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DME's and insurance

I am still fairly new at CPAP, having completed 80 nights on it as of this writing. I am still struggling to find a mask that is acceptable, with the help of my sleep center and DME. A few weeks ago, my sleep center sent a new script to my DME for a different mask (F&P Zest nasal mask), based on my difficulty adapting to the first mask I was using.

When I visited the DME to pick up the new mask, I was told that I had to give them my old mask (a nasal pillow model), because they would return it to the manufacturer for a refund. I refused, because I wasn't sure about the new mask and wanted to keep the nasal pillows as a backup. In the interim, I have been using a loaner from my sleep center.

So today I visited my sleep center again and worked with a respiratory tech there. We decided (after my trying yet another couple of masks) to stick with the Zest, and she is FAXing a new script for the Zest plus a ClimateLine heated tube. She told me emphatically, however, that I should not have to trade in my old mask - it can't be used by someone else, and the insurance will pay for the new mask. So if the DME is asking me to give up the old mask, they are just making extra profit that way -- the old mask has been fully paid for by insurance, and so will be the new mask.

So can anyone tell me who's right?

BTW, my insurance is Medicare plus a Blue Cross supplement plan, and I live in Albuquerque, NM, if any of that is relevant.

Thanks.

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Replies to This Discussion

Permalink Reply by Mary Z on March 20, 2012 at 10:55am

I believe it is the usual practice to return the old mask to be returned to the manufacturerif resturned for exchange within the first 30 days. I believe Medicare will only pay for a new mask every six months (three months? lost my replacement schedule). I know it cannot be used again, but perhaps it is used as proof that it was returned when a new one was issued. I have a similar insurance plan to you. It's called Anthem Medicare as Anthem is my add on plan. If you have had the mask more than 30 days insurance will only pay for a new mask on their replacement schedule. I would call the insurance company.

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Permalink Reply by Bruce Bon on March 20, 2012 at 2:29pm

I have also heard of the 30-day rule, and the 3 or 6-month rule, but I think there is an exception, when the doctor decides there is difficulty adjusting to the mask and writes a medical-necessity script. That is my situation -- I am well beyond the 30 days. I think I am going to refuse to return the old mask, and look for a different DME if they don't like it. But I'd better make sure I can find a DME with a different policy first!

Thanks for your reply.

Mary Z said:

I believe it is the usual practice to return the old mask to be returned to the manufacturerif resturned for exchange within the first 30 days. I believe Medicare will only pay for a new mask every six months (three months? lost my replacement schedule). I know it cannot be used again, but perhaps it is used as proof that it was returned when a new one was issued. I have a similar insurance plan to you. It's called Anthem Medicare as Anthem is my add on plan. If you have had the mask more than 30 days insurance will only pay for a new mask on their replacement schedule. I would call the insurance company.