Mask Exchange Policies

We live in the USA and have a fairly good health care insurance policy. We've spoken with two DMEs in our area and both told us that we could only test 2 masks (total) within the first 30 days. one said that it was their policy to never allow you to test more masks afterwards, no matter what the doctor or insurance said (you have to buy). the other said they could allow 3rd/4th tests with a written prescription from my doctor explaining why the change was necessary.

I've read many times here that we may need to test several masks, so I would like to hear from people how they handled this.

Change DME's. (Yes, you CAN)
Sometimes another local outfit WANTS your business.
I ordered masks from cpap.com, and got return insurance.
Sometimes it is free. In that case, I got a full refund.
Otherwise, they kept the insurance fee.

I got the first two I tried from my DME. I got the second one after the first one made my nose sore. Others I have purchased from my DME, CPAP.COM, and various members of this forum. The mask I am currently using I got from a forum member. Often members purchase masks and find they don't like them and can't return them for one reason or another. They then offer them to other members at reduced prices. Some people find them on Craigs list. There are several sources of masks available to you.

My dme had loaner masks, the first tech I worked with did not mention that at all, but the 2nd tech was much more helpful. At one point, I had 3 of their masks in my possession. I didn't want to go with one of my insurance dme providers based on other things I had heard about them, found out the provider I went with was also owned by them. They can be sneaky and make up rules that your insurance will deny is their rule.

MDee wrote:We live in the USA and have a fairly good health care insurance policy. We've spoken with two DMEs in our area and both told us that we could only test 2 masks (total) within the first 30 days. one said that it was their policy to never allow you to test more masks afterwards, no matter what the doctor or insurance said (you have to buy). the other said they could allow 3rd/4th tests with a written prescription from my doctor explaining why the change was necessary.

I've read many times here that we may need to test several masks, so I would like to hear from people how they handled this.

My advice (and what I did) is to do LOTS of research beforehand. Go to CPAP.COM and look at all the masks. Decide what type of mask may work for you. Do measurements of your face. Download the sizing guides and other manuals from the manufacturers' websites. Try to know as much about the mask before you select one. Don't just rely on the DME to hold one up and just say "that one should fit"......without doing any measurements to your face. Another way of saying this is........pretend that it's all of your own money you're spending out of pocket and you have one shot at selecting the right mask. That will help you keep the replacements to a minimum.

In my own case, I did lots of research and measurements, ordered the mask from CPAP.COM (along with all my other equipment) and it's the one I've been using ever since. I managed to pick the one that works best for me in the first selection. Oh, I've tried a few others in the ensuing years, but none of them came close.


Den

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The policy of the DME about how many times you can swap masks has NOTHING to do with your insurance company or your doctor. The insurance company doesn't pay for more than one mask at a time, and a doctor's prescription is NOT required to swap masks unless your doctor wrote the prescription for a specific mask only. Neither cares how many masks you need to try before finding one that's comfortable.


Manufacturers provide DME's with FREE sample masks for fitting purposes. Manufacturers also credit DME's for returned masks that don't fit or work for the patient, but it requires some paperwork to get the credit. Manufacturers understand that a patient who can't use a mask comfortably is going to fail CPAP, and a repeat customer for life is lost. A relatively small investment in a "free mask" is worth it in the long run.

DME's are the weak point in this system. They get free masks, and sell them, one way or the other. Were you ever given a mask marked "Sample" to "try" and then charged for it? Remember when CPAP.com ran an auction site and some "private sellers' had literally hundreds of brand new masks? This was mostly DME's selling the free samples out the back door. The DME's don't want to do the paperwork to receive credit for a mask that didn't work, so they limit the returns. Some patients do take advantage of the system, but some genuinely need to go through 8 or 10 or 12 different masks until they find THE mask that works for them.

That's why I recommend on my blog that if you have a choice of DME's under your insurance or you are paying out of pocket, you find a DME with a liberal mask return policy. When a DME limits you to 2, what happens if neither works? Most likely you are going to give up on CPAP, a tragedy, IMHO. The DME doesn't care.

whatever happened to The Great Mask Exchange?

