DMEs

1. Do you folks know who the best overall DME supplier is for cpap equipment? I guess I mean a company that is easy to work with, who offers a wide variety of machines, masks, etc. Someone mentioned Apria to me, but I don't know if they are the best or not.

2. Do you know which DMEs will supply the Bleep products?

As you can guess, I want to try the Bleep, and want my DME to provide it. Preferred Homecare, the company I am with now says they cannot order the Bleep for me. I have learned that I cannot use two DMEs, one for the mask and one for everything else.

Any input would be much appreciated.

Copied directly from the buy page at bleep: Contact Aeroflow and their Sleep Onboarding Team at 800-480-5491 ext 4022 to speak to a customer service agent about having your insurance benefits verified for coverage.

They most certainly CAN order the Bleep for you.....they just won't.

Go to the Bleep website and there are now 2 DME/cpap suppliers who will file insurance for the Bleep. I think a second one was just added. See if either of those will do business with your insurance.

ANY DME CAN ORDER THE BLEEP....there's nothing stopping them except their own laziness.
The HCPCS billing codes are EXACTLY the same as for any nasal mask and the box of replacement ports uses the same code as the cushion or pillow replacements. Even Medicare pays for the Bleep.

This "I can't" crap is a crock of you know what. They are just lazy or unwilling to do it.

Pugsy,

Yeah, I figured they just don't want to be bothered. I would like to find a DME that will order Bleep and who is also an overall good supplier.

The best DME that fits your requirements is our host, CPAP.com. But it won't work with most insurers, it's all out of pocket. Still worth it to avoid the hassle IF you can afford it.

You might check with the supplier that dreaming1 just mentioned. They just came on board a couple of weeks ago I think it was for filing insurance and supplying the Bleep. Rumor control has it that their customer service might be better than Nationwide.
I haven't had a chance to verify of course and they are new to the game.
It's a crap shoot with DMEs....plus you have a limited listed to choose from depending on who your insurance has a contract with.
It doesn't matter if they are the best DME in the world and they will supply the Bleep for you....if they don't have a contract with your insurance company. You have to start with the list of DMEs that YOUR insurance has a contract with if you want to use your insurance.

Pugsly,

I note that you have said that the Bleep Dreamports are billed as pillow masks. How is the Bleep unit itself billed, as a nasal mask? Someone said it would be on the 6 month wait, but that makes no sense to me. It's headgear that is on 6 months, and of course there is no headgear with Bleep.

The reason I ask is because I'm due to order my next 3 month supplies in just a few days.

Deborah K. wrote: ↑

Fri Jul 03, 2020 4:00 pm

How is the Bleep unit itself billed, as a nasal mask?

Yep....nasal mask without headgear (since there isn't any headgear)...A7034
It is a nasal mask...pure and simple.
not to mention headgear is always billed out separately anyway.
The box of ports...A7032 or even A7033 will work.
See image below of all the usual HCPCS billing codes for cpap equipment....everyone uses these billing codes codes...Medicare and all insurance use the same code numbers.
Now the frequency allowed might be a bit different...this image below is a Medicare allowance schedule but most insurance will follow Medicare guidelines. The billing HCPCS number though....EVERYONE uses this same number.

"I have learned that I cannot use two DMEs, one for the mask and one for everything else."

BULL

Chunky Frog,

Really? That's what my DME told me. So I CAN use 2 DMEs if I want to? Boy, these companies are weasels, aren't they?

Pugsy,

Thanks for the chart. Your information is very helpful.

Deborah K. wrote: ↑

Sat Jul 04, 2020 12:49 am

That's what my DME told me. So I CAN use 2 DMEs if I want to? Boy, these companies are weasels, aren't they?

Have you ever heard the saying "if their lips are moving....they are lying" ??

You don't ever, ever, ever believe what they tell you. You always verify with your own insurance yourself.

