Better to use Medicare for new apap, or buy used/new?

I have a back up machine. Murphy's Law says if your machine fails it will be on a weekend or holiday and your DME will be closed and even if he happens to be open he might night provide a loaner while your machine gets fixed. Some do and some don't.

Is it overkill? Probably unless you happen to have a failure and then it will be the smartest decision you ever made.

Still waiting for word back on the used machine, but we did sign up with the local DME for the new machine and have the setup appointment set for Tuesday. Only odd thing - they said he probably can't try on different masks due to covid. They also said that Medicare prefers he stick with the mask recommended by his doctor (a nasal mask), when I told them my father is a mouth breather and we might want a full mask instead. Does that sound correct, or should we be pushing for the right to try on (or at least choose) our own mask? They did say there is a 30 day mask guarantee in the beginning so he can exchange the mask if it doesn't work out - but it seems like they should be showing him multiple types and letting him pick.

PopIsGettingGrumpy wrote: ↑

Fri Aug 13, 2021 5:18 pm

Only odd thing - they said he probably can't try on different masks due to covid. They also said that Medicare prefers he stick with the mask recommended by his doctor (a nasal mask), when I told them my father is a mouth breather and we might want a full mask instead. Does that sound correct,

Honestly, Medicare pays by billing code and does NOT care about which mask he will ever use. And I doubt they will take your mask back if/when it needs to be exchanged.

In fact, just have the doc write "Mask of the patients choice" on the order and get a copy of everything including the sleep study.

PopIsGettingGrumpy wrote: ↑

Fri Aug 13, 2021 5:18 pm

They also said that Medicare prefers he stick with the mask recommended by his doctor

Lying or gross incompetence? You will have to keep an eye on these peeps.

This is why I'm skeptical of DME's. I wonder if the doctor wrote "nasal mask" on the rx. I can try to contact the doc on Monday. Just seem strange that we would be limited on what mask we choose.

PopIsGettingGrumpy wrote: ↑

Fri Aug 13, 2021 5:18 pm

They also said that Medicare prefers he stick with the mask recommended by his doctor (a nasal mask), when I told them my father is a mouth breather and we might want a full mask instead.

Sigh...as the others have pointed out....bold face lie. Medicare could care less what mask you use.

Also...they will likely tell you that Medicare doesn't allow mask swaps or exchanges or might limit you to one or limit you to 30 days tops...another bold face lie.
ALL the mask manufacturers offer a 30 day return warranty on ALL their masks for any reason and while it is true Medicare only pays for the first mask and won't pay for any others until replacement time is up....people can "return" a mask within 30 days and the mask manufacturer will reimburse the DME for it...and remember Medicare will also pay...DMEs won't lose money if they swap out masks because they can get reimbursed by the mask manufacturers for subsequent masks they dispense after the first one that insurance pays for.....they won't lose money but they do have to a do a bit of paperwork...but most are lazy and don't want to do the paper work so they just tell people that their insurance only allows so and so...and that's it...big lie.

Now used to be people actually physically had to return the masks to swap them out and DMEs had to send them back...then years ago the DMEs only had to fill out some paperwork and people returned them and the DMEs tossed them in the trash and then filled out the paperwork. Some actually told people to just keep the mask because they would just toss it in the trash...those are honest DMEs who care about people.

Now with covid...they probably don't want to bother with tossing in the trash but they still have the manufacturers 30 day warranty available. This warranty covers everything including, doesn't fit, don't work, I hate it.

The DME has already lied to you once...watch them like a hawk and don't believe anything they tell you about what Medicare says or does without verification.

You absolutely don't have to use whatever mask the doctor first orders...but you can also ward off this particular excuse...just have the doctor write "Mask of patient's choice"...

PopIsGettingGrumpy wrote: ↑

Fri Aug 13, 2021 5:18 pm

They did say there is a 30 day mask guarantee in the beginning so he can exchange the mask if it doesn't work out - but it seems like they should be showing him multiple types and letting him pick.

This is per mask and actually goes beyond the first 30 days...it's PER MASK...not a strict 30 day time frame...but they won't tell you that part.
Used to be there were demos in the office for people to try....not now with covid.
The masks could be sterilized but again...that involves extra work and most of these guys avoid extra work like the plague.

Why does he mouth breathe? That is a bigger question and would help with figuring out which mask to start with.
Does he have chronic nasal congestion issues that he can't clear up and he has to mouth breathe to survive???
Or does his mouth just fall open sometimes and he mouth breathes out of habit and because the mouth has fell open.
If he can normally breathe through his nose just fine during the day ....there's a good chance he can be successful with a nasal interface mask.
Does he have facial hair?

Nasal masks have less real estate to keep sealed and easier to get sealed. I always suggest that unless a person has really bad chronic nasal issues they can't clear up....start with easy first. Sometimes it works.