This is all great help. I have now called all the DMEs in my area (both in and out of network) and they all say the same thing. no loaners, no rentals, and only 2 masks (thereafter I buy ...although I still have a 30 day return policy so that may be my workaround).

The only advantage of working with a DME for masks is if they do a proper fitting with measurements, so I will focus on that question.

The limit of 2 masks probably refers to the process of pick one, take it home, doesn't work, bring it back for exchange. Even with that kind of limit, you should still be allowed to try out (with the machine running) a number of different masks during your visit to the DME office. I was able to eliminate a couple of possibilities that way, and felt comfortable with my choice. Even so, I returned it in 2 weeks for a smaller size. My DME's policy is you have 30 days to return/exchange.

There are two major DMEs in my area. One who I went with ended up having the 2 mask "rule". The other DME allows you to take home as many masks as it takes in 30 days. So with them you could get and try a new mask every day. They want your business. The other DME that I am now with wants my business, but they wanted to make more money up front with it. I have been very happy with my DME choice other than the mask exchange "rule". Fast and reliable which has been very surprising to me. Anyways all of that being said the DME you do go with should let you try on as many masks as you would like when you have your fitting, but is only going to allow you to take one home. If that one does not work out for you then you go back and you try on some more masks or you may have chosen a second mask in your fitting that you think will work, but you thought the other mask was a better fit. If that is the case then you would just go back and pick up the other mask. So just hang in there and make sure you take your time during your mask fitting and make the DME work with you because they want your money so they need to earn it by doing their job to the fullest extent. Good luck!!

There are two major DMEs in my area. One who I went with ended up having the 2 mask "rule". The other DME allows you to take home as many masks as it takes in 30 days. So with them you could get and try a new mask every day. They want your business. The other DME that I am now with wants my business, but they wanted to make more money up front with it. I have been very happy with my DME choice other than the mask exchange "rule". Fast and reliable which has been very surprising to me. Anyways all of that being said the DME you do go with should let you try on as many masks as you would like when you have your fitting, but is only going to allow you to take one home. If that one does not work out for you then you go back and you try on some more masks or you may have chosen a second mask in your fitting that you think will work, but you thought the other mask was a better fit. If that is the case then you would just go back and pick up the other mask. So just hang in there and make sure you take your time during your mask fitting and make the DME work with you because they want your money so they need to earn it by doing their job to the fullest extent. Good luck!!

palerider wrote:whatever happened to The Great Mask Exchange?

Do you mean the free trial site?
It was discontinued after several people ABUSED the system, and kept the masks without paying for them.
THEFT. Ruined it for everyone.

Nods, that's correct. They have a 30 day return policy, but only 2 masks during that 30 day period. They were all very clear on that and that the clock started ticking with the first mask and the second mask did not extend - it was a firm 30 day window. If you need to try a third or 4th mask during the 30 day period, you have to buy it (one said I could try get a doctor to write a new prescription and maybe the insurance company would honor it). After the 30 days, you have to buy a new mask (although the insurance would cover a new mask eventually).

I did call back and asked about loaner masks (thanks for the tip!) and was told they do not offer any. It seems to be fairly consistent across the board between in and out of network DMEs in our area.

MDee wrote:This is all great help. I have now called all the DMEs in my area (both in and out of network) and they all say the same thing. no loaners, no rentals, and only 2 masks (thereafter I buy ...although I still have a 30 day return policy so that may be my workaround).

The only advantage of working with a DME for masks is if they do a proper fitting with measurements, so I will focus on that question.

you can download mask fitting templates.

chunkyfrog wrote:

palerider wrote:whatever happened to The Great Mask Exchange?

Do you mean the free trial site?
It was discontinued after several people ABUSED the system, and kept the masks without paying for them.
THEFT. Ruined it for everyone.

I seem to remember years ago there was a thing where members here would ship spare masks around so others could try them out for a few days, then ship 'em on to the next person.