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DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
#1
DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
I'm hoping to find an answer from one of you for what I think is a simple question relating to my DME supplier:
Who decides which mask is allowed replacement parts through the Medicare schedule? 

I started CPAP in January, and during my three-month trial period I received three masks from my DME supplier which were covered by Medicare (plus I have supplemental insurance) and I also bought several other masks out-of-pocket online.  Due to Covid, there was no walk-in office to try on masks (and no DME within 50 miles anyway), so I was reading this forum and researching online which masks might suit me and going by trial and error.  I honestly don't know what I would have done without this resource - it has been beyond helpful.

The most recent mask I received from the DME is the one I'm currently using (Airfit F30i), and when I called them for replacements after the first three months, they sent me what I was entitled to by Medicare.  It's obvious the Medicare schedule is very generous, so I asked the person on the phone if in the future I could get replacement parts for a different mask (Airfit N30i) which I bought out-of-pocket.  I was told no. I think I even asked about the two masks I got from the supplier prior to the N30i, and was told no, but I was a little flustered by then so I'm not positive.

I have had issues with this supplier in the past so I don't totally trust them, but I would sure like to find out if Medicare cares at all, or if it's this supplier's policy.  Thanks for any reply and sorry for being so wordy!!
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#2
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
I can only tell you that I have purchased from Amazon and got replacement headgear and replacement mask without any problems by from my DME.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
It sounds like the DME was allowing you to try different masks during your trial period.

And as generous as Medicare is with their replacement schedule, they normally only pay for 1 mask at a time.
Also, your DME would not be able to bill Medicare for more than one mask or mask parts during the replacement schedule.

And I've never heard of a DME replacing any mask parts or anything else that you purchased elsewhere.
So it seems they are being fair with you, as long as they are following the replacement schedule.

http://www.apneaboard.com/wiki/index.php...t_Schedule
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
Interesting to get two such different answers. Thank you.

To clarify, I don't at all expect to get anything more than what is laid out in the very clear Medicare resupply schedule, but three months from now, should I be able to get the listed resupply parts for a mask I bought out of pocket?

(Re them "allowing" me to try on different masks during the trial period, yes, I was allowed to try several masks - especially after I complained when they sent me a random mask rather than the one requested in my doctor's prescription - and due to Covid restrictions they were not returnable. I probably should have waited - it would have been more efficient to be able to go into an office and be "fitted" etc.)
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#5
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
My DME supplier allows me to switch masks as I desire. No problem changing back & forth. I'm only using two masks at the time. 

I started out my therapy with an AirFit F20. When the F30 came out, I went with that one. When it's time for new supplies, they actually ask me if I want to change anything.
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#6
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
Big Guy - thank you. I appreciate your input.
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#7
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
I have found that I can only “claim” one mask at a time when getting supplies, so I order cushions/headgear/frame for the AirTouch F20 one month and the F30 the following month (or whenever I actually need replacements). Trying to order for both in the same month was not allowed by my DME.
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#8
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
Why Me - thank you!
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#9
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
It would appear you should designate the mask model and size you want listed as being on your resupply list.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance)
I'll look into that - I wasn't aware there was a specific mask listed on a "resupply list" now.  Thank you!

(Everything has been handled over the phone from Day 1, and during the 90-day trial period the information given to me varied depending on which employee returned my call.  Due to Covid they were all working from home, obviously.  I learned to take notes and eventually asked to speak to a supervisor who said it was clear after our conversation that he needed to have a "customer service" training session with his employees.  To be honest, I felt like I was dealing with used car sales people. So I don't necessarily trust that the person on the phone knows - or cares - what the customer is actually entitled to.  It's been an eye-opening experience...)
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