I cant believe my DME

My DME called today to tell me it was time to get new pieces for my comfortgel mask, I said why when Im not using it. He acted all shocked that I wasnt using my cpap, I told him no, I was using it with a swift LT mask I got somewhere else, he actually tried to tell me that I couldnt use a RESMED mask with a RESPERONICS apap machine. Of course all he sells is resperonics. Then acts interested in how my therapy is, told him the mask made a huge diffeence, then I got a memory foam pillow and since then have been able to go 7+ hours a night, compared to 2-4 hours with the comfortgel. And just now after switching masks I am almost feeling rested in the morning.

AND his schedule for replacing stuff is:
new hose every 3 months
new mask pieces monthly
new complete mask and headgear every 3 months
and filters of course, however he wants to give me filters monthly at a copay of 5 dollars, which at a 20% copay means hes raping the insurance for 20 more. when i can get them online for 15 dollars for like a 6 month supply.

doesnt this seem excessive??? I have read of people having their hoses for years, and I dont really see my headgear wearing out more than maybe yearly, I could see replacing the nasal pillows on my swift LT every few months, but besides that I think he's trying to rape me and my insurance.

thats my soapbox, i just needed to vent....

What was your clue, you couldn't have seen his lips move over the phone, That's what most of us use to tell if they are lieing. If you see them move, look out! Jim

boston,

This is the standard replacement schedule for CPAP supplies (although I thought headgear and hose was every 6 months). Most insurance companies will pay according to this schedule. Depending on how well you take care of your equipment (and what equipment it is) you may be able to get away without replacing as often.

BTW I buy the filters for my M-Series from cpapauction.com (I've had good luck with both Breath Rite and Tina's Home Care) 12 disposable ultra fine + 2 foam for around $16 plus shipping - at a rate of $5 per month you'll save money.

Well, yer right, you USUALLY can't believe your local DME supplier, or at the very least must take what they say w/a grain of salt.

However, that replacment schedule is pretty much the "norm". The "norm" usually following Medicare guidelines. Altho, usually altho the mask itself can be replaced every 3 months, it is usually only every 6 months that the headgear can be replaced meaning in effect most masks can only be replaced every 6 months since headgear usually is not interchangeable w/other style masks. If I remember correctly, Medicare has changed their policy from one hose a month to one hose every 3 months.

You don't have to accept the various items on that schedule but it is good to know that is the schedule your local DME supplier will provide them if needed or wanted. Insurances contract w/various local DME suppliers at specific rates for the various items and the items are identified by a code, the HCPCS code, rather than by brand or model. Rest assurred the billed amount is NOT the amount your insurance pays.

Even if you don't really need anything yet (and yes, a lot of the equipment items last much longer than the replacement schedule) it's not a bad idea to occasionally take advantage of the chance to stash away replacements for a few things. You never know when something might break, tear, whatever. It's good to have a little collection of "extra's."

Boston, the person at the DME that called you is a sales agent regardless of their official job title. The replacement schedules for some of those items are designed more with the ideal of generating revenue flow than ensuring you get good therapy. Replacing filters on schedule or even before schedule I can definitely understand.

I do agree with rested_gal about having spare supplies on hand but you may be able to get your supplies cheaper somewhere else other than the DME... especially if you have insurance and they will reimburse you for purchases from online suppliers.

Right now I'm rolling with 1 machine, 1 hose and 1 mask... and I'm not feeling all that comfortable with the situation. Ideally I would like to have a backup machine and extra hoses & masks... I'll get there sooner or later.

you can THANK medicare for its stupidity in:

-Paying those ridiculous prices, then including a stipulation that no one else can buy it cheaper.
-Setting up a piece-meal schedule for replacement parts which only drives up the cost they pay

It is stupid because what Medicare "negotiates" is what establishes what everyone else has to pay including the private sector
for health care. It is why the cost of everything we have to pay for heathcare is thru the roof.

We are getting RIPPED off people. You can also thank the HME industry and their lobbyists for the same.

All this high prices then we only actually get paid this amount is SO they can hide the costs from the public. I've been on
this therapy 8 years and never once needed to purchase a replacement hose much less one every 3 months.

regarding the replacement hose, i have been thinking of going to an 8ft (from 6 ft), but was wondering if the longer hose would affect the pressure any ???

What Snoredog said.

Any wonder why our government is BROKE?

Still using the same hose (and mask) I started out with in May of 2005

Den

boston wrote:regarding the replacement hose, i have been thinking of going to an 8ft (from 6 ft), but was wondering if the longer hose would affect the pressure any ???

Most machines specs cover up to and including a ten foot hose, without a problem. Jim

Don't feel bad, guys, my DME decided since I'm on a Malibu VPAP, that even though my pressures changed at my titration, the machine didn't need adjusting, "since it'll take care of that automatically." Thankfully, I was able to find instructions to get into the clinical menu, and drop my pressure to 19 (it was 20, but I kept waking up tired). Now, after 1 night (day, actually--I work nights ), I can definitely feel the difference. I've also adjusted breath length, rise, etc. based on what I've read here, and I definitely feel better. My DME told me that I would get used to the panting breaths the Malibu forced on me.

I also get a hose, cushion and filter every month. At the rate they're coming, I'm going to run out of storage room before long!

Lord Darth Beavis wrote:I also get a hose, cushion and filter every month. At the rate they're coming, I'm going to run out of storage room before long!

If you can learn to lie without smiling, you too can become a DME, and sell off your extra supplies. Jim

Goofproof wrote:

Lord Darth Beavis wrote:I also get a hose, cushion and filter every month. At the rate they're coming, I'm going to run out of storage room before long!

If you can learn to lie without smiling, you too can become a DME, and sell off your extra supplies. Jim