trying to determine whether my husband's dme is honest

[jta]

My husband has been on cpap therapy for about 6 months and I have been trying to research for him as he is having a hard time with it. I was just recently diagnosed with it also but am not rushing into a relationship with a dme until I know more about the equipment so have been reading these wonderful informative comments from all of you.He was told he could get 3 new nasal pillows for the Opus every 3 mos. They charged Medicare for 6 nasal pillows. When he called and told them he only received 3 they said they count each nostril so each nasal pillow is counted as 2. What's with that? Sounds fishy to me. So not sure I want to go with them also. Anyone have any insight on this? Thanks in advance

[Julie]

If you get six, you'll have your answer, if not, then complain to his boss or see about using another DME. Believe me, the insce. co. doesn't care about the pennies involved with pillows.

[GumbyCT]

Doesn't sound right to me. Here, try to order one nostril....lmao

https://www.cpap.com/productpage/opus-n ... -cpap.html

[kevincoop]

Yes, most insurances pay for 2 sets every month but you should be getting a set, not one side. He should be getting 6 pillows every 3 months if he wants. If not, tell them not to send them.
Kevin

[fidget]

The billing code is A7033, Medicare allowable is 2/1 month REPLACEMENT PILLOWS FOR NASAL APPLICATION DEVICE, PAIR
That is 2 PAIR, not 2 pillows.
They don't even come packages singly, so if they're trying to bill per pillow, they're ripping you off.
HOWEVER-
Medicare pays per month, if they send you 3 pair in one month, they'll only get paid for 2 pair.
Order 2 pair per month, and there will be no problem

[oscar98]

The billing code is A7033, Medicare allowable is 2/1 month REPLACEMENT PILLOWS FOR NASAL APPLICATION DEVICE, PAIR
That is 2 PAIR, not 2 pillows.
They don't even come packages singly, so if they're trying to bill per pillow, they're ripping you off.
HOWEVER-
Medicare pays per month, if they send you 3 pair in one month, they'll only get paid for 2 pair.
Order 2 pair per month, and there will be no problem

Where would I find these billing codes and replacement guidelines? My hubby has medicare and his DME is not offering us replacement pillows, cushions or filters. When we asked for a new filter we were told to wash the old one even though the patient manual says to never get it wet. As for cushions or nasal pillows we were never even told that was an option. All we were offered was a replacement mask every six months.

[Slinky]

Oscar, I can't find where I filed the URL. But I'm sure it was at the Respironics website that they had a link to the Medicare replacement schedule. If no one posts an URL try the Respironics website.

[wacyone]

Here is a break down on replacement:

http://www.cpapsupplyusa.com/CPAP-BiPAP ... edule.aspx

Wes

[GumbyCT]

jta, oscar, et al ...
It might be worth your time to call and ask the Medicare folks about your concerns.

http://www.cms.gov/DMEPOSFeeSched/01_overview.asp
Contact Information:
Who should you contact to determine which HCPCS code to use for billing?

PDAC Helpline: 877-735-1326

[oscar98]

Thank you.

[DreamOn]

[post deleted]

[brain_cloud]

Someone should be collecting unintentionally humorous thread subject titles.

[GumbyCT]

Someone should be collecting unintentionally humorous thread subject titles.

lmao - I would say to assume they are NOT and you won't be disappointed...lmao

[jennmary]

Someone should be collecting unintentionally humorous thread subject titles.

I know!!!! Are you volunteering?

[finchy]

Hmm....sounds like they accidentally send two packs of 3, and probably dont want to go through the trouble to take them back and to reimburse insurance. Too bad they made up a foolish lie about each nostril counting as one pillow!? Pretty lame, look at the packaging slip, it should clarify the contents and take that in and tell them they are mistaken.