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What is A Nasal Pillow?
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #11
RE: What is A Nasal Pillow?
(06-26-2012 02:35 PM)BabyDoc Wrote:  Well, guess what the DME said to the insurance company? According to Medicare, we are entitled to a SET of TWO pillows, a pillow for each nostril.

Tell them that if they won't give you two per month you'll switch to a different DME who interprets the rule correctly.

Quote:How ridiculous is this?

It's as ridiculous as saying you have only one working nostril and claiming you need to replace the pillow for that nostril twice a month to comply with Medicare regulations.

Sleepster
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(This post was last modified: 06-26-2012 09:14 PM by Sleepster.)
06-26-2012 09:11 PM
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BabyDoc Offline

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Posts: 184
Joined: May 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model:
Humidifier: ResMed H5i with Climateline Tubing
CPAP Pressure: 6.0 -16.0 CM
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Beachwood, OHIO

Post: #12
RE: What is A Nasal Pillow?
Well all is well, that ends well. Armed with all the codes that Zonk provided and the support from the rest of you, I called my Insurance company, who then called the DME. Apparently, EVERYONE at this particular location for this DME was misinterpreting the Medicare guidelines for the nasal pillows. Fortunately, there was no incorrect billing done. The insurance company was only getting billed for the 1 set of pillows by this DME office.

At another office for the same DME, they WERE providing 2 sets of pillows per month. The bottom line is: they will now be sending me 2 pillow pairs per month, or if I want, they can send a 3 month supply at a time (per Medicare guidelines), so I don't have to call every month.

Thanks to all of you here.
(This post was last modified: 06-27-2012 04:38 PM by BabyDoc.)
06-27-2012 04:37 PM
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ekubaskie Offline

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Posts: 2
Joined: Jun 2012

Machine: PR System 1 BiPAP Pro w/ Biflex
Mask Type: Nasal pillows
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CPAP Pressure: BiPAP 7cm-10cm
CPAP Software: SleepyHead

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Sex: Male
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Post: #13
RE: What is A Nasal Pillow?
So what I don't understand is... You order two per month. They give you two per month. They bill your insurance. What insurance doesn't pay, they collect from you later. Just because insurance might only PAY for one a month, as they thought, doesn't mean you can't order more and pay out of pocket!

Edit: And by the way, I would have to define the "pillow" as the main body of the unit, not the individual nasal nozzle.
(This post was last modified: 06-30-2012 07:36 PM by ekubaskie.)
06-30-2012 07:29 PM
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