insurance / medical supplier question

[d373]

i have respironics machine from 3 yrs ago from DME supplier, paid for by insurance company in monthly installments, which appear to have ended over a year ago, insurance covers 100% DME. Assumption is that machine is now fully-owned, since no insurance payments? Admittedly I havent used it for almost as long, but want to start again. I have mispalaced mask, headgear, and hose, which were and are still 100% covered as consumables. Question to this board is: can I just call up the DME supplier and request hose, mask, headgear, or are they going to want to want to refer me back to doctor for checkup or are they going to want to pull the stats from my machine, which hasn't been used, or ??? Need advice, as I really want and need to start using the machine. Reason I never used it is that I was never able to fall asleep with it, went many full-nights w/o any sleep at all when trying machine, so figured that some sleep is better than none at all. Now I really need it. Thanks for your advice.

[Kevin G.]

Assume that you own the machine.

You should be able to take your prescription in to them and say you want the new mask. The only reason why you would have to see a doctor is if the insurance company had some requiremetn but I would not even ask the question.

If you gave it a good try and it did not work then it may be a good idea to check with a sleep specialist. If you have a CPAP you could check the pressure to see if it was set right. You can check your pressure by pushing the end of the hose into a bucket of water and measuring the penetration when the bubbles stop comming out.

[cflame1]

Chances are they're going to want a new script. A lot of the DME's (medical suppliers) want new scripts after 1 year.

[Gia]

If the DME has your RX on file, they may not require a new prescription. A lot of DME supplies will honor an RX for the life of the RX (if you doctor wrote it for 99 months it is considered lifetime). BUT you must file the original RX within one year of the data it was written. And this usually only applies to the consumables (mask, tubing, filters, replacment parts etc). The actual machine itself is considered a one time thing by alot of brick and morter DME. Not sure about internet vendors - they are more likely to interpret any regulations more liberally than a physical DME.

[LoQ]

A lot of DME supplies will honor an RX for the life of the RX (if you doctor wrote it for 99 months it is considered lifetime). BUT you must file the original RX within one year of the data it was written.

I contacted 4 or 5 local DMEs recently. Not a single one of them would accept an Rx that is more than a year old, regardless of what was written on it. Apparently, even if you filed it with them originally, they still want a new one every year, because I asked that.

I'm sure policy varies, but not where I live.