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Mask replacement standard?
My insurance, Kaiser Hospital, says "We follow the sleep industry standards of 6 months replacement. Medicare guidelines allow for replacement at 3 months for reimbursement. KP also follows Medicare guidelines and technically you can get a replacement mask."
I got a mask in Feb and need a new one and my insurance is reluctantly giving me one, though they say "It is not standard". My question is..are these the standards for the sleep industry?
I got a mask in Feb and need a new one and my insurance is reluctantly giving me one, though they say "It is not standard". My question is..are these the standards for the sleep industry?
Views: 57
Replies to This Discussion
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Permalink Reply by E.M. on
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this article gives some info: http://www.sleepguide.com/profiles/blogs/old-sleep-apnea-supplies
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Permalink Reply by Mike on
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i don't know of any "standard" for the sleep industry other than the one that Medicare adopts and that private insurance companies tend to follow.
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Permalink Reply by bonesigh on
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At first they said that it was too soon and they wouldn't replace it. Wish I had an every 2 week replacement as per article above! I pushed them and they are reluctantly giving me a new one. They are trying to be cheap I guess. I'm hoping that they will mail it to me because they are an hour away. I asked about the mailing in my first email to them but of course they never answered that question.
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Permalink Reply by Dan Lyons on
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What part(s) are wearing out on you mask in 2-3 weeks? What mask are you using? If it is wearing out this fast, I am wondering if you are not doing something wrong with the fitting or cleaning.
I use a Resmed Mirage Quattro. Mine usually last between 9 months and a year with no problems. I then rebuild the mask with a new cushion and it is good to go again for another year. The headgear will last about the same time frame. Basically, these are the only 2 items subject to wear on this mask.
They don't need to be cleaned every day (my opinion), as the detergents will degrade the cushions and seals resulting in premature failures.
You need to keep in mind that the manufacture wants you to wear the mask out as fast as possible because that results in them selling more products. It is called reoccurring revenue.
You insurance carrier has standards. Mine is a new mask every six months and a new cushion every 3 months which I consider reasonable. Medicare standards are for Medicare, not the general insurance standard. Each and every insurance company has multi-tiered coverages and the standards vary with the different tiers. You are trying to compare Apples and Oranges.
Contact you coverage administrator and obtain a copy of your coverage standards and payment schedules. They are required to provide you with written standards.
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Boy you sure know how to put a person on the defensive. I have been trying to get a direct answer from Kaiser and member services is giving me the run around. What I wrote above was the exact answer they gave me in an email so, what I wanted to know was, is 6 months really the "sleep industry standard"? They are the ones who said they go by the standards of the sleep industry and medicare. I'm not comparing. I just want to know.
I wash my mask every night with a mild hand soap. Not to do so would simply be gross in my point of view. I have a high pressure of 18/14 so have to wear my mask very tight or it leaks. I think only a person with a high pressure could understand this. What is your pressure? It just works a whole lot better for me when it's new and I would like to be as comfortable as possible. I also wear a Mirage Quattro full face mask.
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Sorry to put your pressure under pressure.
You have to understand something about insurance companies. They don't care about you; they care about their stockholders. You have to always remember that they want to make money. If they can run you around "robin hood's barn" and save a buck, they will.
Now, you can get a hold of your state's insurance commissioner's office and explain the run-a-round you are getting and enlist their assistance. Large corporations tend to listen to a governmental agency a tad quicker than if it is just "Joe Schmo" public. Patience is required though. Government's cogs turn slowly.
To answer your question as to high pressure - I am an 18. The Quattro mask actually works better if it isn't smashed against your face, compressing the cushion. It is designed to inflate the seals when worn properly, allowing for the cushion to form to the facial shape. Your problem may exist because you are over compensating.
In so far as cleaning my mask, personal preference. If I were sick, I would clean it everyday, but otherwise you are destroying the silicone seals using "mild" soap daily. Any soap is a detergent and it is abrasive.
Manufactures also say use vinegar. Vinegar is an acid. They want you to wear it out fast. It makes them richer.
bonesigh said:Boy you sure know how to put a person on the defensive. I have been trying to get a direct answer from Kaiser and member services is giving me the run around. What I wrote above was the exact answer they gave me in an email so, what I wanted to know was, is 6 months really the "sleep industry standard"? They are the ones who said they go by the standards of the sleep industry and medicare. I'm not comparing. I just want to know.
I wash my mask every night with a mild hand soap. Not to do so would simply be gross in my point of view. I have a high pressure of 18/14 so have to wear my mask very tight or it leaks. I think only a person with a high pressure could understand this. What is your pressure? It just works a whole lot better for me when it's new and I would like to be as comfortable as possible. I also wear a Mirage Quattro full face mask.
