Exchanging mask within 30 days

[Grandma Judy]

I received my ResMed 9S Auto and Swift FX Nano for Her on June 6. I'm a mouth breather so I was also given a chin strap. My AHI number has increased from 3.4 the first day to 6.7 now 11 nights later. At the moment, I'm too new to all of this to have know of why this is happening. The only thing that I can think of doing is exchanging my current mask for a mask that covers both my nose and mouth since I must still be breathing through my mouth even with a chin strap. I am wondering how the 30 day mask exchange policy works. I have Medicare and Supplemental Insurance. Does the 30 day exchange policy start back at day one when I receive the replacement mask? How many times can you do this if you keep exchanging masks within the 30 day deadline. I'm thinking of calling my DME and asking to try another mask but this time one that would cover my nose and mouth. I won't see my Sleep Doctor and Respiratory Therapist until June 30. If I wait until I see them for a suggestion for a replacement mask, I'll be at the tail end of my 30 day deadline and my DME doesn't move swiftly. Also, do you have to return the original mask when you get a replacement? Thanks.

[Pugsy]

You need to call your DME and ask them what their mask swapping policy is.
The manufacturers all have 30 days per mask but DMEs often have their own in house rules.
Medicare and your supplement will only pay for the one first mask that gets billed out. Any subsequent swapping is done with the manufacturer getting credit for a failed mask from the manufacturer. Medicare is out of it after the first mask get billed.
In theory you should be able to keep trying masks until you find one that suits you within the 30 days for each mask but DMEs often will limit a person to a set 30 day period because they don't want to deal with multiple swapping paperwork needed to get credit.

Whether or not you have to return the failed mask is also up to the DME. Some will want it back only to toss it in the trash but others will let you keep it. So again you have to ask what their procedure is.
My DME is a bit different. They allow 60 days and I could try every mask they own within that 60 day period if I wanted to but I have to return one before they will give me another one to try and it doesn't matter that I have been on cpap therapy for over 5 years now.

[Cuda]

My DME let's me keep exchanging until I find one I like. I did have to return the old one. I have the quattro FX and it works well. I recommend a pad-a-cheek liner. Without the liner I always had leaks and other problems.

[LookingEast]

Hi, I'm also new to this, less than one month at this point in time.
My DME is letting swap out my mask for another.
They told me I have 30 days in which to exchange a mask 1 time at no charge.

Sue

[tortoisegirl]

Agreed to get in touch with your DME. The earlier the better, as if it turns out to be one 30 day period then you have more time to do as many swaps as you need. Try to get them to let you try it on when lying down with your max therapy pressure. You can access your leak data and see how likely mouth breathing is (if you are getting a lot of leaks). Your machine can compensate for leaks up to 24 L/min (the large leak threshold). AHI can vary a lot night to night, especially at first, so an increase may not indicate mouth breathing. A dry mouth could, but still, that doesn't tell you how long you were doing it, and if it was influencing therapy. So if your leaks were low and you are more comfortable with a nasal mask and chin strap, it could be reasonable to continue with that, but especially if you can keep your old mask, its probably a good idea to try a full face mask.

Here is info on Sleepyhead software: viewtopic/t88983/Pugsys-PointersSleepyH ... Hints.html

Mine does one 30 day period for mask swaps for new patients, but doesn't ask for the old mask back (as they would just trash it). However, my DME says they bill insurance for every mask, and if they don't pay then the mask swap free (or someone would only pay the copay on the difference if the new one was more expensive). My insurance does DME as medically necessary, not on a schedule, so they paid for my replacement mask as well (so I'll have two mask copays). Although that won't be the case with Medicare, I thought I'd mention it for other folks. If I was having mask problems I'd probably try to find a DME which wouldn't bill my insurance for every mask, but I'm good now. Plus I assume insurance would eventually start denying mask claims after a certain number in a short period of time. Best wishes.

[chunkyfrog]

My "worst" DME let me take three home at once, and return what didn't work.
I kept the Swift FX.