Mask sales and insurance dilemma..long story

[Elle]

When i started cpap a year ago i tried the breeze. After a few weeks I traded it for the activa (sore nose) and didn't have to pay. The activa didn't look new and that surprised me but I figured someone else would be buying the Breeze I had tried because obviously the company couldn't just throw all the trial masks out.

A few months ago (before discovering that I just needed a new cushion) I went to try the breeze again b/c activa was giving me problems and the breeze I bought leaked like crazy. I then bought an activa cushion from cpap.com (for $35. instead of the $125. my RT's co. was charging) but decided when in visiting the RT, (who sold me the breeze) for another matter, to tell him about the leaks with the Breeze. He told me it had severe leaks because it wasn't glued together properly and I should epoxy it. I wanted it returned so insurance would cover a new mask but he said it had been too long.

So according to my insurer I had recently had a new mask and was not due for another yet. When I explained the situation they said to have the RT send in a pre-approval form stating that my masks were not adequate. The RT would not do a pre-approval for anything less than $1,000.

When I decided to buy one anyway and take a chance that the insurer would cover it they brought out a fisher paykel model from what looked like new packaging. I said "Oh it has the same head gear as my resmed activa", and she said "Oh no. It is just similar". I said "Odd that it would have a label saying 'mirage activa' on it". She blushed and put it aside and said it was a mistake and took out another one. Needless to say at their prices and without a guarantee that insurance would cover it I didn't buy anything from them.

I told the insurer that I wanted to buy from cpap.com because masks were 1/4 the price but they need that signed form from an RT saying that I actually NEED a new mask.

Normally the person you are buying from (at least here in my city) sends in paper work when you purchase a mask saying that it is necessary. I don't want to pay out of pocket for something that may not be re-imbursed in the long run and it also bugs me that the prices are so high and the masks are NOT NEW.

That's my rant for today.

[OREO]

Insurance companies are impossible...we are having to buy most of our items out of pocket...Good luck!![quote][/quote]

[Patrick A]

Try dealing with medicare they are fun too.
Try going thru Apria Rip off

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CPAPopedia Keywords Contained In This Post (Click For Definition): medicare

[Slinky]

Well, now, if you are sure that these masks the local DME keeps bringing out are NOT new and they are trying to sell them to you as new ..... REPORT THEM! What they are doing is clearly illegal. Report them to your insurance company, the local better business bureau or chamber of commerce, your xpap ordering doctor, the state licensing bureau, the local and state health departments .... who did I miss?

[Patrick A]

[quote="Slinky"]Well, now, if you are sure that these masks the local DME keeps bringing out are NOT new and they are trying to sell them to you as new ..... REPORT THEM! What they are doing is clearly illegal. Report them to your insurance company, the local better business bureau or chamber of commerce, your xpap ordering doctor, the state licensing bureau, the local and state health departments .... who did I miss?

[Elle]

But what would they do with all the masks that people try for a bit and return?

I guess I should have asked whether it was Fisher/paykel or Resmed that made the mistake of putting parts of two different masks together.

I am just tired of the fight so I just left....as I walked out of the other company where they told me they had been fighting with the Breeze people because many of their customers have had to "epoxy" their masks to prevent leaks. BUT they still sell them and they don't give refunds. argghhh.

First reaction is to say "Ok then I guess I won't do treatment"...that'll show em.

[Patrick A]

[quote="Elle"]When i started cpap a year ago i tried the breeze. After a few weeks I traded it for the activa (sore nose) and didn't have to pay. The activa didn't look new and that surprised me but I figured someone else would be buying the Breeze I had tried because obviously the company couldn't just throw all the trial masks out.

A few months ago (before discovering that I just needed a new cushion) I went to try the breeze again b/c activa was giving me problems and the breeze I bought leaked like crazy. I then bought an activa cushion from cpap.com (for $35. instead of the $125. my RT's co. was charging) but decided when in visiting the RT, (who sold me the breeze) for another matter, to tell him about the leaks with the Breeze. He told me it had severe leaks because it wasn't glued together properly and I should epoxy it. I wanted it returned so insurance would cover a new mask but he said it had been too long.

So according to my insurer I had recently had a new mask and was not due for another yet. When I explained the situation they said to have the RT send in a pre-approval form stating that my masks were not adequate. The RT would not do a pre-approval for anything less than $1,000.

When I decided to buy one anyway and take a chance that the insurer would cover it they brought out a fisher paykel model from what looked like new packaging. I said "Oh it has the same head gear as my resmed activa", and she said "Oh no. It is just similar". I said "Odd that it would have a label saying 'mirage activa' on it". She blushed and put it aside and said it was a mistake and took out another one. Needless to say at their prices and without a guarantee that insurance would cover it I didn't buy anything from them.

I told the insurer that I wanted to buy from cpap.com because masks were 1/4 the price but they need that signed form from an RT saying that I actually NEED a new mask.

Normally the person you are buying from (at least here in my city) sends in paper work when you purchase a mask saying that it is necessary. I don't want to pay out of pocket for something that may not be re-imbursed in the long run and it also bugs me that the prices are so high and the masks are NOT NEW.

That's my rant for today.

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CPAPopedia Keywords Contained In This Post (Click For Definition): resmed, breeze, activa, cpap.com, CPAP[/qu

Medicare allows 1 mask every three months, 1 headgear every 6 months,1 chinstrap every 6 months, 2 cushions/nasal pillows every 1 month, 1 new 6' tubing every 1 month, 2 disposable filters every 1 month, 1 non-disposable filter every 6 months. and 1 water chamber every 6 months.

Most insurance companys follow the medicare policy. I got this list from cpap.com when they sent memy new mask. I have a couple of extra hoses because I bought a new machine and I also bought a new mask and hose.

[Elle]

Patrick, I am in Canada and unfortunately my insurer (Pacific Blue Cross) will give a mask once a year unless you have paperwork from DME explaining that it is necessary to get one sooner. DME (still have no idea what that means or if I am using it right) has to check current mask and report to insurer that it is no longer viable for treatment.

Since the cushion for my current mask is so cheap at cpap.com I am not in a panic but am just ranting about the feeling that I am being duped.

Thanks for the info and for listening to my rant. I knew this was the place to do it. non hosers don't get it. take care

[Patrick A]

Well just have another cup of coffee and put some Canadian Club or a good Canadian Whiskey in it .


I like CC or Segrams VO, but mostly Old Bushmills Irish Whisky in it myself.

[Elle]

Johnny Walker red here

[geoDoug]

who did I miss?

State or federal politicians, if they're sympathetic to the problems with the health care industry. It has a different goal (changing policy versus fixing the current situation), but it can be effective if you've got representatives who will listen. If you're in California, your Assemblyperson may be a good first step.

Doug.