Pays to ask

Hurricane · Post by **Hurricane** » Fri Nov 16, 2007 6:51 pm

Just found out I can get a new mask every three months, and only found out by calling my insurance provider, when I called my dme and mentioned this, they said yes we will send one out today, as long as my Dr wrote a prescription for the mask, here I thought I would have to wait at least six months, does pay to inquire. As easy as picking up the phone.
Ed

RipVW · Post by **RipVW** » Sat Nov 17, 2007 7:05 am

That's great! My insurance pays for mask replacement only every six months. Every three months is excellent! You must have very good insurance (mine is BCBS).

Slinky · Post by **Slinky** » Sat Nov 17, 2007 7:16 am

Ted, sometimes it isn't insurance so much as it is the DME supplier. For instance: Medicare only pays for headgear every six months, but will pay for the mask every 3 months. Local DME suppliers generally don't carry separate headgear and masks, so the DME supplier will tell you and only replace the mask AND headgear every six months.

On the other hand, SOME local DME suppliers will provide Medicare patients w/a new mask AND headgear every 3 months. Less profit for them but obviously they are satisfied w/that.

The interesting thing is these local DME suppliers who will only replace a mask every six months bill separately for mask and for headgear.

RipVW · Post by **RipVW** » Sat Nov 17, 2007 7:43 am

Oh! Didn't know that. I'm going to inquire with my insurance company. I wouldn't be surprised to learn that this is the case with my coverage.

Thanks, Slinky!!

Slinky · Post by **Slinky** » Sat Nov 17, 2007 7:58 am

Yer welcome. Another interesting little Medicare tidbit: Medicare would reimburse for a new hose every month! So who needs a new hose every month?? That was just recently changed to where they are reimbursing for a new hose every 3 months which is much more sensible in my opinion.

In addition (unless this changed as the same time as the hose issue) Medicare would, for those masks that can be disassembled, reimburse for the nasal pillows (just the pillows, not the mask, not the headgear) every month; the nasal cushion (not the mask, not the headgear) every month or the full face cushion (not the mask, not the headgear) every month. I didn't and don't see the sense of that.

HOWEVER, what I ran into w/my first local DME supplier when my cat put a puncture in my mask cushion was that their RT tried to tell me Medicare wouldn't pay for the replacement cushion. It gave me GREAT PLEASURE (since I disliked her AND her company so much) to bring in a Medicare printout showing replacement frequency AND the HCPCS code for it. It took her 3 weeks to order it and get it in but I got it. Gloat!!

RipVW · Post by **RipVW** » Sat Nov 17, 2007 10:11 am

Just goes to show (again!) that we must be vigilant, must ask those questions, and then when they give us the wrong answers, we just have to do our own research.

Crazy, isn't it!

Ted

Slinky · Post by **Slinky** » Sat Nov 17, 2007 10:46 pm

Yep, shouldn't be that way, but it is. So we go w/the flow and double check what we're told. By the way, see the post subject

2007 CMS (Medicare) Reimbursement ......

It has frequency, codes and reimbursment highs and lows.

jennmary · Post by **jennmary** » Sat Nov 17, 2007 11:16 pm

I found out my ins pays for a new mask every 3 months as well, but not head gear. But i have a good dme....they just write off the headgear and give it to me for free. I do get a new cushion every month. I think it is the face oils or something, but after about a month my mask wont seal and starts feeling rubbery and too elastic. But I dont replace hoses as often my insurance would let me....waste of landfill space.

Hurricane · Post by **Hurricane** » Sun Nov 18, 2007 10:12 am

ted wrote:That's great! My insurance pays for mask replacement only every six months. Every three months is excellent! You must have very good insurance (mine is BCBS).

Ted,
My insurance also is BCBS, said as long as I have prescription,three months for replacement. A call will clarify it whether your coverage is the same.
Ed

RipVW · Post by **RipVW** » Sun Nov 18, 2007 10:17 am

Thanks, Ed! I plan on checking with BCBS this week.

Ted

sleepycarol · Post by **sleepycarol** » Sun Nov 18, 2007 1:23 pm

I have always said -- all they can do is say no and often times they say YES!!