DME experience - Grrrrr....

So I thought I had a DME I could work with... I started CPAP a year ago and found out fast at the first DME I visited that some of them offer very poor service. I was told flat out at that company that the first mask you try, you are stuck with it for 90 days, end of story. I ended up not doing business with that company. As a result, I found another company. I related my bad experience and went through in detail their policy regarding what happens if you try a mask and it doesn't work out for you. I asked this question multiple times and the answer was always, if you return the mask in 30 days you will not be charged for it. No problem, we'll be happy to work with you until you find a mask that will work. "We want you to be happy." So I have been with this company for just about a year now, during which time a new company absorbed the original company. I recently decided I would like to give the F20 mask a try and went in for a fitting. I had been using, and at this point am still using, the Amara View. Long story short, the F20 did not work out. I thought it was a bit odd that the RT handed off to me at the time of my visit an F20 mask system with headgear along with an extra F20 cushion, along with new CPAP tubing for my machine, "because I was eligible". So I returned the entire F20 system and headgear which of course had been used when I tried it out, and the unopened F20 extra cushion. In return, I picked up a new Amara View cushion. So... I was reviewing my Medicare statement and I noticed there was no credit for the materials I returned. Called the DME today and got the following story. So this guy now tells me "Well you used the cushion so we can't sell it to anyone else" ..." oh yes, the manufacturer does give us a rebate if the mask you used didn't work out." "They" (he made it sound like it was a manufacturer's requirement) will give you a different mask if the one you tried doesn't work out, not a refund. He wanted me to take a complete new Amara View mask setup so he could still bill Medicare. I have no need for a whole new Amara View mask setup at this time, just periodically I do need to replace the cushion. I pointed out that the Amara View and the F20 are made by different manufacturers. Then he started to get more tangled up in his story, explaining that the billing codes are the same for the two masks - which is a Medicare insurance thing and not a manufacturer thing. A bit of a yelling match ensued. He told me Medicare insurance guidelines say I am eligible for a new mask every so many months and I am eligible so I should take the new Amara View mask setup - insurance guidelines are for cleanliness, etc, for the patient's well being. A bunch of crapola if I every heard any. I told him that is why insurance rates get high because DMEs try to get people to buy things they don't need just because insurance will pay for it. On and on.. I told him I am going to report his company to Medicare and I probably will. As we left things, he was going to "see what he could do" to get the Medicare charges reversed. We'll see what happens...

If you are on Medicare, the DME is not allowed to supply you with new supplies because you are eligible or because you are allowed. You must request the items that you need. Hit them with that and see what they say.

LSAT wrote:If you are on Medicare, the DME is not allowed to supply you with new supplies because you are eligible or because you are allowed. You must request the items that you need. Hit them with that and see what they say.

I'm not planning on letting them get away with this, don't worry... he changed his tune a little bit and offered to "see what he could do" when I said I was going to report them to Medicare. It's just such a drag to have to even have this kind of discussion with them.

IMO unless and until you have spares of everything you need mask, hoses, filters, water chamber, etc. you should get your supplies on time when you are eligible. Else there will come a time when something breaks and they are closed and you will find out you can't sleep w/o cpap. Just sayin...

#1Guest wrote:IMO unless and until you have spares of everything you need mask, hoses, filters, water chamber, etc. you should get your supplies on time when you are eligible. Else there will come a time when something breaks and they are closed and you will find out you can't sleep w/o cpap. Just sayin...

We keep one spare of everything, including bipap machine. Since my wife and I use the same set up including machine and mask, We only need to keep one set of spares. We do keep two extra hoses and water reservoirs which stay in the bags. That way, when we travel, we only need to pack the machine and masks.

You should have enquired about the CURRENT policy since policies change over time even if the company is not purchased by another. Instead, you will cost them money and then you want them to spend even more time wasting Medicare personnel time over something that costs Medicare $47.78 (that's what it shows for Medicare reimbursement on the bill I got the other day). In my opinion, just take the mask and use it when your current mask breaks down, which it will. My bro unexpectedly had a mask break only 3 weeks after he started using it. Fortunately, we had another spare because Medicare doesn't care if a supply item broke. You have to wait that 6 months to get a replacement or buy out of pocket.

Would you buy a pair of pajamas, sleep in them for one night and expect to return them for full credit because they did not work out?

I think you are getting upset over nothing. My understanding of how this works:

1. DME buys masks from manufacturers wholesale. Or maybe DME gets masks from manufacturers and DME pays for them wholesale when the DME issues the mask to a patient. Not sure which is true.
2. When you get a mask from the DME, the DME bills Medicare using a CPT billing code (Medicare does NOT care which mask you get!). This bill goes through the whole Medicare and supplemental insurance policy process and eventually DME gets paid for providing a mask.
3. If that mask doesn't work out for you, DME will put in paperwork (for the DME) to get credit for that mask, and meanwhile issue you another mask. It doesn't have to be from the same manufacturer because DME is going to get credit for the returned mask (not you) and issues you a different one in its place.

Medicare only really covers ONE mask per period of time. What happens with mask returns and exchanges and DME deals with manufacturers is not under Medicare's purview--good thing as we would not want Medicare to have to spend a lot of time and money to process returns when you need a different mask--the option of trying a different mask if one doesn't work out would probably disappear if Medicare had to deal with returns and issuing new masks.

So I think your anger at the DME is misplaced. They billed Medicare for 1 mask by CPT code, you got a mask that fits and it's covered by that CPT code, so there's really no problem here.

The other truth is that nobody really wants your old mask, even if you hardly used it. Some DME's will take it from you and throw it away because I suspect they are contractually bound to do so, but most will tell you just to keep it. They certainly aren't wasting time and money either sterilizing it for another user or mailing it back to the manufacturer.

As for a whole new mask--it's overkill to have many masks on hand, but to have a spare or two is priceless when something happens--always on a weekend and always at night when you can't replace the mask or other part when you need it. The first year or two you should always accept replacement parts when offered, after that only if needed.