Insurance Question

[xdman911]

I have a Wisp CPAP Mask which I'm assuming the insurance company considers it a Mask. The package comes with all 3 sizes (Petite, S/M, Lg), headgear and a small tube. Then I see online some CPAP Suppliers sell cushions for the wisp. The unit is one piece. Is the one piece also considered a Cushion?

[Pugsy]

Do you mean for insurance billing purposes?
Normally DMEs will break down the mask into Head gear bill and mask frame bill (which would include the cushions) even though everything came in one package. It's pretty standard and even Medicare accepts and expects it to be done this way.

So there is typically a charge for the Headgear separately and then a charge for the rest of the mask.

Then the cushions are expected to wear out sooner and need replacement sooner so those are then sold totally separately and depending on insurance replacement schedules you can get a new cushion once or twice a month. When just getting a replacement cushion a person would get only the size they need.

Here's a link that shows the billing codes and typical replacement schedule for Medicare (and a lot of insurance companies just go by what Medicare does...but we usually tell people to call and find out for themselves when private ins is involved).

http://www.resmed.com/us/documents/1018 ... rd2011.pdf

[xdman911]

Thanks again Pugsy! You are always there when needed It is very nice to have people like you on a forum always lending your insight and knowledge.