My DME first told me that insurance wouldn't pay for the Bleep....then they back peddled when confronted with the HCPCS numbers which is what they use...uh,..uh...uh...well then I got the "we can't order it" BS. To which I told them "bullshit....you don't want to order it"..."at least be honest about it and admit it so I can go find someone else".....to which they did.
My problem is my Medicare Advantage plan and finding someone in their network to file insurance and let me use my insurance.
It's a crappy little plan which will probably get switched out this fall when open enrollment allows us to change.
Nationwide Medical Insurance would do it but after a lot of work....they aren't in network and there are no provisions for out of network stuff in the crappy little plan. There is the new online supplier just added a couple of weeks ago to the Bleep website that will file insurance but I haven't yet felt up to tackling them to see if they are in network. I doubt it though.

The other plans that are in network (with Nationwide)...would end up costing me more per month than the Bleep supplies would cost me out of pocket. I am pretty healthy otherwise and don't really have any other major health issues that might add up to the point where I really need a "better" or more extensive supplement to my Medicare. To go back on regular Medicare and a regular supplement...the supplement would cost me an arm and a leg because I got Medicare prior to age 65. I am 68 now but the fact that I got on Medicare prior to age 65 is baggage I will carry my entire life and the prices for supplements are sky high for me. The last quote I got on a real supplement was nearly 300 a month...I can buy a lot of ports for that.

My next step is to appeal to my Medicare Advantage plan itself to make an exception for Nationwide or the new company (once I jump those hurdles) since my own DME is being an asshole about ordering the Bleep for me... I won't give up though. Exceptions are made when services needed are out of network and no one else can or will provide the service. We got it done for my own mother who needed a very special kind of home health nurse to do some care on my mom and the only provider in the network didn't have a nurse home care qualified for that type of care. Lots of hurdle jumping but it can be done.

Or they might just call up the DME and tell them to "order the damn mask for her".... They could if they just would...they would make money too. Actually more money in the long run since I would be making use of the 2 boxes per month thing and I haven't bought a nasal pillow replacement (which I am allowed 2 per month) since I started using the Bleep Dec 2018. I haven't bought a damn thing from them since when the Bleep was released in March 2019 and they started telling me their lies about it.
Had 3 water chambers spring a leak...2 were my fault because I dropped them and one was just the usual leaky chamber thing....bought the replacements off Amazon. The DME could have had 3 water chambers sold. Not to mention the 2 boxes of ports every month and maybe something else I might have wanted or needed that they could have made money on.

If you haven't spoken directly with your insurance company yourself about the situation....take the time to do so.
Tell them what you want and the HCPCS billing codes and your DME won't order it for you....they might just light a fire under that DMEs ass. If you don't ask the answer is always "no"....is how I look at it.

I haven't lately felt up to fighting with them again but I haven't given up. I will be taking the fight up again shortly just out of spite. I just need a bit of energy that I haven't had lately.

But when it comes to what a DME tells you......never, never believe what they say without verifying with your insurance.
If their lips are moving..... just remember that.

Deborah K. wrote: ↑

Thu Jul 02, 2020 12:09 pm

As you can guess, I want to try the Bleep, and want my DME to provide it. Preferred Homecare, the company I am with now says they cannot order the Bleep for me. I have learned that I cannot use two DMEs, one for the mask and one for everything else.

Any input would be much appreciated.

What I have done was order all my supplies from the DME who would order the mask I want. When the day comes (and it will) when they say they can't order it then it is time to feed another supplier. But by all means stop feeding any DME's who refuse to get the supplies you want.

Sometimes you are stuck with a particular DME because it's the only one covered by your insurer. When that's the case, I suggest:
1. Ask your doctor to write the prescription for the Bleep mask and write "Dispense as Written".
2. If the DME refuses to order the Bleep, file a complaint with your insurer because they are refusing to provide what the prescription calls for.

Caveat: Some HMO's like Kaiser have their own "formulary" of masks. If that's the case, you may be SOL if you want a mask not covered by their formulary.

Pugsy said

My problem is my Medicare Advantage plan and finding someone in their network to file insurance and let me use my insurance.
It's a crappy little plan which will probably get switched out this fall when open enrollment allows us to change.

