DME

[rlyndecker]

I am really mad, I have had my CPAP since late Nov., and I can't get a straight answer about the replacement "stuff" I wash everything but haven't replaced anything. Aren't I supposed to replace the tubing & the mask & the filter????

I am so confused, I call, I email not one reply from them...They just keep sending me bills!

Any advice? I pay for it out of my insurance so I didn't get a choice on who to use for the DME...

I am desperate right now because I have a cough/asthma issues and the CPAP is helping with it but I don't want to make myself sicker either...

THANK YOU!

[tetragon]

For a straight answer, ask your insurance provider. According to some insurance policies, you don't need a new mask, hose, or filter for six months, but others cover replacements at different intervals.

[Sheriff Buford]

Call the insurance provider. A tet stated, some insurance providers will provide you with supplies at a 6 or 3 month interval. See what your insurance provides. as far as the DME.... well... if you look back in this forum, not many folks here have a "good", DME. I believe they don't exist. I once thought I had a good one. As soon as I stated here that it was good, they went south on me.

Sheriff

[retrodave15]

Here is the Medicare replacement schedule that most insurance companies use as a guide:

Item Replacement Schedule
Full Face Mask 180 days
Full Face Cushion 30 days
Nasal Cushion 30 days
Replacement Pillow 30 days
CPAP Mask 90 days
CPAP Headgear 180 days
CPAP Chinstrap 180 days
CPAP Tubing 30 days
Disposable Filter 30 days
Non-disposable Filters 180 days
Oral Interface 90 days
Heated Humidifier 5 Years
CPAP Machine 5 Years

Some DME's have an autofill program, but I must call mine to order. Since I have met my out of pocket max for the year I order items as frequently as possible so I have a bit of a stockpile as I have found that with proper care items will last longer than the schedule above. I can get a new humidifier chamber every 6 months, I ordered one at 6 months, left it in the bag and kept on using the first one I got, but now I have a spare. Even if I had to pay the 20% charge I would have done it so I could have had a spare.

[Pugsy]

Insurance allowed replacement schedules will vary. Some go by Medicare's replacement schedule.
You do need to confirm with your insurance company exactly what they allow. The DME won't do that work for you.

The long hose will last a lot longer than Medicare's allowable replacement...No need to worry about it.

The filters....you mention some lung issues.
The gray foam filter...it will last a long time. Wash it once a month. Insurance normally allows 1 ever 6 months. They will last much longer than that. You can find them on EBAY though...dirt cheap with careful shopping. I got 12 for less than a dollar apiece and that included shipping.

The white fine filters are considered the disposable filters and Medicare allows 2 per month. If I had lung issues...I would do 2 per month. I don't have lung issues but I do change mine about once a month. They get pretty cruddy looking after a month in my old house.
Again...with careful shopping on EBay you can often find them in bulk much cheaper than at DME with insurance and for sure no hassle.

On EBay...the M series white fine filters have a tab on them. They will work just fine in the PR S1 machine...cut the tab off for easier placement.

Send me a private message with your name and address... I have several foam filters and white fine filters for use with the PR S1 machine. I will gladly mail some to you as a gift. I am using ResMed machine now so no need for them now. You need to change the filters now and wash the foam filter. I can send you enough to get you by for a month until you get your issues sorted out with your DME and insurance or you can use EBay if you wish.

[rlyndecker]

Thank goodness for you guys, I swear between the insurance and everything else I am ready to SCREAM!!! I will get home at a decent hour tomorrow from work for the only day, and I will make calling the insurance a priority. the lady (DME lady) who came out in late Nov. said I got a new mask every 3 months & new tubing every 6 months & something about owning the machine after a year. But my ? is if I call the insurance and they agree with that info. HOW do I get it?

My roommate said to screw the DME, find a medical supply place local & then try to get reimbursed from the insurance...I have Blue Cross PPO..What do people think about that suggestion?

Thanks!

[DiverCTHunter]

[quote="rlyndecker"
My roommate said to screw the DME, find a medical supply place local & then try to get reimbursed from the insurance...I have Blue Cross PPO..What do people think about that suggestion?
[/quote]

I can do a benefits lookup for you if you like. PM me with which BCBS (on back of card, top left corner; they have a separate company for each state), PPO Network / Blue Network code (front of card, bottom left corner) and Group code (front of card, immediately underneath the Subscriber ID number). DO NOT include your subscriber ID number or any personal information.