bridge of nose, or tender upper lip under the nose area.

The ComfortLite 2 fooled me completely for almost 3 months. It was my best fitting, most comfortable (the Medium size simple nasal cushion - altho I started using it w/the Small nasal pillows). However, around that 3 month mark my hair follicles on the top of my head in the area of where the swivel sits on the headgear got very tender, and I had some hair breakage and thinning in the same area. Other than the CL2 tho, I've known w/in 7-10 days.

Things I've learned to look for is width of the bottom of the nasal cushion at the cheeks, width of the nasal cushion at the bridge of the nose, length of the nasal cushion for fit on bridge of nose and at the bottom of the nose on the upper lip. Is there adjustment in the piece between forehead and bridge of nose? I NEED that adjustment.

In my own estimation, 2 weeks, is a fair amount of at home "trial" time for masks. I have no idea how you fairly handle the situation of trying a number of masks in the office but I found that necessary to rule out several that I had read about and "thought" I wanted to try. If I had had to take each mask they let me try home I'd still be trying to find the "right" mask!! By letting me try and then discard in the office those that I thought I'd like that obviously weren't going to work once held to my face we saved a LOT of time in finding what I think just may be "the" mask for me.

Unfortunately, I do need to do a couple of "fixes" to the Simplicity headgear as the center strap is way too long for proper adjustment for me and the velcro for some reason is the same width as the straps and thus very liable to scratching your neck raw unless you take the scissors to the velcro and narrow it. Why that is I don't know as the other Respironics masks I've tried w/velcro have the velcro narrowed and even the Simplicity has the narrow velcro strip on the center strap instead of velcro as wide as the strap.

[RosemaryB]

Double post, sorry.

[RosemaryB]

I have asked this question because I have about 20 or so patients who bring their Respironics mask back without fail at around the 25-30 day mark. All of these patients have been doing this for over 24 months (Long before I started at this job), and some of them have been doing it for as long as 4 years.

This week my Manager asked me for a recommendation for a timeframe on an acceptable use policy. I told her I would give her an answer on Tuesday after i talked to some other DME RT's and ofcourse polled you folks here at cpaptalk.

These folks don't really switch mask either, they just simply change the size they ask for from month to month. None of them have ever had to pay for a mask, since they are returned before the billing cycle is reach.

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, DME

I don't understand why they would try a different size each time if it is the same mask. Is it that their insurance only pays for one mask? How could they get the proper fit? Maybe I'm dense, but I don't understand the motivation here. To have 20+ of them, there must be something else going on.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, DME

[RAINSUX]

First, what does Respironics say? They're providing the free masks, right? I think 30 days is way too long. If a mask isn't working for them, they should know after just a few nights. Obviously, changing to the same mask isn't going to change anything. As a DME you should be able to evaluate them in terms of fit, leaks, comfort, etc, and provide them with a different mask that will better fit their needs. Allowing these freeloaders to keep doing this can only raise the mask cost for the rest of us.

[jvoisin]

It's not that way up here on Ontario.. I fitted the mask, and I was on my way.. I have the Swift.. I didn't even get all 3 pillows.. they billed my insurance like 350-400 for the mask.. and with my S8 Elite, they didn't include the data card.. they said that was extra and wanted another 50 for that...

There is alot of abuse going on on both sides.. DME's abusing insurance providers (and patients if they don't have coverage) and the patients abusing the DME's (and subsequently the manufacturers/distributors)..

I think that it is really up to the DME's to try and limit the abuse by the patients.. keep track of every mask and size.. don't let them try the same size again.. they will very quickly run out of masks.. and make them pay for the fitting.. I would think this is one of the reasons things are so friggin' expensive from the DME's.. they have to recoup the costs associated with the abusers..

I'm happy with my equipment.. and since I want a second mask (something that isn't a pillow) I will buy it myself out of pocket.. but from CPAP.com instead of the DME due to the markup..

I like this forum, there is alot of good information, and I am pleased to see that some of the DME's are also participating..

[Slinky]

I would like to add that both my original DME and my sleep lab tech and manager thought the Small masks would best fit me. Not knowing there were Petites in some mask styles I never tried a Petite.

I've since found with the ComfortLite 2 simple nasal cushion I need the Medium cushion, with the Simplicity I need the Small cushion but with the HC 407, I would need the HC 406 instead. Since I've not tried the 406 I don't know that it "would" be a good fit, but I do know the 407 cushion is a skosh too long.

[Daffney_Gillfin]

Here is what I was given from my DME.

Every effort is made to achieve the best fit possible for your mask. If you are not happy with your mask or feel it does not fit, federal law prohibits the resale of the mask. Hence, it cannot be returned for credit after use. If you wish to purchase another mask, we will sell you one new mask of your choice at our cost. Purchase must be made within 21 days of receipt of your equipment. We reserve the right to refuse the sale of an "at cost mask" if we believe the customer is abusing the policy.

The first sentence is bull. When I requested a full face mask, I was handed a UMFF in the box, unopened, at the counter, with no mention of actually fitting it. They also push ResMed products to a fault. (I wonder why.) I will say though that at least my DME gives me the full kit when getting a mask that comes with different sized pillows, etc. I have also received a new mask every three months paid for by my insurance, and either my DME has absorbed the cost of the headgear or submitted the claim in a way that insurance pays even though they cover headgear every six months.

