How often does your Ins. Co.

How often does your insurance co allow for new mask; hoses; filters?

ktdid wrote:How often does your insurance co allow for new mask; hoses; filters?

Don't know. I've never asked them. Beyond the initial purchase about four years ago (they reimbursed me 80% of my out-of-pocket online purchases), I've purchased all of my additional equipment and supplies myself (out-of-pocket). It's cheaper for BOTH of us that way......there aren't the over-inflated charges (deductibles and co-pays) to pay and I've gotten what I want and need, which will last me for a long, long time.

Den (who believes it's all going to come out of OUR pockets anyway)

I have BCBS and, as I recall, it's masks 6mo, hoses and filters 2 mos, and machines 2 yrs.

But then, I DO have memory issues!

When I started CPAP 3 months ago I asked my carrier (GEHA, a federal employee insurance) for a replacement schedule and was told they don't have one but will replace items "when medically necessary".

So I sent them the list below which I pulled off a Medicaid or Medicare site and said that I understood that many insurance companies base their coverage on Medicare policies. My insurance replied that they considered the list as an appropriate replacement policy.


Item Replacement Frequency
CPAP Mask Every 3 months
CPAP Headgear Every 3-6 months
CPAP Tubing Every 3 months
Disposable Filter 2 new filters every month
Non-disposable Filters 2 new filters every 6 months
CPAP Chin strap Every 6 months
Full Face Mask Every 3 months
Oral CPAP Mask Every 3 months
Humidifier Chamber Every 6 months
CPAP Machine Generally, every 3-5 years, or as necessary

I did the same thing with Aetna

Guest wrote:When I started CPAP 3 months ago I asked my carrier (GEHA, a federal employee insurance) for a replacement schedule and was told they don't have one but will replace items "when medically necessary".

So I sent them the list below which I pulled off a Medicaid or Medicare site and said that I understood that many insurance companies base their coverage on Medicare policies. My insurance replied that they considered the list as an appropriate replacement policy.


Item Replacement Frequency
CPAP Mask Every 3 months
CPAP Headgear Every 3-6 months
CPAP Tubing Every 3 months
Disposable Filter 2 new filters every month
Non-disposable Filters 2 new filters every 6 months
CPAP Chin strap Every 6 months
Full Face Mask Every 3 months
Oral CPAP Mask Every 3 months
Humidifier Chamber Every 6 months
CPAP Machine Generally, every 3-5 years, or as necessary

ktdid wrote:How often does your insurance co allow for new mask; hoses; filters?

No fixed schedule for replacement items such as humidifier tanks, seals, filters, hoses, masks, etc. BUT, I'm not pushing it by ordering a new mask each month and submitting a claim.

I will be going to the DME very soon now to get a new Quattro (not that I need it but do want a backup) along with new hose and filters for the machine... then submitting the claim with expectations of 100% coverage. It was September 2008 when I last purchased anything... so I'm overdue and don't expect problems.

I am on Anthem (Blue Cross) Classic HMO. My coverage is 80%/20%.

• Masks every 3 months
• Filters every month
• New machine every 5 years

Not sure about hoses and such. I imagine if something broke, it would be replaced right away.

I have Blue Cross Blue Shield of Illinois
Mask every three months
Headgear every six months
Mask cushions two a month
Hose one a month
Foam filters two every six months
Disposable filters two a month
Machine they will pay to repair it indefinitely until my dme says it is cheaper to get a new one, unless my prescription changes and I need a different machine with a feature mine doesn't have.

My wife also has the same insurance I have so we pay very little out of pocket. One insurance kind of wipes out the deductible for the other.

I have Blue Cross/Blue Shield of Omaha. I have no idea about the coverage other than that the entire $62 per month rental of my machine is being paid for by me as part of my deductible. I think they will cover 80% once I reach the deductible but it's $1k.

OK, I guess my insurance co (Tricare Standard) is on track. I got my initial set up last year when I had reached my out-of-pocket, so it was covered 100%. They paid for the machine in total, not rental. I get a package from them once every three months. It contains:

1 Full face Quadro with head gear
Three hoses
six filters

But I have to pay a co-pay. I wonder if I really need a replacement mask that often. My original looks the same as the one I'm about to replace and the new one. I haven't trown any away. What do you do with your old (month old) hoses and masks?

Thanks for the feedback

The company I work for has uses a a non profit private carrier for insurance and it benefits their employees immensily ... everything related to my sleep therapy is at my discretion with the exception of the CPAP itself, I can replace my CPAP once every two years or change it to a different model / type at anytime if my doctor requests it. Everything else I can get at anytime through my local DME supply as needed, no time restraints attached.

After a lifetime of playing the game with the for profit insurance companies it sure is nice to have a change like this for once ...


--Quinda

DME said 3 months. Then changed it to 6 months....(go figure. You'd think they'd want the billable sales as often as possible!!! )
Insurance company said "when I need it", they'll cover it.
I don't abuse the "privilege" and generally get "stuff" every 3 months - including a new mask.

I would never trust the DME to know.
Always talk to the insurance company directly -- I think most would be surprised.....
All of my equipment and supplies are covered 100%....I've yet to pay a nickel out of pocket (except by my choice)!!!
All that said, Den's right -- it all comes out of our pocket somewhere along the line.......

cheers
goose

Mother Goose wrote:OK, I guess my insurance co (Tricare Standard) is on track. I got my initial set up last year when I had reached my out-of-pocket, so it was covered 100%. They paid for the machine in total, not rental. I get a package from them once every three months. It contains:

1 Full face Quadro with head gear
Three hoses
six filters

But I have to pay a co-pay. I wonder if I really need a replacement mask that often. My original looks the same as the one I'm about to replace and the new one. I haven't trown any away. What do you do with your old (month old) hoses and masks?

Thanks for the feedback

I'm still using the original mask (all original) and hose I started out with in May of 2005. I have a few spares (masks, seals, filters and hoses), most of which are still in their original packages, waiting for the night that'll I'll eventually need them.

Den

I forgot to mention that my insurance carrier will pay out for those items on that time frame but my DME doesn't want to give them to me. They told me I shouldn't need them that often. They agreed to give it to me when I was going to go someplace else.
GerryK

Hi---I have Cigna -PPO. I use APRIA with no deductibles. When I call they send what ever it is that I am asking for. It is really good coverage --I am lucky. I could get a new mask a week if I wanted one!!! LOL!
Carrie