So the big question ...why the mouth breathing?

Very much appreciated. That's the kind of information I was hoping to have beforehand so we wouldn't get mislead by the DME's. It's disappointing that a first time consumer needs to do this much homework but I really appreciate the advice so we can be prepared. It's a lot to take in at once and I want to get things correct for my father.

I asked my father about the mouth breathing. He isn't aware he does it and he does not have issues with congestion. I only know because I've seen how he sleeps. I believe that's just his natural state. After his sleep study, he commented that he was bothered because the air was coming out of his mouth - which led me to assume that he would be better off with a full face mask, or that he would at least need a chin strap. Perhaps that was a bad assumption, but I guessed that it's not good for the air to push out his mouth. If nothing else, he wasn't comfortable with the air doing so.

After his own research, he himself would like a nose-only mask, but NOT the type that goes into his nostrils. That's what he has during the study and he didn't like the feeling of the mask in his nose.

Thoughts?

Have your dad look at these nasal masks that aren't the kind that go up in the nose at all. The ones that go up in the nose were probably some sort of nasal pillow mask...and to be honest...they are supposed to rest gently against the nostrils and nothing actually goes up inside the nose that would be felt UNLESS the sleep study people had the mask too tight or wrong size pillow. Which there is a good chance that is what they did but for now he has decided he doesn't want to try again and that's fine...we can find something else to try. I used a nasal pillow mask for years...nothing is supposed to be touching anything inside the nose for a person to feel and if it is...something is wrong with the fitting or size. I guarantee it.
Properly fitted...you don't feel a thing inside the nostril.

Traditional over the nose cushion
https://www.resmed.com/en-us/sleep-apne ... irfit-n20/

New cradle cushion...fits under the nostrils but not inside the nostrils.
https://www.resmed.com/en-us/healthcare ... irfit-n30/

Same N30 but frame is different and hose attaches over the head.
https://www.resmed.com/en-us/healthcare ... rfit-n30i/

And/or take a stroll through all of them
https://www.cpap.com/plp/nasal-cpap-masks/ZT0yNjQ

Thanks. One final question on this potential "blanket ABN" -- If they do give us one to sign, how should we proceed? I've been reading online, but I'm still unclear on exactly what signing one will lock us into. It was my understanding that if my father failed compliance, or didn't want the machine, we would simply return the machine and pay the final month rental fee. Does a "blanket ABN" force us into a legal obligation to pay more money beyond that. If so, how do we protect ourselves in the event that we are presented with one tomorrow when we pick up the machine?

PopIsGettingGrumpy wrote: ↑

Fri Aug 13, 2021 7:47 pm

After his own research, he himself would like a nose-only mask, but NOT the type that goes into his nostrils. That's what he has during the study and he didn't like the feeling of the mask in his nose.

Thoughts?

The Philips Dreamwear Nasal Cushion is what my sleep doc had me start with and am happy with it.

https://www.directhomemedical.com/cart/ ... XEQAvD_BwE

Have tried other nasal types, including ResMed AirFit N30i (cushion) and Brevida (pillow), but still find the Dreamwear to be most comfortable.

Some folks on here have more than one mask type and periodically switch to and from for a few nights.

PopIsGettingGrumpy wrote: ↑

Mon Aug 16, 2021 10:16 am

Thanks. One final question on this potential "blanket ABN" -- If they do give us one to sign, how should we proceed? I've been reading online, but I'm still unclear on exactly what signing one will lock us into. It was my understanding that if my father failed compliance, or didn't want the machine, we would simply return the machine and pay the final month rental fee. Does a "blanket ABN" force us into a legal obligation to pay more money beyond that. If so, how do we protect ourselves in the event that we are presented with one tomorrow when we pick up the machine?

You simply refuse to sign a blanket ABN....ABN's need to be service specific.

With all the covid stuff now...I don't know how that affects compliance failure returns on the machine itself.

First month initial costs will include items that have never been returnable though...
Masks have never been returned.
Humidifiers have never been returnable.
Same with water chambers and hoses.

Thanks. I just want to make sure that we don't get tricked into having to keep paying for the machine if my father fails medicare compliance or just absolutely hates cpap. My understanding was that we would simply return it, pay the current month rental, and be free and clear.

What is a "Blanket ABM" ?

Thanks

pratzert wrote: ↑

Tue Aug 17, 2021 10:33 am

What is a "Blanket ABM" ?

Thanks

A general statement that essentially says "I will pay for anything that Medicare denies coverage for".
It doesn't specify what service or product that Medicare might disallow.
Often hidden in the huge paragraphs of legal mumbo jumbo that people sign without ever reading.

Years ago I had some blood work done and I was given an ABN to sign acknowledging that Medicare might not pay for it and if that happen then I would pay. It was very specific and easy to understand and explained thoroughly to me....which is what they should do.

Thanks Pugsy !