newbie - DME provider question

Hi everyone, I am rather new to CPAP (have only had mine 3 weeks) and am just now learning how to deal with my DME. When I attended my initial appointment, I was surprised to learn that they only would give me the mask that I slept with in my sleep study (that I had NO choice in) because "that's what the doctor prescribed for you so that's the only mask we can give you - but if it doesn't work, come back". (how am I supposed to know what actually works if I can't try anything else??)

A week later, I was back because I was snoring with the mask and it was leaky/didn't feel like it fit properly. They fit me with another mask and sent me out the door - again with only ONE choice. They seemed disgruntled that I would not try the nasal pillows, but I am a mouth breather and have a lot of sinus issues AND it didn't work when I tried one during the titration study - so why would I waste my time and theirs?

In the meantime I have switched back and forth from the first mask to the second mask because the second mask hurts the bridge of my nose. I finally gave up and called the DME this morning to let them know I am still having problems - and I was told they can only do one mask refit in 30 days. I called my insurance company and this is not an insurance requirement - so is my DME just being lazy or is this normal procedure?

I am concerned about this DME - but like I said this is new to me so it may just be "the way things are" in the industry. I want to stick with CPAP - but if these are the only two mask choices I have I am not sure I will be able to.

Thanks for any advice you can give me!

YES...Your DME is lazy! Many DMEs will allow numerous exchanges. they get reimbursed from the manufacterer. each DME makes their own rules. You are not obligated to use that DME. Check with your insurance as to other DMEs in their network.

My question is whether your Insurer has a limit on the number of masks you can purchase in a given time? Usually they do (1 per 3 to 6 months) but it sounds like yours may not. So call and ask. If they don't have a limit, ask if you can purchase online and get reimbursed, or if you have to use a preferred DME.

If you can get a mask any time you want, you have a few steps:
1. Call your doctor and ask for a separate prescription for " CPAP mask of patient's choice". (Be sure to tell the doctor that you are having trouble with your current mask and the DME they referred you to is not being helpful--put it in writing and cc it to the DME, when you have a chance).
2. If you can use any DME, find another one. Call around to make sure they will bill your insurance, and ask what their mask return policy is. What you want to hear is "we will work with you until you find a mask that works best for you." Go to that DME for a good fitting and finding your "one true mask". If they are good to you, and your insurance reimbursement is decent, then you will give them your repeat business for life, or at least until they turn into *&^%$ like all the others. If they aren't good to you, once you find your one true mask, you can always order it online if your insurance will reimburse.

If you are stuck with the lazy DME, CALL your doctor and tell him that you are having trouble with the mask, but the DME is not being helpful. Complain in writing to your doctor with a cc to the DME. Call the mask manufacturer and complain about the DME. This is important. Mask manufacturers know that the mask is the key to using CPAP successfully (and earning them repeat sales), so they will replace the mask for the DME for FREE if you need to switch masks. Your DME is too darn lazy to do the paperwork to get the replacement mask. And if they don't have samples of the mask for you to try on and perhaps take home to try, it's an indication that they are probably selling free samples provided by the mask manufacturer out the back door. So they deserve to hear from the mask manufacturer, as the manufacturer's authorized representative.

I think a huge reason people fail at CPAP is they can't get comfortable with the mask, and your DME's laziness is inexcusable. Time to stop this nonsense!

Thanks so much! I will try all of these suggestions. I have an appointment with the RT Supervisor tomorrow - I thought I might be on the right track, you guys confirmed it I sleep and feel SO MUCH BETTER with my CPAP I was really anxious about not being successful with it! I have more confidence now.

Be polite and firm with the supervisor. Let him/her know you want to work with them to find the right mask and you expect their help.

Most manufacturers will only reimburse one mask exchange per patient. It must be in the first 30 days.

Quite a few DME's do more than that. I'm not sure if they eat the cost, get reimbursed by the manufacturer anyway, or play games with the paperwork.

archangle wrote:Most manufacturers will only reimburse one mask exchange per patient. It must be in the first 30 days.

Quite a few DME's do more than that. I'm not sure if they eat the cost, get reimbursed by the manufacturer anyway, or play games with the paperwork.

AFAIK manufacturers have no limit on the number of exchanges each month. They do want you to be successful and use their product.

One could easily call or email a manufacturer to confirm.

When I called my insurance and asked questions about what was covered and how often, they told me that they have seen up to 5 different mask come through billing in the first month for a patient. My insurance understands that you need to find the one that fits right. Hope yours does too.

Ogeo wrote:When I called my insurance and asked questions about what was covered and how often, they told me that they have seen up to 5 different mask come through billing in the first month for a patient. My insurance understands that you need to find the one that fits right. Hope yours does too.

OMG not only did you get the DME from heaven you have wonderful insurance too.
Most insurance plans aren't anywhere near that good. Medicare...one mask and that's it. DMEs have to use the mask return paperwork thing to get reimbursed for failed experiments with Medicare patients.

Though my DME has a quite reasonable mask exchange policy and it pertains to newbies as well as cpap veterans like myself.
Get a mask and you have 60 days to swap it out and you can swap it out for any other mask as many times as you need to within that 60 days. Could try every mask they have withing that time. Only they do require the unwanted mask to be returned before another mask is dispensed but given they don't limit the swaps I think I can understand that requirement.
Arch...I don't think that the manufacturers care about the number of swaps.

Mask swapping policy is up to the DME to set their own in house rules. Sometimes they are stupidly rigid and sometimes they are quite lenient.