"How to change masks" ???

[FrayedTrain]

Newbie here. Sorry if I am posting a duplicate question. I tried to search through the forum for this topic. I think answers on how to order supplies, and manage changing masks could be an addition to the "table of contents" post. That was a good post and has provided me with a lot of answers.

I will get my machine and mask tomorrow. I was thinking about mask options and saw many posts on here about changing masks and even posts about being a 'mask junkie.'

I understand that the insurance has a replacement schedule for masks, cushions/pillows, tubes, filters, etc. I also understand that the mask manufacturer (ResMed) in my case has a 30 guarantee for the 'first' mask. Meaning that if I try a few masks with the technician tomorrow and decide on the nasal pillows mask, then in a week or two realize that it just isn't cutting it, I can swap out for a different mask without extra payment.

Am I correct in assuming that at the time I am due for a mask replacement, I believe it's once every 3 months, that I can choose to change to a different mask at that time? If that is the case, what are the rules (if any) for the replacement supplies during that time period? Let me give an example to better illustrate. Tomorrow I decide to go for the Airfit P10, over the next three months I like the mask and get a few replacement pillows, and whatever else I'm entitled to. At the three month mark, I decide that I should have a backup full face mask to help with mouth breathing due to a head cold. I get the mask, and about 6 weeks worth of replacement supplies (cushion, etc.) Now my cold is better and want to switch back to the nasal pillows. Since the nasal mask is eligible for 2 replacement pillows per month (I believe) can I just call the DME and say to start sending supplies for the Airfit P10? Or are they going to say they can't switch the replacement supplies until I 'switch masks' again?

I was thinking that even if I didn't have a cold, thought I had stock piled a few extra replacement cushions (due to careful cleaning), I could use my mask replacement window to pick up a FF mask for a future need (cold, nose bleed, etc.) Then once I got the mask with one set of cushions, headgear, etc. I would immediately return to the replacement schedule of my daily mask, the Airfit P10.

Your thoughts?

[Julie]

I think you should ask your insce. co. what they do, and how - they're not all the same.

[OkyDoky]

Find out from your insurance their replacement schedule. I was able to switch my mask type on insurance but every insurance can be different.
If you don't have a copy of your sleep study and prescription from your doctor. Get a copy to have on hand. My doctor put mask of choice on the mask. If you want to buy outside of insurance, With the Rx you can but supplies from any supplier. Without an Rx, you can sometimes get masks from Amazon and Ebay. Ebay does not allow listing masks, just parts, but if you know what you want you can put them together or look for the word bonus and you might be surprised.

[Tatooed Lady]

You can get as many of whatever variety likes, if you pay out of pocket. That's how I've been doing this. It works for me, and I have the Swift FX (which has worked SURPRISINGLY WELL even through being sick and congested) and my backup Quattro FX, which I don't use much, but have "just in case."

[Pugsy]

The 3 month mask replacement thing....check with your insurance as to if headgear is included because sometimes headgear is only allowed to be replaced every 6 months (that's what Medicare does) and a brand new mask without headgear isn't of much use.
Stupid IMHO but that is what Medicare does and a lot of other insurance plans mimic Medicare.

Check with your DME about getting replacement nasal pillows after you have got a different mask..it shouldn't matter.
Though they might not let you get the nasal pillows at the same time you are getting a completely new mask setup.
When I tried that little trick I was told one or the other...and come back in a week for the other.

Insurance companies have their own rules and they can vary a lot...and then the DMEs have their own interpretation of the rules in general and they can come up with their own in house rules but they tell you that it is your insurance instead of their own in house rules.
The 30 day swap thing...that's really for any mask and not just the first one and this is one of those situations where DMEs modify the rules so that you don't keep swapping masks every 3 weeks for year.

My DME has a rather unique approach to the mask swapping thing. I can try any number of masks within a 60 day period...that's the way they elected to offer the mask swapping thing...and I can still use that 60 day window even now after nearly 6 years of therapy as they don't tie it to cpap newbies. Everyone has the 60 days window if they want to use it.
I do have to return the unwanted mask though...that's to keep people from stockpiling a bunch of masks and maybe selling them on the side.

So make sure you ask your DME what their in house mask swapping policy is and make sure that you know (with information you gleaned from your insurance company and not what the DME says the insurance allows) exactly what your insurance will do.
Everybody's different...both DMEs and insurance plans.

