One replacement cushion a month now

I recenlty went to my DME and was told that my insurance will only pay for one replacement cushion a month now for the full face mask. I was told this is becuase Medicare recently made the same change. I swear I got two new cushions in January so the change had to be after that.

Anyone else run into this?

Oh, bye the way I have BCBS of Illinois and never had any coverage problems.

Gerry

You might check with the local Medicare office.
If your DME is getting less than 'cost', they could be less than candid with you.

I have not heard of such a change in Medicare replacement guidelines...doesn't mean there hasn't been one but my gut says that there has not been.
I would suggest calling them up and asking what the replacement schedule for those nasal pillows
A7033 is the code.
Last I saw or read was 2 per month.

The nasal pillows I was told are still two a month the full face is only one.

I was also told the hose is only every other month not every month. I used to go in monthly and get a new hose and two new full face cushions and I ended up with two bags full in my closet and went over a year without having to order any when I decided to use what I had.

I always thought two full face cushions and one hose a month was extreme anyway.

Yep..never mind what I said...for some reason I totally missed the full faced mask part.
Yes, the cushions for full face mask are a once a month item and have been that way for some time now with Medicare. I don't think this was a recent change..if you got 2 replacement cushions for a full face mask this past January then I think someone messed up.

Oh they did mess up and they even said Merry Christmas. My insurance was never billed and neither was I. I got a new humidifier chamber, two new full face cushions, a complete new mask with headgear a new hose and several fine particle filters and a couple regular filters.

I have asked them three times since then to bill me and the insurance and they finally said Merry Christmas to not ask again as it is too much paperwork.

Gerryk wrote:I recenlty went to my DME and was told that my insurance will only pay for one replacement cushion a month now for the full face mask. I was told this is becuase Medicare recently made the same change. I swear I got two new cushions in January so the change had to be after that.…

Gerryk wrote:Oh they did mess up and they even said Merry Christmas. My insurance was never billed and neither was I. I got a …two new full face cushions….

I have asked them three times since then to bill me and the insurance and they finally said Merry Christmas to not ask again as it is too much paperwork.

These two statements seem to contradict each other, Gerry.

Are you saying that Medicare made a change after January from 2 to 1 replacement cushion per month?

Or are you saying that your DME made a mistake giving you two?

Which is it?

My DME made a mistake and did not bill me or my insurance at all for any of those supplies and probably made a mistake and gave me two cushions in January.
When I referred to recently that was within the past week not in January.

I just ordered a new nasal mask as it had been more than 6 months since my last one.

I called Crapria and they sent me the mask and asked if I wanted s supply of cushions. They said I was now allowed to get a new nasal cushion every two weeks.

Without giving it much thought... I said OK. It's always such a struggle to get anything from Crapria I figured if they were offering... I was taking.

But they sent me a 6 month supply of cushions.... Yep.... 12 cushions. Ain't no way I needed 12 cushions. I figured they would send ONE etxra cushion.

I have gotten the EOB from my insurance company in the mail, and they paid it 100%.

But next time... I'l clarify how many of something they are sending me. I'm sure they push the cushions now since they can get more of the reimbursed.

I bet they sent them to you and billed that they sent them out over the past six months.

Gerryk wrote:I bet they sent them to you and billed that they sent them out over the past six months.

Hmmm... Never thought of that... but you may be right !

I woud not be surprised to learn they have a training class on how to circumvent the checks and balances of insurance billing and how to generate the most income with some creative invoicing.

I can understand nasal pillows being replaced often, but Nasal Mask cushions and Full Face Mask cushions? Well, I guess I got the short end of the replacement straw because I can only get a new nasal mask every 6 months with no options to get replacement nasal cushions anytime between those 6 months . I have Kaiser (who is their own DME here where I live) and the supplies are sent from Apria when Kaiser tells them to do it. I finally bought some replacement Nasal Mask cushions/parts from our forum host so I could have them on hand should I need to replace something before my 6 months schedule.

It's like being in a weird kind of candy store, with the way we all get our PAP stuff/accessories; everyone gets a different piece of candy, it costs a different price for each piece and person, and some can visit the store often and some have to wait a long time to visit...

John