I find it interesting that you're saying that Respironics is providing the free replacement. Is that just Respironics, or is it standard practice throughout the industry?

Back to your original question... Given that they don't even change masks, I would cut them off much sooner. I voted six months as it was the shortest interval, but I would do it sooner in the situation you describe.

[Slinky]

Just me - again. What you didn't make clear, akcpapguy, is whether patients are given the opportunity to try masks on in your office to determine which ones they "think" might work. That eliminates a lot of "free to the patient" masks right then and there.

Then, when they choose one to take home, is when I think a two week trial is fair. IF they have had the opportunity to try and discard several masks in your office PLUS selecting one to take home to try for two weeks then I would think that maybe 3 "take homes" might be my cut off point over a period of 2 - 3 months.

Obviously, for these dead beat "abusers" especially, you would want to keep a list of each mask tried in the office and the date tried, just as you would list the mask they chose to take home and keep that list in that patient's records.

Ideally, in your office you have a bed or cot w/pillow for the patient to lay on whilst trying a mask. Ideally you also have a machine set to their pressure as they try the mask. Even more ideally it would be a machine (such as the Resmeds) that have a Mask Fit guide via the LED screen that you can check as they try the mask. Ideally you would have the patient lay on their back, both sides (and tummy if they are tummy sleepers) and make any fit adjustments thru all this. That is the way my sleep lab does it and the way some of the better DME suppliers handle mask fittings.

I have found that the Resmed Mask Fit feature is somewhat more forgiving than I am about minor leaks.

[new2]

If Respironics is paying for it, why do you care???
It should go on as long as it takes a customer to find a mask that fits that doesn't pull their hair out (CL2), leak in their eyes, have an opti-no-like experiance, comfort curve slider, or whatever until they find something that will last 30 days on them. Ideally, it needs to last at least 90 days for my insurance to pay for another, so hell, make them keep their guarantee.
They know you will hate most of the masks and they need to show forbes they are a trustworthy company......
what does the dme care if Respironics is paying for it and replacing the masks?

[Guest]

Slinky,

They are given the opportunity to try on every mask i have in every size i have. However as you can probably guess the ones who return their masks don't want to come in for a fitting, they just want to return one and get a new one. As far as why would they get different sizes, they will usually just switch between a small or medium, or a medium or large. They are doing it simply to have an excuse like, mask is too small or too large.

new2,

Respironics doesn't always pay for the mask, if they return the mask later than 26 days there is no way for us to get it to Respironics within 30 days. Well I guess we could send it overnight or such, however that is rather cost restrictive up here in AK. Not to mention that we have to carry an extra 20-30 masks in the inventory, just so we have enough of the correct sizes of masks for patients. I agree that a patient should be given the time to findout if the mask they were fitted for and chose at the DME is going to work for them. However when that patient switches between 2 sizes of the same mask every 30 days for over 2 years, I would consider that abusing the system.

[Wulfman]

Random thoughts:

I guess I can't relate to this situation because I never used a "brick & mortar" DME. I gave my equipment a lot of thought before I selected it. Beyond the initial purchase with insurance reimbursement of 80%, everything I've purchased has been out-of-pocket (extra machines, masks, hoses, filters, etc.)
I also can't relate to the "my insurance will pay for a new mask every 3/6 months". I think the deductible/co-pay situation would still make it more cost effective to purchase online.

If Respironics masks were all I had to choose from, I'd probably never be able to find one that worked satisfactorily for me, either. If they're the only brand of mask you carry......that might be a problem.

You're obviously being scammed by some of these customers and they've possibly been spreading the word between themselves as to how this works.

From some of the horror stories I've heard from the patients who come to the forum, it's hard to feel sorry for the DMEs who find themselves on the receiving end of these kinds of "games". (I'll make an exception for YOU)

Possible solutions:

If the DME selects the mask for the customer, they should be obligated to get the customer one that works..... (this may eliminate DMEs giving out the cheapest ones)

If the customer selects the mask (brand, size, etc.).....they "own" it when they receive it. (Obviously, it will help if they have an assortment to try before they buy)

"Defective" masks are a different story. (like the new Quattros may be experiencing)

Don't know if that helps or not......

Den

[akcpapguy]

You're obviously being scammed by some of these customers and they've possibly been spreading the word between themselves as to how this works.

From some of the horror stories I've heard from the patients who come to the forum, it's hard to feel sorry for the DMEs who find themselves on the receiving end of these kinds of "games". (I'll make an exception for YOU)

Hehe Thanks Wulf

Possible solutions:

If the DME selects the mask for the customer, they should be obligated to get the customer one that works..... (this may eliminate DMEs giving out the cheapest ones)

If the customer selects the mask (brand, size, etc.).....they "own" it when they receive it. (Obviously, it will help if they have an assortment to try before they buy)

"Defective" masks are a different story. (like the new Quattros may be experiencing)

Don't know if that helps or not......

Den

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We always give the customer their choice of masks, and I never sell a patient a different style of mask without a mask fitting. I will sell someone a mask of the same style in a different size without a fitting. We carry almost every mask from the major players in every size, we even carry the old "Golden Seal" from Respironics. So it's not that they don't have masks to choose from, they just want to beat the system.

Oh and the Guest post above Wulf's is me.