Insurance | Replacement Schedule | DME Tracking

[phattyre]

I am new to CPAP and haven’t yet submitted my first insurance claim. I am a Federal employee covered by the AFSPA Foreign Service Benefit Plan, which includes coverage for CPAP machines and supplies. However, when I ask specific questions through the Support Team (via the Message Center), they don’t provide direct answers. Instead, they refer me to the DME section of the plan brochure, which is too vague to address my concerns.

For example, the replacement schedule for nasal cushions is listed as every two weeks. This makes it feel like I’ll be in a constant cycle of purchasing and filing claims. At this point, I’m unsure if my insurance provider would reimburse me for something like a two-month supply of cushions in one claim.  What has your experience been?

Does anyone use a spreadsheet or DME tracking system to help clarify replacement schedules for their insurer? It seems like it could streamline the process and avoid confusion for the insurance claim reviewer.

[gainerfull]

Typically DMEs will attempt to max out your durable medical goods insurance on a monthly basis and they're aware of the schedule of what you "qualify" for throughout the year. I use one full face mask cushion a year and unless the nasal cushions are tearing or are functioning improperly you're fine to use them as long as they last.

[ejbpesca]

For 18 years I have paid $0 for CPAP (APAP) machines and supplies.  I get them through a DME Durable Medical Equipment provider. I can choose my DME. I have used 4 DMEs over the years, all with similar practices of shipping and charges. None have charged for shipping. All file insurance claims are filed by my DMEs.  My insurance is Medicare which over the years has been handled by United Health Care and Humana Insurance companies.

My CPAP supplies shipments come every three months.  They work out to the following per year:

12 mask cushions
2 heated hoses
12 filters
1 headgear
1 humidifier tank
and a new machine every 5 years

Your DME provider should know what your insurance will provide and any copays you may have. I've never had a spreadsheet that tracks DME charges and shipments. My DME websites do not have a record of what they ship. My only record is the receipts with the shipments.

I do not file for reimbursement, my DMEs have handled all insurance claims. If you do not have a DME available that will file insurance claims for you then is it not possible to file for reimbursement after several shipments and track/record them by receipts?

Talk with your DME and you may find that shipments will not come every 2 weeks. They may come every few months with several cushions etc. If possible, find another DME if the current one insists on shipping every two weeks.

[SarcasticDave94]

The self plan I did was get 1 or 2 extra everything mask wise, extra filters, an extra humidifier tub, heated hose, then quit stockpiling. Especially if you pay for them.