Update II: Someone (DME?) is Lying to Me...

ThomasMcKean wrote:

The Texan wrote:My DME provided a loaner WITH a humidifier for the 4-6 weeks my machine was back for warranty replacement. In my case, without a humidifier, I get nose bleeds within 3 nights. Your DME is cheap, nothing more.

That is sorta how I feel my investigation turned out today. I was here and elsewhere and what I have concluded is what while she was apparently within her rights to deny me the humidifier, it was overall a very low and uncaring thing for her to do.

When a CPAP malfunctions and the DME provides a loaner they are still required to follow the prescription. If humidification is ordered then there are a couple of choices. The first would be to swap out your CPAP with one just like it. This way you just use your heater with their loaner. If the company cannot match yours (which would be odd if they sold you this one) then they should provide both the CPAP and heater as a loaner. The humidifier chamber is single patient use only so you would probably want a new chamber with the loaner. Your insurance should cover this. If the DME could not accomodate your prescription due to lack of proper equipment they should have sent you to a DME that could.

There are good DME companies out there. The poor ones need to go away. This DME needs to get out of this business as they do not know what they are doing and damaging the reputation of the DME industry.

Medicare *does* have codes to cover rental of humidifier.......which is why I was surprized when I got billing that showed I had been sold a unit specific humidifier for a unit I was paying rental for 13 months. It just would have been nice to have been told before hand since I was on the hook right then for 20%.......

If Medicare has codes for both purchase AND rental of humidifiers, then I can easily imagine that the DME is full of it.......that and the fact that they fed you a line without researching what applied in your insurance and your situation!

J

Yep, my first local DME provider pulled exactly that stunt: sold me an S8 Elite and when it had to be returned under warranty to Resmed, they took both humidifier and Elite to return but only provided me w/a Respironics pre-M Series Plus w/no humidifier on loan. I was blessed by a fellow apnean who provided me w/his used, refurbished F&P HC 100 stand alone heated humidifier when the passover humidifier my sleep lab was able to provide me w/did nothing for me but chap the interior of my nasal passages so bad the air passing thru felt like pouring salt on a raw wound. Needless to say I switched to a MUCH BETTER local DME provider.

DMEmomma wrote:you're right....you own the humidifier....PAP is rented.

Apparently not all are the same. I get an invoice every month for my share of rent for machine at $15.19 AND rent for humidifyer at $4.82 from DME.

If the prescription says 'humidifier' they must fill the whole prescription or send you elsewhere. Half filling a prescription is illegal. Why did they take your original humidifier, if only the cpap was in need of repair? Get it back!

JayC wrote:Medicare *does* have codes to cover rental of humidifier...

Where exactly would I find these codes?

guest22 wrote:If the prescription says 'humidifier' they must fill the whole prescription or send you elsewhere. Half filling a prescription is illegal. Why did they take your original humidifier, if only the cpap was in need of repair? Get it back!

This is a good question but I can answer it.

Yew see the machine I have, the one that broke, it is a ResMed Elite II. For some reason, my nutball DME (who I am liking less and less as I read these messages) appears to be a bit ANAL about Respironics and refuses to have anything to do with ResMed. So what happened is they did not take my humidifer. I still have it. But since all they had to loan me was a Respironics (a very LOUD one at that!), the humidifier I have, which is a ResMed, is incompatible.

guest22 wrote:If the prescription says 'humidifier' they must fill the whole prescription or send you elsewhere. Half filling a prescription is illegal.

How can I get documentation that proves this? I want to show it to her before I move to someone else.

Do you have a copy of your Rx? If not, get it from your doctor. We should ALL keep a copy of our Rx AND a copy of our sleep study. If you ever want to buy supplies or more equipment or a different mask from some other supplier (like cpap.com) you will need a copy of your Rx. I ran off several copies and keep it in a file along with copies of my study. A copy of the study is good to keep to give you a bench mark or starting point to compare your results every so often.

nanwilson wrote:Do you have a copy of your Rx? If not, get it from your doctor. We should ALL keep a copy of our Rx AND a copy of our sleep study. If you ever want to buy supplies or more equipment or a different mask from some other supplier (like cpap.com) you will need a copy of your Rx. I ran off several copies and keep it in a file along with copies of my study. A copy of the study is good to keep to give you a bench mark or starting point to compare your results every so often.

