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possible DME problem ??
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GrammaBear Offline

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Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Air Fit P10
Humidifier: ResMed H5i heated humidifier
CPAP Pressure: 12.2 - 16.2
CPAP Software: SleepyHead

Other Comments: Type 1 diabetes - using Tandem T-slim insulin pump, Dexcom G4 CGM

Sex: Female
Location: northern Illinois

Post: #1
possible DME problem ??
Can anyone explain to me if I am overlooking an obvious problem with my DME provider? A representative called from their office which is headquartered in another city from where I live. She said it was time for me to order CPAP supplies and wanted to know how my 'therapy' was going? I told her fine and then she told me what Medicare said I am eligible for. Since I only needed the AirFit P10 pillows I told her that was all I needed.

When the box came today it had 5 pillows in it and I am wondering if Medicare is restricting the number of pillows we are allowed to have? I thought that Medicare allows 2 pillows per month which would make the number of pillows come out to be 6....right ??? I detest the idea of having to call their office and explain myself since perhaps they can't do math very well........or is it me that doesn't know how to add?
07-18-2015 02:33 PM
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PaytonA Offline
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Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Orange County,California

Post: #2
RE: possible DME problem ??
If you are dealing with Crapria and it sounds like you are, that type of thing is not unusual at all. I requested mask cushions and got a whole new mask........A completely wrong mask. Not just the wrong size but the wrong model and the wrong manufacturer. Make them fix it. it is the only way to try to get them to fix their own problems.

Best Regards,

PaytonA
07-18-2015 02:46 PM
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Mosquitobait Offline

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Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #3
RE: possible DME problem ??
Maybe they actually sent you an extra, as in an every-other-month shipment?
07-18-2015 04:44 PM
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GrammaBear Offline

Advisory Members

Posts: 381
Joined: May 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Air Fit P10
Humidifier: ResMed H5i heated humidifier
CPAP Pressure: 12.2 - 16.2
CPAP Software: SleepyHead

Other Comments: Type 1 diabetes - using Tandem T-slim insulin pump, Dexcom G4 CGM

Sex: Female
Location: northern Illinois

Post: #4
RE: possible DME problem ??
(07-18-2015 04:44 PM)Mosquitobait Wrote:  Maybe they actually sent you an extra, as in an every-other-month shipment?

If they did the every-other-month shipment thing, they are most definitely making money on it. The invoice that came with my package says they have billed my insurance company $304.50 for 5 pillows making each one cost $60.90. My Dad would have called that practice "robbery-without-a-gun."
07-18-2015 04:51 PM
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OpalRose Offline

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Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #5
RE: possible DME problem ??
Are they sending you supplies for say 2 or 3 months at a time? I would try to find out what you are being charged for, or how many pillows they are billing your insurance for.

They either sent you a 2 month supply with 1 extra, or they sent you a 3 month supply with 1 shortage.

My DME never calls me, I have to call them every month if I want something. And even then, they manage to mess it up.

OpalRose
07-18-2015 05:07 PM
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me50 Offline

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Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

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Sex: Undisclosed
Location: USA

Post: #6
RE: possible DME problem ??
this is why I order monthly. GrammaBear, did they send you a mask even though you didn't ask for it? if so, the cushion that comes with the mask counts as one in their world maybe. If they didn't send the mask, then I have no clue what they are doing. Either way you look at it, when you get supplies in any combination for whatever time period, you should have an even number of cushions.
07-18-2015 05:15 PM
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Sleeprider Online
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Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

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Sex: Male
Location: Where they make Respironics

Post: #7
RE: possible DME problem ??
(07-18-2015 04:51 PM)GrammaBear Wrote:  
(07-18-2015 04:44 PM)Mosquitobait Wrote:  Maybe they actually sent you an extra, as in an every-other-month shipment?

If they did the every-other-month shipment thing, they are most definitely making money on it. The invoice that came with my package says they have billed my insurance company $304.50 for 5 pillows making each one cost $60.90. My Dad would have called that practice "robbery-without-a-gun."

They only get paid the "approved" amount for that item, and it will be considerably less. However, if they mange to get you to accept more items that what is allowed, the customer gets to pay the full price without insurance discount.

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07-18-2015 05:39 PM
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GrammaBear Offline

Advisory Members

Posts: 381
Joined: May 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Air Fit P10
Humidifier: ResMed H5i heated humidifier
CPAP Pressure: 12.2 - 16.2
CPAP Software: SleepyHead

Other Comments: Type 1 diabetes - using Tandem T-slim insulin pump, Dexcom G4 CGM

Sex: Female
Location: northern Illinois

Post: #8
RE: possible DME problem ??
(07-18-2015 05:15 PM)me50 Wrote:  this is why I order monthly. GrammaBear, did they send you a mask even though you didn't ask for it? if so, the cushion that comes with the mask counts as one in their world maybe. If they didn't send the mask, then I have no clue what they are doing. Either way you look at it, when you get supplies in any combination for whatever time period, you should have an even number of cushions.

All of my orders up to this time have been for every 3 months. And No, they did not send me a mask, just the 5 pillows. I don't look forward to trying to prove to them over the phone that there are just the 5 pillows.
07-18-2015 05:50 PM
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justMongo Offline

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Machine: ResMed VPAP Auto (S9)
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Post: #9
RE: possible DME problem ??
(07-18-2015 05:50 PM)GrammaBear Wrote:  
(07-18-2015 05:15 PM)me50 Wrote:  this is why I order monthly. GrammaBear, did they send you a mask even though you didn't ask for it? if so, the cushion that comes with the mask counts as one in their world maybe. If they didn't send the mask, then I have no clue what they are doing. Either way you look at it, when you get supplies in any combination for whatever time period, you should have an even number of cushions.

All of my orders up to this time have been for every 3 months. And No, they did not send me a mask, just the 5 pillows. I don't look forward to trying to prove to them over the phone that there are just the 5 pillows.

One pillow is being held hostage.
I would call 1-202-456-1414 and complain.
Say: "Who's the moron that's holding my pillow hostage?"

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07-18-2015 06:14 PM
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me50 Offline

Advisory Members

Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #10
RE: possible DME problem ??
(07-18-2015 05:50 PM)GrammaBear Wrote:  I don't look forward to trying to prove to them over the phone that there are just the 5 pillows.

does the paperwork say they sent 6? I have received the wrong things and wrong quantity before and called and they fixed the problem but I no longer deal with apria and when I did, I ended up going to the district manager because nobody else would return calls and the local DME was almost as bad.
07-18-2015 06:26 PM
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