Insurance and Replacement Masks

According to my DME-RT BCBS (Fed) would replace my mask every 3 months. So, since it has been nearly 9 months and I haven't ordered a replacement, I called the ins. and asked if I could order 2 or just one.

The Customer service person told me, there was no time limit as to when I could get another mask, it just had to be "medically necessary, like needing a replacement part or something". If my Dr. said it was medically necessary for me to have 3 masks, I could have 3 masks. They would approve that number because the Dr. said it was medically necessary. Since my original Letter of Medical Necessity was in 2004, I have to have a new one for this year and each year. I guess the Dr. could put on the letter I was to get one every 2 months for that year, if they wanted to.

It was a good thing I called the insurance instead of just ordering online, because I wouldn't have known about the new letter before I submitted the claim. I called them because we have been on catastrophic coverage (100%) since June 1 (all those lovely back and neck injections and tests I've been having --and all the tests my husband has been having too).

Now, I don't know how other insurance companies work on replacement masks, but I am never going to take an outsider's word again that it is 3 months, 6 months, or never. If you have been told something, or can't find it in your provider booklet, call them and find out the truth. Be sure to get the representatives name for reference if you get flack.

Everyone's insurance coverage is different, even if it is with the same company. In the thread on how much you were paying going through insurance and DME 2 people posted with UHC. Both had different coverage and they were both different from me, also with UHC!

It all depends on the policy that was negotiated. So check your coverage because there is no universal truth when it comes to insurance.