DME, Medicare, Mask Trial Policy??

Hi.....

I am on Medicare and using Lincare DME. Have began CPAP 2 weeks ago. I would like to know, if anyone can help, what is the policy for trying new masks(as a new CPAP user) until you can find one that suits your needs and is comfortable? Like, is there a limit of masks you can try and is there a time limit in order to try these masks? If you try more than 1 or 2 can they charge you for each mask you tried? My DME isn't the easiest to get hold of. Usually takes a couple days of calls, leaving a message with his staff, before he returns my call.

Any info appreciated..........

Usually for the first 30 days, you can trade masks. For your info if the DME balks at this policy, they are not the ones paying for the service, its the manufacturers. All the DME has to do is give you the mask you want and fill in a piece of paper, send it to the manufacturer and they get reimbursed.

Unfortunately, Lincare doesn't have the best reputation in the world. *understatement*

If they give you any static or limit on mask exchanges just bat your baby blues and innocently ask:

Why don't you take advantage of Resmed, PR and F&P's offer to replace FREE to your company ANY of their masks that we patients have tried and been unsuccessful with, when all you have to do is fill out a form and return the mask and form w/in 30 days, given it is in the best interest of patient comfort and compliance to have a good fitting, relatively leak-free mask???

Then smile sweetly and gaze at them expectantly.

DMEs often make their own "house" rules regarding mask trials. Though it is the mask manufacturer that offers the 30 day exchange period. ResMed and Resperonics both offer 30 days and it doesn't matter if you are brand new to cpap or a veteran. DMEs don't/won't usually offer past 30 days of just beginning therapy but they could if they would be willing to do the extra paperwork involved. Best thing is to clarify with your own DME their exact policy. They may not offer publicly repeat mask trials using the manufacturer's offer but might if you specifically mention it. In other words..push the issue.

Medicare...DME is going to bill Medicare probably for first mask choice. To get Medicare to pay for a second mask (such as a trial) the DME would likely have refund any Medicare payment and submit extra paper work for another mask billing.
They aren't going to go through all that paper work and knowing how Medicare is, it would probably just really mess things up. The DME would likely need to resort to getting a replacement mask or credit for the mask that didn't work which cannot be reused or sold. Medicare is going to follow their replacement schedule regardless of the mask working out or not.

A while back someone had a problem with lincare...I posted this as a reply................

"There have been several comments on the board about Linecare's failure to follow the manufacturer's mask exchange policy.
I do not use Linecare, but, I wrote to their corporate office asking about their policy....Here is the reply I received."

Lincare does honor the Fisher & Paykel, ResMed, and Respironics 30 day Mask Replacement Programs as long as you contacted our location within thirty days of delivery of the mask. What location did you purchase your mask through? Please let me know so I can contact them to ensure they understand how this program works. Thank you.


John A. D'Arezzo
Materials Manager

jdarezzo@linecare.com

Thud,

Thanks to LSAT you now have the name of a Lincare corporate executive. I'd suggest the following:

1. Print out the body of that letter(the part in red).
2. GO to Lincare-don't wait around for them to call you, as they may continue to stall. Take the letter with you in case they give you a hard time.
3. Ask to be fit with a new mask to exchange for your current mask--use the letter if you have to.
4. Document everything! If you call or talk to someone in person, write down the date, time, whom you spoke to and what was said until you are satisfied with a mask. Watch the billing to make sure you are not double charged.

Report any problems to Mr. D'Arezzo!

I've had my mask since June, and while I've had moderate success with the mask I have now (QFX), I've wondered if another might fit me better. Does anyone know how this works with the VA?

Yeah, we are, aren't we???

I'm in mid-Michigan, near Saginaw, where in Michigan are you, Thud?

Slinky....I am near Detroit Metro Airport(west of Detroit)

Gotchya. I had good friends who lived in Belleville I used to vist w/each time I went to U of M. I sure do miss the Pickle Barrel Inn! Those deep fried pork chops were outta this world!!!

I see Slinky. U of M health care is really growing fast. I see one doctor there.