I plan to get a copy. Meanwhile I am dead certain it had a humidifier on it. I can see it in my head. It even had the setting on it, a big 12.

ThomasMcKean wrote:[

I plan to get a copy. Meanwhile I am dead certain it had a humidifier on it. I can see it in my head. It even had the setting on it, a big 12.

Way to go Thomas, you are like me if I've read it, its stuck there in my head . Now remember where you saw it, doctor's office, DME's office....go and get it and you will have the proof. Regardless, we need to keep a copy on hand, if you were out of town and something broke you would be up the creek without the perverbial paddle, in worse shape than you are now.
Good luck
Nan

I'm not going to say that there's nothing worse, because there are worse medical things with care and insurance, but it's pretty low to give someone a hard time getting a piece of equipment that they MUST have to sleep!

I would definately look for a new DME.

Now that Nan said that, I definately rememer that when I got my original remSTAR in 2005, they told me I was given the humidifier part outright, and that I was leasing to own the CPAP machine. So I rented the CPAP for like 24-36 months, and then I owned it. Machines were also thousands back then. Since that time, this particular DME got out of the CPAP business, I think they did not feel they were making enough money. I suspect when this first started to catch on big the money insurance would pay was pretty nice and everyone started to jump on the bandwagon. In 2005, I could get new masks and supplies paid for by the insurance company no problem every three months, and now it's every six months and the insurance company demands a new script every six months, even if the old script is written to be good indefinately, they go by the date. And most will not pay for an auto CPAP or a bipap without a LOT of documenation. I suspect it is a money thing with your DME.

Also, in 2005, they did not push the new water chamber every six months or a year like they do now. Now they really make sure you know you can ask for and get a new water chamber.

I've been worried about having a backup for a long time, and I just brought a new PR System One Auto CPAP for a VERY good price. My old machine will now become my backup.

I know it's not right and the DME and the insurance company should take care of you right! But in the meantime, who is suffering, you or them? There are a lot of good used Auto CPAP machines out there for $75 to $150. Not all the bells and whistles, but more than enough to get by with until your machine is repaired. I would get a good backup on my own, and then press them like crazy to get what they OWE you!

The best place I found so far for good used CPAP machines was either Craig's List (which you have to be really careful using) or cpapauction.com. I just got mine from Liz at cpap auction, and I think she had a good used auto cpap for $100. Is it worth $100 to have something good to use that you own, while you fight with these rotten people to fix your machine?

Lee

I can't access the Medicare schedule at the moment but to my recollection humidifiers are a purchased item only. So if Medicare paid for your humidifier in the past five years it may be difficult to get them to pay for a new one.

CMS (Medicare) Recommendations for CPAP Supply Replacement
Item HCPCS Code Replacement Schedule
Full Face Mask A7030 90 days
Full Face Cushion A7031 30 days
Nasal Cushion A7032 30 days
Replacement Pillow A7033 30 days
CPAP Mask A7034 90 days
CPAP Headgear A7035 180 days
CPAP Chinstrap A7036 180 days
CPAP Tubing A7037 30 days
Disposable Filter A7038 30 days
Non-disposable Filters A7039 180 days
Oral Interface A7044 90 days
Heated Humidifier E0562 5 Years
CPAP Machine E0601 5 Years

Right I get all that. But this is different. I mean at least I think it is?

My machine is a ResMed. The loaner is a Respironics. So my humidifier won't work with it.

Beingas that is the case, AND that the humidifier is listed on the prescription proper, what I been trying to find out is what the rules are.

Does the DME have the right to refuse me a humidifier loaner even if it is prescribed? And, if it is prescribed by a dr, where does Medicare stand in regards to a loaner?

I am not looking for a new one, I am looking for a loaner while the old machine is being repaired.