Medicare (US)....

[LaurieP]

I have been helping my Mom with CPAP. She has been using the machine for 2 weeks. I asked Lincare to bring her a new mask which they bought out today. The tech informed my Mom that she could only try two of them, so they will not exchange for anymore. Is this Medicare or Lincare's rules, does anyone know or dealt with this before??

My DME let me exchange a number of times within in the first month.

Laurie

[snuginarug]

Medicare doesn't give a damn how many masks you try. A DME that tells you Medicare is imposing this limitation is lying through their teeth.

[nanwilson]

It is the manufacturers that support this, not the DME. The DME can trade as many as you want within the first 30 days. The manufacturers will reimburse the DME when they trade a mask and fill out the paperwork to get their $$$$ back. Obviously the DME is too lazy to fill in the paper work and wait for the reimbursement from the manufacturer. Some DMEs will only trade a certain number of times within the first 30 days...that is THEIR rules, not the insurance company nor the manufacturer.

[LaurieP]

That is what I thought! Ugh, I'm so frustrated.

So the Tech with Lincare came out (20 mins ago) and left a nasal mask that I did not ask them to bring or did I order. I wanted my Mom to try the Swift LT for Her which they also brought. I think my Mom got confused which is very easy these days and accepted whatever they left. I know the LT is like the Swift FX but alittle steadier and I don't think it will shift as much when she is sleeping. She has leaks but they are small and short so I'm not too worried.

Laurie

[Julie]

I think both Laurie and Nan W. should get their terminology straightened out - Laurie is talking about U.S. Medicare and Nan about Canadian, both of which have nothing to do with each other and both of which have completely different rules - they're in different countries.

[chunkyfrog]

Phooey! I've been doing my (U.S.) research in advance of retirement--hopefully next year.
I found that only ONE of the local DME's in Lincoln accept Medicare assignment; that is, they accept Medicare price as full payment.
All the others are providers--but not 'preferred' providers.
The DME that accepts assignment does not have machines.
For that, I have to drive to Omaha or Kansas City.
The house wins again.

[Pugsy]

U S Medicare will pay for one mask to start with. Any other masks will be paid for per the Medicare replacement schedule. Medicare doesn't care how many masks are tried because they only pay for one and won't pay again till it is allowed per the schedule.

Actually Nan is correct. It is the manufacturers who allow the 30 day return and credit to the DME. DMEs will often establish house rules so they don't have to mess with filling out paperwork for multiple returns. In this case the DME has established its own house rules.

[Janknitz]

As pointed out, it's the manufacturers that will credit DME's for masks that don't work out. This is to the advantage of the manufacturer, so you won't bad mouth a mask that doesn't work for you and you will find a mask that does work for you, thus assuring them of a lifetime repeat end user.

Lincare's arbitrary policy (because they are to damn lazy to apply for the credit) is not good for the manufacturer. There is your ally in this process.

Write an email to someone high up (vice president) in the manufacturer's office saying that Lincare brought the wrong mask and now refuses to allow you to return it and try a mask that might work better. As a result, your mother's therapy is negatively impacted. Ask them, politely and firmly, to please intervene with the DME (be sure to give them the name of the local DME and who you worked with there).

My guess is that by doing this you will soon get an embarassed call from Lincare inviting your mom to try on as many masks as she needs to until she finds the right one.

Manufacturers also supply DME’s with samples so they can let patients try on masks and even try the samples overnight. If a DME is limiting trials it’s a good bet that they are selling the samples on the side for extra profits. So when you shine a spotlight on them by calling the manufacturer’s attention to a particular DME, you are not letting them get away with this.

[nanwilson]

..Julie as you can read.......
I wasn't compairing U.S. insurance to Canadian insurance. Insurance has nothing to do with the mask trial program as I stated. It is the "manufacturer" that supports the mask trial program and its the DME that is to damn lazy to fill in the paperwork to get reimbursed...in Canada and the U.S.

[LaurieP]

After a couple of phone calls with my Mom and Lincare, they are overnighting my Mom the mask that I wanted her to try. I will send back the one they left today but they didn't take the first mask back. I think that is strange but I will double check the billings to make sure they don't pass the cost on since Medicare will only pay for one.

Thanks for your posts and information, much appreciated!!!

Laurie

[ems]

After a couple of phone calls with my Mom and Lincare, they are overnighting my Mom the mask that I wanted her to try. I will send back the one they left today but they didn't take the first mask back. I think that is strange but I will double check the billings to make sure they don't pass the cost on since Medicare will only pay for one.

Thanks for your posts and information, much appreciated!!!

Laurie

Whatever mask you decide to send back, be sure you send it registered, return receipt. That way you'll know they got it! Better yet, drop it off and get a receipt.

[jamiswolf]

Hi...
I'm in the US and have Medicare coverage. I tried 5 masks during my first month and they never asked for the old masks back. They can't sell a used mask so it would just get thrown out. Don't give the old mask back unless they come asking for it.
Jamis

[yeti]

I think my DME uses the returns for fittings and loaners. they had a ton and let me take two for a week before buying one.

[NJSleepless]

U S Medicare will pay for one mask to start with. Any other masks will be paid for per the Medicare replacement schedule. Medicare doesn't care how many masks are tried because they only pay for one and won't pay again till it is allowed per the schedule.

Actually Nan is correct. It is the manufacturers who allow the 30 day return and credit to the DME. DMEs will often establish house rules so they don't have to mess with filling out paperwork for multiple returns. In this case the DME has established its own house rules.

What is the US Medicare replacemant schedule anyway? I know that they cover 80% of a machine but have no idea how the masks are covered.

[Pugsy]

What is the US Medicare replacemant schedule anyway? I know that they cover 80% of a machine but have no idea how the masks are covered.

viewtopic/t58780/Medicare--finding-repl ... -area.html

CPAP equipment (machines, masks, replacement parts, filters, etc, that are covered expenses under Medicare, falls into the Part B category and the usual 80/20 allowable charges after deductible. Link above has the actual schedule for replacement.