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Heads Up Nano users on Medicare
#1
Medicare has determined that the Nano nasal mask cushion is part of the frame and will only cover 1 replacement every three months.
I called ResMed and told them if they want people to use their mask they needed to make it clear to Medicare that the Nano mask is a cushion and should be replaced more often than every three months for health reasons.
It is not my DME but MEDICARE who has said that the Nano cushion is a frame and can only be replaced every three months.
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#2
I just called Apria about the ResMed Swift FX Nano as it is viewed by Medicare. The cushion is part of the frame when you get the whole mask. It is not part of the frame when you get it separately.

Billing code A7034 - Entire mask

Billing code A7032 - cushion only (2 per month)
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#3
Thanks I will forward this to my DME.
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#4
Just another bit of info - they send me three months worth of supplies at a time so 6 cushions. I don't know if Medicare allows that but you should ask.
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#5
Remember you are using the pillows. My DME will give me plenty of swift fx pillows I have a drawer full. It is the whole cushion of the nasal mask they don't want to replace more than 1 every three months.
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#6
(01-31-2014, 05:43 PM)Lukie Wrote: Remember you are using the pillows. My DME will give me plenty of swift fx pillows I have a drawer full. It is the whole cushion of the nasal mask they don't want to replace more than 1 every three months.

nasal cushions and nasal masks are the same in the replacement scheme of things....2 per month. the 3rd month when the hose/frame can be replaced, I am guessing they give the cushion, frame, and an additional cushion but I don't know for sure. It seems as though they should give an additional cushion on the months that you are allowed a new frame.
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#7
I don't get why the Nano mask does not last longer.

Given that there is no ability to claim mask parts on any insurance in Australia I would not buy a mask with pillows/cushions that did not last for 12 months.

With careful use and daily cleaning my Pilairo cushions easily last 12 months.
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#8
(02-01-2014, 03:48 AM)Moriarty Wrote: I don't get why the Nano mask does not last longer.

Given that there is no ability to claim mask parts on any insurance in Australia I would not buy a mask with pillows/cushions that did not last for 12 months.

With careful use and daily cleaning my Pilairo cushions easily last 12 months.

it isn't about how long they last. the guidelines are in place to prevent potential infections, etc. and that is why it is allowed to change the nasal cushions/pillows twice per month. of course, just as with topping off the water tank, it is personal preference on how someone does this. It costs more but I order and use 2 cushions per month. If insurance pays for it then I will change them out.
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#9
(02-01-2014, 04:59 AM)me50 Wrote: it isn't about how long they last. the guidelines are in place to prevent potential infections, etc.
What infections? I wash mine every day in soap and water
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#10
(02-01-2014, 05:18 AM)zonk Wrote:
(02-01-2014, 04:59 AM)me50 Wrote: it isn't about how long they last. the guidelines are in place to prevent potential infections, etc.
What infections? I wash mine every day in soap and water

glad that works well for you and others.

it isn't always enough though. just like there are many masks, cpap machines, etc., some people are more susceptible to infections, etc., and it is beneficial to do things to alleviate that possibility. If someone gets pneumonia, especially those with compromised immune systems and/or the elderly, it is harder to cure and some don't survive. Precaution is not a bad idea and each individual has the option to replace or not replace their supplies as often as allowed.

It is why people get flu and pneumonia shots, some take vitamins, etc. Not everyone has the same immune system.

As always, YMMV.
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