Mask Rx, DME, and Insurance

Is it common for a brick & mortar DME to require both an Rx and a copy of your sleep study to sell you a mask? The DME says they need a copy of the sleep study in order to submit a claim to insurance. In months of reading on this forum, I don't recall ever seeing that mentioned. I'd like to buy a new mask before the end of the year, because insurance includes a deductible next year. The DME from which I got the rest of my equipment doesn't carry the mask I want to try (Opus 360).

Jim

Yes, this is the standard. In order to bill and have insurance pay DME's have to meet their qualification guidelines. An Rx and sleep study showing the medical necessity is typically the requirement.

Thanks. It seems to me that an Rx would be sufficient to indicate medical necessity. Mine even says "Certificate of Medical Necessity" at the top. After all, pharmacies don't (yet) require a copy of one's lab results to get insurance reimbursement for a prescription for meds, many of which are more expensive than a CPAP mask.

I have been through three different DME's and they all required a copy of my sleep study as well as a copy of my scrip befor they would sell me anything. I'm not real sure thy would sell me a filter without it.

Jerry

I checked with one of the local firms here when I was looking for a convienent supply of the white filters... they needed a copy of the study and a script (even if I was paying cash).

Cash price would have been $50 for two... highway robbery!

Now I buy them in 6 packs from cpap dot com... and keep a stash on hand... less than 1/2 the price.