[FrayedTrain]

Thanks for the info Pugsy. I think you 'get' what I'm saying here. I don't want to 'scam' the system, but also would like to get what I pay for. I am paying for the insurance.

I'll check with the insurance and the DME. And also talk with the Dr. I would think that if I took my prescription to someplace out of network, and payed out of network prices, I should still be able to get reimbursed for the supplies as long as I'm not getting more supplies than the 'replacement schedule' allows.

[Pugsy]

I don't want to 'scam' the system, but also would like to get what I pay for. I am paying for the insurance.

I hear you. I will use my insurance for my one per 6 month complete mask....I have Medicare so headgear isn't covered at 3 months so my DME doesn't even offer any products without the headgear. I could push the issue I suppose but it isn't worth the hassle.

Sometimes I will use insurance for the replacement nasal pillows on occasion but I have never needed to replace nasal pillows very often so once I got a couple of spares set aside I didn't mess with it.

I pay for the insurance so I want to get at least some part of my money back.
I don't like the hoses they sell so I always got hoses online and often if I shop smart I can find a good deal on a mask on EBay for not much more than my co pay with insurance. Like last week I got a complete P10 for her with all 3 pillows for $40 and that included shipping.
My co pay would be almost that much and this one didn't involve me driving 30 miles and making sure I was there during business hours.

I think I got my last mask using insurance in late Aug or Sept of last year so I should be about ready to use it again...and I will but I haven't bothered with replacement pillows through the DME because I just didn't need one.
I have only used the 60 day mask swapping thing once with my DME. It was used to try the Wisp and I told them I probably wouldn't like it but they wanted my input anyway because they know I like to try new stuff. So they talked me in to trying the Wisp and after a week I took it back and explained my difficulties with it.....and I think at that time picked up a Swift FX nasal pillow mask because the P10 wasn't out at that time and I can always find a use for the Swift FX.

I like my DME....they have never called me to bug me about anything and that's the way I like it. I didn't have to provide a credit card and they just send me a bill for my copay once insurance has paid and they have never (knock on wood) made a mistake.
And I never have bought a machine from them....only masks and maybe one hose in nearly 6 years.

[archangle]

Be sure to get a copy of your prescription for the CPAP machine and a mask so you can order online if you need to do so later.

[mike1953]

Thanks for the info Pugsy. I think you 'get' what I'm saying here. I don't want to 'scam' the system, but also would like to get what I pay for. I am paying for the insurance.

I'll check with the insurance and the DME. And also talk with the Dr. I would think that if I took my prescription to someplace out of network, and payed out of network prices, I should still be able to get reimbursed for the supplies as long as I'm not getting more supplies than the 'replacement schedule' allows.

Out of network you will not get reimbursed by your insurance. Out of network is just that out of network. No pay no reimbursement its all out of your pocket period.

Mask wise its one or the other not both. You don't get a new mask and replacement parts for that one or another one at the same time. Sounds like your trying to "scam" the system IMHO. Get something for nothing then turn around and sell that item to line your pocket. IMHO

[Pugsy]

Out of network you will not get reimbursed by your insurance. Out of network is just that out of network. No pay no reimbursement its all out of your pocket period.

Depends on the insurance. Some insurance will indeed pay for out of network services but often at a reduced rate along with a separate deductible. All depends on the insurance plan that a person has.

[mike1953]

Out of network you will not get reimbursed by your insurance. Out of network is just that out of network. No pay no reimbursement its all out of your pocket period.

Depends on the insurance. Some insurance will indeed pay for out of network services but often at a reduced rate along with a separate deductible. All depends on the insurance plan that a person has.

Exactly what I just said, you don't get reimbursed what you paid for your our of network expense.

[Pugsy]

Exactly what I just said, you don't get reimbursed what you paid for your our of network expense.

No...that's not what I said. There's a big difference between "no reimbursement it's all out of your pocket" and reimbursed at a reduced rate. It all depends on the insurance plan. I have out of network reimbursement at 60 % for out of network vs 80% for in network.

Out of network is just that out of network. No pay no reimbursement its all out of your pocket period.

[mike1953]

Say goodnight Pug. PERIOD YOU DO NOT GET YOUR MONEY BACK PERIOD. End of discussion.

[Pugsy]

End of discussion.

That part is correct. I don't have a 2 X 4 big enough to fix things in this situation and you aren't worth the effort.
Some things can't be fixed.

[mike1953]

Yes you sure cannot fix anything. LMAOROTF