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medicare questions?
#1
medicare questions?
I've been on my APAP for 4 months and it's time to order supplies based on recommended schedule.  I found many schedules...here's one:

  • CPAP Mask (Nasal, Full Face, Pillows, Etc.) – replace every 3-6 months

  • Nasal Replacement Cushion – replace every 1-3 months

  • Pillows Replacement Cushion – replace every 1-3 months

  • Headgear – replace every 3-6 months

  • Chinstrap – replace every 3-6 months

  • Tubing – replace every 3-6 months

  • Air Filter – replace every month

  • Full Face Cushion – replace every 3-6 months

  • Water Chamber- replace every 3 months
When ordering supplies for Medicare paid replacements, they ask: does your mask have holes, tears, discolorations, does your hose have..... and so on.  If you say no, you don't get medicare replacements.  There seems to be a complete disconnect between Medicare and the medical supplier field on this.

Personally, I don't know when something is worn out or the filter is dirty and I'm not omniscient,  I don't know in advance when something will rip, tear or become otherwise unusable.....so I'd like to have a spare, rather than trying to get a replacement after something is broken/no longer working.  I also travel and can just imagine trying to get a replacement part for my CPAP in the Galapagos (only an example) or even in the UK, France.

The obvious answer is for me to just say yes to all the "is your mask ripped, torn or discolored" questions.....but, although no one but me would know, that's medicare fraud.....so there must be a right way to get supplies in advance of having no working CPAP from Medicare.

How have others worked this problem?
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#2
RE: medicare questions?
My personal opinion is that the replacement suggestions are way too often for most of these supplies.

I replace my filter every couple of months. I have an air purifier in my bedroom and I'm quite sure the air is clean most of the time, so changing them more often is a waste.

I do replace my cushions for my nasal mask about every six months. Usually just because they become "worn out" after a while and don't fit properly. I also get new nasal pillows at that time too.

I've been using the same hose for well over a year with no problems. It is good to have a spare hose so that you can clean one and use the spare while the other is drying out. The frame and headgear just need to be cleaned with warm soapy water....maybe monthly for me. Humidifier chamber has never been replaced. Not sure why it would need to be as long as it's not damaged and cleaned regularly.

My DME will send me a six month supply of the items I request and I have spares of everything, so I'll be set for life I think.  Smile

Stock up on the things you think you'll need and don't worry about fraud. If they say you need it, get it.
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#3
RE: medicare questions?
The problem is that the rules are interpreted weirdly (they are NEW rules). The rules were supposed to apply to durable medical equipment, not the replacement supplies, but someone in the gubmint interpreted them strangely (why do non-medical people make these stupid decisions?).

This is the current Medicare replacement schedule.
CPAP Mask (Nasal, Full Face, Pillows, Etc.) – every 6 months
Nasal Replacement Cushion – Don't know schedule on this but pretty sure it's one per month
Pillows Replacement Cushion – two per month
Headgear – replace every 3 (many DMEs won't replace headgear only; they will only replace a complete mask unit)
Chinstrap – replace every 6 months
Tubing – replace every 6 months
Air Filter – two per month
Full Face Cushion – once a month
Water Chamber- every 6 months

Ok, that said, you should have zero guilt getting these supplies the first year. You NEED backups. Once you have backups, then it's up to you how often you would like to reorder. Then just say no to those items you don't need (not discolored, ripped, torn, whatever). I hear you though. I wanted to get my supplies every 3 months and that keeps stopping my order. It's maddening because it's ANOTHER thing I have to track (as a caregiver, you get to really hate dealing with this Medicare stuff no matter what it is).

Example: My brother had a water chamber that worked perfectly fine for 2 years. They busted it at the hospital. Brought in replacement. They then busted it at the nursing home. Fortunately, I had a SECOND backup. So, I go with two backups for everything because you just never know when that is needed. His unit would have been UNUSABLE for him without those extra water chambers. Some can do without the humidity - he can't.

As to fraud, it is not fraud to have sufficient supplies for the durable medical device to continue to work without interruption. If this bothers your, then buy some supplies online as a backup to use during that time between when your Medicare paid-for supply fails and you get a new one from the DME.
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#4
RE: medicare questions?
OK I'm going on my soapbox. First you pay into Medicare your whole life. Your entitled to those supplies you've been paying for them already not the Government.

Second the DME has no right to be asking you if the parts are worn out. They are required to supply you and are just trying to scam you out of those supplies.

Last is that the DME's don't make much profit if any off the supplies so they don't like to send them. But don't feel sorry for them because they more than makeup for it off the machines they sell. If you don't want to order due to the co-pay than I understand. But don't feel any guilt if you do order.
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#5
RE: medicare questions?
(12-22-2017, 08:32 PM)Walla Walla Wrote: OK I'm going on my soapbox. First you pay into Medicare your whole life. Your entitled to those supplies you've been paying for them already not the Government.

Second the DME has no right to be asking you if the parts are worn out. They are required to supply you and are just trying to scam you out of those supplies.

Last is that the DME's don't make much profit if any off the supplies so they don't like to send them. But don't feel sorry for them because they more than makeup for it off the machines they sell. If you don't want to order due to the co-pay than I understand. But don't feel any guilt if you do order.


+1  Some DME's will do anything they can to maintain contriol over what products you get and don't get.  Others will follow the guidelines perfectly.
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#6
RE: medicare questions?
I think "entitlement" is one thing, but it's pretty obvious that some people obtain supplies beyond their needs and sell them to supplement income. Especially individuals that quit using their CPAP but keep getting the supplies are the very definition of fraud. I think it's fine to establish some "need" for the supplies, and I'm sure that is done a number of different ways. It's really not okay to just accumulate or sell surplus stuff due to a sense of entitlement. Most people here seem to get it right.
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#7
RE: medicare questions?
(12-22-2017, 10:54 PM)Sleeprider Wrote: I think "entitlement" is one thing, but it's pretty obvious that some people obtain supplies beyond their needs and sell them to supplement income.  Especially individuals that quit using their CPAP but keep getting the supplies are the very definition of fraud.  I think it's fine to establish some "need" for the supplies, and I'm sure that is done a number of different ways.  It's really not okay to just accumulate or sell surplus stuff due to a sense of entitlement.  Most people here seem to get it right.

I didn't mean to imply that just because you can get supplies you should even though you don't need it.  That wasn't my intent.  There are many dishonest people out there who could (and do) abuse the guidelines.

I find that I lose the seal on my full face masks pretty close to a month if I use the same mask every day even though it looks fine and I clean it per instructions.  I don't know how some people get months out of a mask without replacing the cushion.
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