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+--- Thread: Had my first follow up with sleep doctor. (/Thread-Had-my-first-follow-up-with-sleep-doctor)
Had my first follow up with sleep doctor. - dracus - 12-14-2017
Howdy,
I had my first follow up since getting cpap machine.
Doc downloaded some report from the machine. It was identical to the summary page from sleepyhead.
He asked me what I thought.
We talked about my therapy. He was impressed with my therapy changes and congratulationed me on troubleshooting my problems which arguably were nothing thanks to you all.
Asked if I was having issues.
I told him Dme was saying my insurance wouldn't cover mask cusions and pillows. He got a little upset (at them) and said you should have both a full face mask and a nasal mask per my orders and they need new parts regularly.
He copied the orders which are very specific on replacement schedule (Medicare guidelines although I'm not on medicare) and gave me them.
Looks like I'm going to have an interesting discussion with the Dme.
Sleep doc thanked me for coming in set a follow-up for 6 months.
Anthony
RE: Had my first follow up with sleep doctor. - kiwii - 12-14-2017
Congratulations! Sounds like it went really well. Dealing with the DME should be a breeze with the order in hand.
RE: Had my first follow up with sleep doctor. - Sleepster - 12-14-2017
(12-14-2017, 07:31 PM)dracus Wrote: Doc downloaded some report from the machine. It was identical to the summary page from sleepyhead.
Actually identical, or just the same data? I would think the doc would be printing the ResScan summary page.
RE: Had my first follow up with sleep doctor. - dracus - 12-14-2017
He did print the summary page. The data matched I mean.
Sleep hours, AHI, compliance data etc.
It wasn't litterally the same page.
RE: Had my first follow up with sleep doctor. - dmeRT - 12-14-2017
Call your insurance company and ask them what they cover. I'll bet your DME is correct. Doesn't matter what the Dr. orders. Each insurance can vary on what they cover.
RE: Had my first follow up with sleep doctor. - Mosquitobait - 12-14-2017
Congrats on your doctor interaction! Yes, I agree, your insurance company may only cover ONE mask per 6 months no matter what your doc wrote on there. My prescription covers both masks I switch between, but Medicare covers only one at a time. It was so difficult to get supplies for one for a few months and then supplies for the other, I figured out what I would pay (20%) and bought extras of the Wisp and let the DME/Medicare supply the Dreamwear stuff. Make sure you get a copy of the prescription. It might be cheaper for you to get one of them through an online supplier.
RE: Had my first follow up with sleep doctor. - trish6hundred - 12-16-2017
Hi dracus,
It's great to hear that your appointment went so well, keep up the good work.
RE: Had my first follow up with sleep doctor. - Schweb - 12-18-2017
Good to hear positive things and on track
RE: Had my first follow up with sleep doctor. - Mosquitobait - 12-19-2017
If your insurance doesn't cover mask and cushions, they don't cover mask and cushions. Nothing in your doc's prescription is going to change that. It's actually pretty common for an insurance company to cover the machine but not the supplies. If that is the case, then seek an online retailer, buy from Amazon, Ebay, Craigslist, etc. But, before you do that, ask if your DME will match (or closely match) an online retailer's prices. You'd be surprised how many will today, although some absolutely will not budge on it. Use the Medicare listing as a guideline. You will find that most of that stuff will be useful long past the 'recommendeded replacement'.
I use two different masks, but buy all the mask parts for the one and let Medicare get the more expensive one. It's an absolute hassle to keep trying to switch between the two.
RE: Had my first follow up with sleep doctor. - dracus - 12-19-2017
Going to get the Dme to send a prior authorization.
The insurance company says "we cover all medically necessary equipment"
Currently I bought my latest ffm airtouch f20 retail but replacement cushion is $60 supposed to be replaced monthly.
My other mask is p10 supposed to be replaced every 2 weeks. The pillows though are only $20.
I'm sure I can stretch the nasal pillows a lot longer than 2 weeks. Not so sure on the memory foam.
The doctor wrote order for standard medicare replacement. Also wrote that I get both a nasal and ffm. The Dme only provided me one mask.