What is A Nasal Pillow?

[Sleepster]

(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.

[BabyDoc]

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.

[ekubaskie]

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.