Did you know that you can only move from one Advantage plan to another (with some exceptions-see below)? You can't always move back and forth from an Advantage plan to a non-advantage supplement plan. This is very confusing to people. You CAN switch from Advantage to Original Medicare, but in most cases you CANNOT get a supplement plan to go with it.

Q: Can I switch between Medicare Advantage and Original Medicare?
A: Medicare open enrollment occurs each fall, from October 15 to December 7. During that time, you can switch from Original Medicare to Medicare Advantage, or vice versa. If you are already enrolled in a Medicare Advantage plan, you can drop it and enroll in Original Medicare and a Part D plan during open enrollment, with coverage effective January 1.

And between January 1 and March 31 each year, if you are enrolled in a Medicare Advantage plan, you can decide to leave your plan and return to Original Medicare (and purchase a Part D plan to supplement your Original Medicare coverage), OR you can switch to a different Medicare Advantage plan. (This option became available as of 2019; prior to that, there wasn’t an option to switch from one Medicare Advantage plan to another in the first part of the year).

There are also some circumstances in which you’ll have a special enrollment right that will allow you to switch from Medicare Advantage to Original Medicare or enroll for the first time.

Medigap
But in most states, you will not have guaranteed issue access to a Medicare supplemental insurance (Medigap) plan when you leave Medicare Advantage to switch to Original Medicare, although there are some exceptions to this.

You can enroll in a Medigap plan, but you will generally be subject to medical underwriting unless you qualify for a Medigap special enrollment period or guaranteed issue right — which does include some limited situations in which the enrollee is switching from Medicare Advantage to Original Medicare during the trial right period.

But some states have regulations to ensure ongoing access to Medigap plans, outside of the initial Medigap open enrollment period:

New York and Connecticut don’t allow medical underwriting for Medigap plans.
Maine requires Medigap insurers to offer at least Medigap Plan A on a guaranteed-issue basis for at least one month each year.
Massachusetts has an annual window, from February 1 through March 31, when Medigap plans are guaranteed-issue.
Missouri requires Medigap insurers to allow enrollees to switch to the same letter plan from another insurer on a guaranteed-issue basis during a 30-day period each year preceding the anniversary of when the plan was originally purchased (this is known as the state’s “anniversary rule”).
California and Oregon have “birthday rules” that give Medigap enrollees a 30-day window each year (following the enrollee’s birthday), when he or she can switch to any other available Medigap plan that has equal or lesser benefits, without medical underwriting.
Washington state allows Medigap enrollees to switch to another Medigap plan at any time, as long as they’ve had Medigap coverage for at least 90 days. People with Medigap Plan A can only pick another Plan A. But people with Medigap Plans B through N can switch to any other Plan B through N.

https://www.medicareresources.org/faqs/ ... -medicare/

Janknitz wrote: ↑

Mon Jul 06, 2020 1:08 pm

Did you know that you can only move from one Advantage plan to another (with some exceptions-see below)? You can't always move back and forth from an Advantage plan to a non-advantage supplement plan.

Actually very familiar with it since I used to sell insurance and still have a very good friend (I used to work with him) who does and he helps me wade through all the new regulations even now.
I always sit down with him and we discuss what we need or want vs what we are getting with the plan we have now (both myself and my mom) and we put a pencil to things to figure out which works out best for either of us.
While I haven't sold insurance in a few years and rules change....I have a grasp on the basics and with his help we wade through it all and figure out the pros and cons of our choices.

And those rules you quoted....they can all be appealed and he told me that he has had occasion to need to appeal those rules and hasn't had one denied. So there are ways around them if someone does a little extra work. It's the extra work part that unfortunately can put a monkey wrench in things. Some people don't know about or want to do the extra work....just like with everything else in life.
We had an almost situation when it came to my mom's plan with BC/BS advantage and it potentially being out of contract with her preferred hospital grouping. They finally came to a contract agreement but it was well after open enrollment had ended but we were prepared to start the appeals process if we had to and make appropriate changes after the first of the year.

I always have Plan B and C on the back burner for just about everything.
I always put the pencil to cost vs rewards in any of my choices.
My only real problem is sometimes I tend to want to cut my nose off to spite my face and really have to sharpen the pencil to stop that unwanted behavior.