Insurance and masks

How often do most insurance companies replace masks? What about the nose pillow things?

Do I go through the DME or my Dr?

benalexe wrote:How often do most insurance companies replace masks? What about the nose pillow things?

Do I go through the DME or my Dr?

I think it depends on your insurance. For me, I'm on medicare and they authorize a new mask every three months. I keep track, as does my DME, and I just call them a few days ahead of time to make sure they have it in stock.

Unfortunately, I don't use nose pillows so I have no idea what the replacement schedule would be on those.

So it would be the DME not the doctor that I call for a new mask?
DO most people switch them every few months?

My current insurance BCBS allows for two filters and two pillows per month. Replacement hose every 3 mos, New complete mask and humidifier chamber every 6 months.

I am going to Cigna next year so who knows. I am prepared to buy my supplies out of pocket.

I have Cigna. They pay for two new nasal pillows every month and a new mask every six months.

This year I did not have a deductible. Next year I have a $500 deductible. I'm not sure if I have to pay for the parts up to the first $500 deductible next year or not. I will need to check that out.

Hi benalexe,

Do I go through the DME or my Dr?

Your doctor's role in PAP therapy is to write you a prescription based on the results of your sleep study.
With your prescription, you can purchase a mask a number of different ways:
A DME or Home Care Company is an equipment provider that will a) bill your insurance and b) provide the assistance of respiratory professionals.
Online retailers often offer cpap supplies at a discounted rate but offer limited assistance and do not bill insurance.
You may also be able to purchase your supplies directly from the manufacturer, although this is not typical.

How often do most insurance companies replace masks? What about the nose pillow things?

Madalot is right: It does depend on your insurance. Typically a replacement mask is covered every 3-6 months and nasal pillows at least once a month. Do yourself a favor and check with your insurance directly to ensure that there are no unpleasant surprises.
Furthermore, if you purchase from a DME, some (not all - always keep track yourself regardless!) will call and remind you when you are eligible for new equipment. Keep in mind that the lifespan of your equipment depends on many factors (cleaning, usage, materials, etc.) You may want to keep some spare parts...

Good luck to you and keep up posted!

Happy New Year!
Jess

My BCBS pays for 2 pillows, or 1 cusion, 1 hose per month, filters every 3 months. mask, headgear every 6 mo. I give them a call and tell them what I need and either pick up or have it shipped. After collecting a few spares I won't need so many hoses, but the pillows wear out fast.

benalexe wrote:So it would be the DME not the doctor that I call for a new mask?
DO most people switch them every few months?

YES...you call the DME. As far as switching masks...if you find one that works, stick with it. The only reason to switch masks is if you have unfixable leak problems or discomfort. A mask will last a long time, but, cushions, pillows and head gear needs re[placing periodically.

Rule of Thumb:

NEVER, NEVER, NEVER, NEVER take your DME's word for what's covered and what's not and how much YOUR particular insurance plan will pay and what your out of pocket costs will be. They get it wrong and lie sometimes.

If you are on Medicare Part A and B without a supplemental policy, we can show you where to find that info for your state. If you have a supplemental, you need to call your supplemental insurance carrier to understand how much (if anything) they will cover of the Medicare deductibles and co-payments.

If you are on any other insurance, including a Medicare HMO/Advantage plan, check with your insurance carrier.