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New Masks
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bingo49002 Offline

Members

Posts: 15
Joined: Jun 2012

Machine: Resmed S9 VPAP S
Mask Type: Nasal pillows
Mask Make & Model: Resmed Swift FX
Humidifier: Resmed H5i
CPAP Pressure: Bi Level 15 over 11
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Michigan, USA

Post: #1
New Masks
I obtained a new Swift FX nasal mask last week from my DME. I really enjoy my DME provider but something bothered me a little bit this time. This model mask comes with 3 sizes of nasal pillows in the package---small, medium, and large. The DME provider removed the other 2 nasal pillows and left me the one that I use. Am I wrong to think that he should exchange the 2 pillows he removes for the size I use. DME bills my insurance for new pillows every time. It just seems to me that he should not take something that is in the package without offering and exchange for what he takes. What do you think? Am I being petty?
10-04-2012 06:23 AM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: New Masks
the lousy DME is a crook
the mask comes with 3 pillows, its yours to keep and you might later want to try the other sizes
me going to bed - Sleep-well
10-04-2012 07:09 AM
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trish6hundred Offline

Advisory Members

Posts: 6,449
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #3
RE: New Masks
Hi bingo49002, I have always gotten three (3) different sizes of pillows with each mask. Since you haven't had any trouble up to this point with your DME, you might ask them about this and I don't think you are being petty, you should at least get the three sizes of pillows.

trish6hundred
10-04-2012 08:28 AM
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SuperSleeper Offline

Administrators

Posts: 9,973
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #4
RE: New Masks
(10-04-2012 06:23 AM)bingo49002 Wrote:  The DME provider removed the other 2 nasal pillows and left me the one that I use. Am I wrong to think that he should exchange the 2 pillows he removes for the size I use. DME bills my insurance for new pillows every time. It just seems to me that he should not take something that is in the package without offering and exchange for what he takes. What do you think? Am I being petty?

This is actually a version of insurance fraud - billing insurance companies for a product that was not delivered to the customer. You are absolutely 100% correct.

If the DME gives you any gruff, tell them that you're considering turning them in for insurance fraud to the state department of insurance or at least contacting your insurance company to issue a complaint.

No excuse for this. They are taking your extra nasal pillows and handing them out to other customers and likely charging those customers for your extra pillows (and possibly billing insurance for these as well). [in effect, double-billing the insurance company for something]

Unacceptable. You paid for it through your insurance and you have every right to the product you paid for.

Cool

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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.

10-04-2012 09:15 AM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #5
RE: New Masks
maybe give the DME the benefit of the doubt (not a crook)
just following insurance instruction and gives stuff on need basis
so insurance pay what you actually use to stop the fraud
10-04-2012 02:21 PM
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SuperSleeper Offline

Administrators

Posts: 9,973
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #6
RE: New Masks
There is no separate insurance or Medicare billing code for the individual small, medium and large nasal pillows included with the full Swift FX nasal mask package. If they are billing for an entire mask, (that is billed as one unit), this includes mask, headgear and the 3 nasal pillows that came with the mask, because that's the way the manufacturer ships them.

I think Bingo is correct in saying that they either ought to:

1. Give Bingo all the complete, unopened mask package, including the 3 sizes of pillows...

or

2. At least replace the remaining 2 pillows with the same size as Bingo uses.

Anything less than this is fraud, IMHO.

If (for instance) Bingo uses the medium nasal pillows, and the DME removed the small and large pillows from the package, this tells me that they are retaining the small & large pillows for their "own purposes", which may include giving them out to other patients (theft and redistribution) or worse, giving them out to other patients and also billing insurance a second time for the distribution of those nasal pillows when they are given to other patients (insurance fraud).

But, then again, I hear all the horror stories of DME shenanigans every single day it seems-- I've become rather intolerant of this ongoing attempted fraud that many DMEs perform on a regular basis. Thinking-about

This is very similar to the practice with some DMEs of handing over a used, older technology CPAP machine to a patient, then billing insurance or Medicare for the complete cost of a brand new modern CPAP machine. This happens A LOT, and it's fraud also.

"The system" is too stressed to police these issues in a proper way. On Apnea Board, we promote "patient empowerment", and along with that empowerment comes "patient responsibility". Part of our collective responsibility is to help police these abuses within the system ourselves. It's only costing us in the long run with higher insurance premiums or Medicare taxes if we allow these DME companies to scam the system with our money.

The DMEs are counting that the patients will just grow weary of "trying to fight the system" and simply drop any complaints out of sheer exhaustion. Nobody wants to call up the insurance company and complain because it's likely to take an hour or two on the phone with several call-backs and clueless phone reps that just want to get you off the line. So, we're kind of alone in this. Then the DME wins, and we end up paying more and more for health care.

Oh-jeez

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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.

10-04-2012 03:15 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,067
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #7
RE: New Masks
Amen, brother, preach it.

Of course, we're the choir....

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
10-04-2012 05:43 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #8
RE: New Masks
I,m just about going to see the doc but just speaking about Medicare fraud ... it reminded me of this news
Authorities charge 91 in $430 million Medicare fraud
http://www.reuters.com/article/2012/10/0...7320121004
10-04-2012 05:53 PM
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SuperSleeper Offline

Administrators

Posts: 9,973
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #9
RE: New Masks
(10-04-2012 05:43 PM)PaulaO2 Wrote:  Amen, brother, preach it.

Of course, we're the choir....

...waiting for Zonk's picture of a choir....

wait for it.... wait for it.... Coffee

(it's morning in OZ, and he's probably close to finishing his coffee and fried Kangaroo eggs or whatever they eat down under... Thinking-about

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


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.

10-04-2012 05:54 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #10
RE: New Masks
(10-04-2012 05:54 PM)SuperSleeper Wrote:  
(10-04-2012 05:43 PM)PaulaO2 Wrote:  Amen, brother, preach it.

Of course, we're the choir....

...waiting for Zonk's picture of a choir....

wait for it.... wait for it.... Coffee
maybe be later .. got to rush for doc appointment
1 hours drive in heavy morning traffic
10-04-2012 05:56 PM
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