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Permalink Reply by Melinda Hertel on
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Medicare guidelines actually state that you can get a complete new mask every 6 months. You can get a cushion or pillows every month (2 per month), and the mask with cushion and frame every 3 months. You can only get the headgear every 6 months. So if your headgear and frame are in good condition, you should only need to get replacement cushions/pillows as they wear out.
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Melinda Hertel said:Medicare guidelines actually state that you can get a complete new mask every 6 months. You can get a cushion or pillows every month (2 per month), and the mask with cushion and frame every 3 months. You can only get the headgear every 6 months. So if your headgear and frame are in good condition, you should only need to get replacement cushions/pillows as they wear out.
A lot of insurances follow Medicare guidelines. So, I guess you can call that the industry standard. There are insurances that handle replacements differently. For instance, many United Healthcare policies allow for a dollar amount per year, not a number of masks per year or a mask every so many months.
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I guess "Jan Schmo" needs to put her foot down on Kaiser. The mask definitely does not work on my face being on gently. Everyone's face and mask fit is different.
Dan Lyons said:Sorry to put your pressure under pressure.
You have to understand something about insurance companies. They don't care about you; they care about their stockholders. You have to always remember that they want to make money. If they can run you around "robin hood's barn" and save a buck, they will.
Now, you can get a hold of your state's insurance commissioner's office and explain the run-a-round you are getting and enlist their assistance. Large corporations tend to listen to a governmental agency a tad quicker than if it is just "Joe Schmo" public. Patience is required though. Government's cogs turn slowly.
To answer your question as to high pressure - I am an 18. The Quattro mask actually works better if it isn't smashed against your face, compressing the cushion. It is designed to inflate the seals when worn properly, allowing for the cushion to form to the facial shape. Your problem may exist because you are over compensating.
In so far as cleaning my mask, personal preference. If I were sick, I would clean it everyday, but otherwise you are destroying the silicone seals using "mild" soap daily. Any soap is a detergent and it is abrasive.
Manufactures also say use vinegar. Vinegar is an acid. They want you to wear it out fast. It makes them richer.
bonesigh said:Boy you sure know how to put a person on the defensive. I have been trying to get a direct answer from Kaiser and member services is giving me the run around. What I wrote above was the exact answer they gave me in an email so, what I wanted to know was, is 6 months really the "sleep industry standard"? They are the ones who said they go by the standards of the sleep industry and medicare. I'm not comparing. I just want to know.
I wash my mask every night with a mild hand soap. Not to do so would simply be gross in my point of view. I have a high pressure of 18/14 so have to wear my mask very tight or it leaks. I think only a person with a high pressure could understand this. What is your pressure? It just works a whole lot better for me when it's new and I would like to be as comfortable as possible. I also wear a Mirage Quattro full face mask.
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Thanks Melinda. Your information gives me more to go on. They said that they go by Medicare guidelines as well as the standard (whatever that really is). I did ask them to just replace the cushion because everything else is okay but I guess they don't want to do that.
Melinda Hertel said:Melinda Hertel said:Medicare guidelines actually state that you can get a complete new mask every 6 months. You can get a cushion or pillows every month (2 per month), and the mask with cushion and frame every 3 months. You can only get the headgear every 6 months. So if your headgear and frame are in good condition, you should only need to get replacement cushions/pillows as they wear out.
A lot of insurances follow Medicare guidelines. So, I guess you can call that the industry standard. There are insurances that handle replacements differently. For instance, many United Healthcare policies allow for a dollar amount per year, not a number of masks per year or a mask every so many months.
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Permalink Reply by Judy on
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Insurances can provide the benefit they want to and that they contract w/your for.
The MEDICARE eligibility SOP is headgear at 6 months. Mask w/o headgear at 3 months. Cushion for mask at 1 month. Hose at 3 months. I've never needed any of these supplies that often. But did have a problem w/my cat puncturing a cushion and I managed to break one swivel. It took a real battle of the wills, and a print out of Medicare "allowances" for the various parts and accessories rubbed in their nose to get what I needed. Needless to say, as soon as my 13 month CPAP capped rental was over I switched local DME suppliers.
Local DME suppliers like to bill each part separately. And they don't like to carry the extra parts. At least that has been my experience w/a sheister local DME supplier.
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With Kaiser I'm confused as to who my DME supplier is. I go to Kaiser for my apnea check up appointments and I also get all my supplies from them. Kaiser member services, via email, says I need to talk to my DME supplier about replacement but, I think that's them. I going to call tomorrow and actually talk to a person, hopefully.
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