Resmed Airfit P10 mask insurance replacement?

[dream321]

Hi.

My DME told me that all insurance companies replace the frame of the Resmed P10 (the part with the tube) once every 6 months and the strap (headgear) once every 3 months. Since my tube seems to have a small leak, it looks like I'll have to buy one out of pocket, and may just switch to a mask where they replace the tube every 3 months. (Getting info from my insurance company is very difficult. Usually have to wait to see what they'll pay. I use Ambetter.). Can any of you tell me how your insurance handles the P10? I want to figure out if my DME is correct. Thanks

Mike

[Pugsy]

Usually it's the other way around.
Headgear per 6 months and frame per 3 months.
Here's what Medicare does. Most insurance companies will use pretty much what Medicare does.
Now DMEs on the other hand often will do what they want and blame your insurance. Your DME is telling you a big whopper and it isn't the truth.

The P10 is under "nasal" category A7034.

If you just need the short hose...check EBay. If it's a very small hole...something like duck/duct tape is usually sufficient.

[JimW159]

Hi.

My DME told me that all insurance companies replace the frame of the Resmed P10 (the part with the tube) once every 6 months and the strap (headgear) once every 3 months. Since my tube seems to have a small leak, it looks like I'll have to buy one out of pocket, and may just switch to a mask where they replace the tube every 3 months. (Getting info from my insurance company is very difficult. Usually have to wait to see what they'll pay. I use Ambetter.). Can any of you tell me how your insurance handles the P10? I want to figure out if my DME is correct. Thanks

Mike

Are you certain the tube has a leak? If so, you might want to try a stop-gap until you get a replacement such as wrapping medical tape around the tube to cover the leak. Where do you live, Mike?If you want and If in the US, you pay the shipping and I'll send you one. PM me.

[dream321]

Usually it's the other way around.
Headgear per 6 months and frame per 3 months.
Here's what Medicare does. Most insurance companies will use pretty much what Medicare does.
Now DMEs on the other hand often will do what they want and blame your insurance. Your DME is telling you a big whopper and it isn't the truth.

The P10 is under "nasal" category A7034.

If you just need the short hose...check EBay. If it's a very small hole...something like duck/duct tape is usually sufficient.

I use a DME. Same sleep dr that did my sleep study. I explained the Medicare chart to them and they told me they deal with insurance everyday and they don't cover the hose on the P 10 because the pillow bed is attached to it, and thus, not just a hose. That's why I'm also interested in seeing if anyone has any firsthand experience with insurance on this.

[palerider]

interested in seeing if anyone has any firsthand experience with insurance on this.

your insurance and my insurance are not the same.

[Pugsy]

The billing codes are universal. Medicare and all insurances companies use this HCPCS billing code system in terms of the billing code.
Now the frequency of replacement allowance can change.

A7034 is the frame/short hose and nasal pillows...pretty much a complete mask without the headgear.
Headgear is always billed separately anyway even if the packaging contains everything in one package which is why it has a separate billing code.

I can't find a billing code for just the short hose by itself and no time to look.

You are going to have to find the answer from your insurance company though because just because mine might do something doesn't mean that yours will. Different companies...different allowances and even different plans within the same company.
Call them up and give them the billing code for the headgear by itself and the A7034 package and ask how often.
Or scour for the HCPCS billing code for just the frame/short hose portion and ask your insurance directly how often you can get it.
It doesn't matter what someone else's insurance will do or won't do...yours could do something entirely different.

Or just bite the bullet and pay $27 for it on EBay
http://www.ebay.com/itm/New-Resmed-Airf ... SwJGlZiKvF

[RicaLynn]

I've used a P10 since I started CPAP three years ago. I've used the *same* P10 for 2.5 of those years because I was uninsured and broke. My cat thought the short hose was a snake and put several small punctures in it, which I covered with duct tape (the cute stuff scrounged from my daughter's craft bin) as a short term solution. Pretty? Not especially. Functional? You bet. Costly? Nope, probably 50cents worth of tape. Then as soon as my insurance kicked in for my new job I ordered a new mask assembly.

[dream321]

Hi.

My DME told me that all insurance companies replace the frame of the Resmed P10 (the part with the tube) once every 6 months and the strap (headgear) once every 3 months.

I'm going to check if the DME bills the strap/headgear to the code for the frame. If they do this, it would be fraud. They would be able to sell the frames someone should have gotten on eBay for a tidy profit