What are the policies for mask exchange?

I here people comment all the time that they went thru many masks before they found the best for them. However my DME seems to restrict my mask changes after the the second mask exchange I was told that it would be the last until my insurance would pay for a new mask. I thought that the mask manufacturer was the one who made that policy. Am I wrong?

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It's strictly up to the DME...they make their own rules. There is no hard and fast rules. When you choose a DME it's one of the questions you should ask...."What is your mask exchange policy?"

Mask manufacturers do a 30 day thing and that's per mask but DMEs often make up their own in house rules for mask swapping.
They will then blame the limitations on "your insurance only pays for...." instead of telling you the truth.
The truth is that your insurance only pays for one mask period per the allowance schedule but DMEs can get reimbursed for additional masks they might end up giving you as a swap out.
They have to do a bit of paperwork to get credit for the unwanted mask and seems like the DMEs will only allow 1 swap because they don't want to do the paperwork.

So DMEs make up their own in house rules and it's allowed. Not much we can do about it other than shop around for a DME with a more flexible swapping allowance.
Example...my DME will let you swap out masks for 60 days after you get a mask under your insurance allowance. Applies to cpap veterans as well as new to therapy patients. I could try every mask they maintain in inventory within that 60 days if I wanted to.

So the mask swapping in house rules can and most likely will vary between DMEs. They can do it. Nothing illegal about it.
I just don't like it that they are honest about it and put the blame on "your insurance won't let us". I would respect them more if they were just honest and up front about their policy.

LSAT wrote:It's strictly up to the DME...they make their own rules. There is no hard and fast rules. When you choose a DME it's one of the questions you should ask...."What is your mask exchange policy?"

So I guess I should be looking for a new DME. My sleep doctor chose them. Though that won't be until my insurance will pay for the new mask 3 months. Being that they get a credit from the manufacturer, it shouldn't matter how many times I change the mask. Perhaps they will be less restrictive if I went to pick them up rather than them delivering it.

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Jerseyguy wrote: ↑

Sat Mar 10, 2018 9:23 pm

LSAT wrote:It's strictly up to the DME...they make their own rules. There is no hard and fast rules. When you choose a DME it's one of the questions you should ask...."What is your mask exchange policy?"

So I guess I should be looking for a new DME. My sleep doctor chose them. Though that won't be until my insurance will pay for the new mask 3 months. Being that they get a credit from the manufacturer, it shouldn't matter how many times I change the mask. Perhaps they will be less restrictive if I went to pick them up rather than them delivering it.

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with most insurance you can get a mask every 3 months, but can only get headgear every 6 months. so don't be alarmed if they give you a mask and no headgear. if they do give you a mask with headgear, find out specifically if your insurance is going to pay for it. they could give to you then bill you full price and say the insurance declined it.

greatunclebill wrote:

Jerseyguy wrote: ↑

Sat Mar 10, 2018 9:23 pm

LSAT wrote:It's strictly up to the DME...they make their own rules. There is no hard and fast rules. When you choose a DME it's one of the questions you should ask...."What is your mask exchange policy?"

So I guess I should be looking for a new DME. My sleep doctor chose them. Though that won't be until my insurance will pay for the new mask 3 months. Being that they get a credit from the manufacturer, it shouldn't matter how many times I change the mask. Perhaps they will be less restrictive if I went to pick them up rather than them delivering it.

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with most insurance you can get a mask every 3 months, but can only get headgear every 6 months. so don't be alarmed if they give you a mask and no headgear. if they do give you a mask with headgear, find out specifically if your insurance is going to pay for it. they could give to you then bill you full price and say the insurance declined it.

I'll have to check to see if my insurance EOB is in there. I just got a mask last month with headgear after 3 months. But if they do and I get billed for it I'm going to be as difficult as I can be before I actually pay for it. As far as CPAP. Com goes I'll need to get my rx from my sleep doctor.

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... As far as CPAP. Com goes I'll need to get my rx from my sleep doctor.

Always a good thing to have anyway. I keep a digital Rx with CPAP.com in case a part breaks while traveling or I forget my mask. CPAP.com has overnight shipping. Expensive, but they have it. I also email a copy to myself for myself.

Yes, customer service is an important part of choosing a DME.

I was very lucky. The first DME that contacted me told me that everyone got the SAME machine, no choice! I said I didn't want that machine and they said too bad. I called my doctor and they found another DME who could get me the machine I wanted (I didn't end up with that one but that's another story ). New DME SO accommodating...I easily tried out 8 or more masks. They are quite a bit farther away, but they are a small local company and I couldn't be happier with the service! So glad the big national outfit (that has a horrible rep on these boards!) gave me such a hard time on the first phone call!

Good luck finding someone else!