[Equipment] Question about getting new mask

[sleepytimegal]

Hi, I'm new to the Forum and have a question. Some things I already found out by reading the Forum before I registered. So I already know how helpful you guys are.
Here's my problem: When I went to my DME provider I got the nasal pillow mask which is working out fairly well, although I need the chin strap too, and tape the corners of my mouth so I can still get air through my lips but it keeps them from slipping open as the night goes on. 6 weeks after starting I went to my sleep doctor for the first time - he had just come to our community a couple of weeks before, so I had not seen any doctor at all until then. I was under the mistaken impression that my apnea was pretty mild because my symptoms seemed not so bad and I (mistakenly) thought my pressure (7-12) meant I was mild to moderate. My DME tech knew my AHI score, but never mentioned it. So I didn't find out it was 57 until I saw the doctor. He was adamant about me using the machine every night and always for napping and told me I had very severe apnea. I was shocked. After I got home I was thinking I should maybe have a FF mask in case I had a cold. One was sure to come eventually and then I wouldn't be able to use the pillows if I couldn't breathe through my nose. I went to my DME assigned tech and told her I was worried that I would have to discontinue the machine if I had a cold, and my doctor said I should never go without my machine. She said if I had a cold I should just wait until the cold was over and not use anything. I got more insistent, and then she said I couldn't get the FF mask until Jan. - 6 months after I got the pillows. I want to continue with the pillows and just have the FF for backup. She said I had to pick one or the other. Does this all ring true? I don't really think she knows what she's talking about. For instance, she told me I couldn't use the FF mask because I don't breathe through my mouth. Well, if you can't breathe through your nose, aren't you going to breath through your mouth?? Actually, I did mouth breath before I got the apnea machine - have a deviated septum, but the air pressure gets past it and I can breath OK with the pillows. Sorry this is so long. I would love to hear from anyone who suffered through this and has an opinion as to whether I have to wait until Jan. to get a FF mask, and is it true that I have to choose one or the other.

[srlevine1]

It is your health and your money ... you can simply purchase any mask you want from one of the online suppliers listed above, such as Supplier #1, to relieve your anxiety.

As for severity, many people use the following scale when speaking about AHI scores ...

Normal: 0-4
Mild sleep apnea: 5-14
Moderate sleep apnea: 15-29
Severe sleep apnea: 30 or more

Anything 5 and below is considered as "treated" when using your CPAP machine.

As for the absolute necessity of using your machine with a cold, I have heard it both ways: "don't use it" and "use it." Personally, I use mine with colds (without the humidifier) and it seems to help my breathing. Of course, daily cleaning is a must to prevent reinfection. I suggest you get another opinion from your primary care physician.

I am sure others will weigh in on the topic and you can form your own conclusions and take the appropriate action. Best of luck with your therapy.

[sleepytimegal]

Srlevinel, I appreciate your quick reply. I think you maybe hit the nail on the head. I should call my doctor and ask his opinion. I hadn't thought about getting my own mask, which makes sense. I was wondering though, if Medicare would pay for it. I heard they let you experiment with masks in the beginning. So getting a second mask could fall into the experimental stage. So why should I have to wait six months to change my mask since I'm a beginner? I just don't trust my DME tech at all. She's told me some rather bizarre things - it's like she really doesn't understand the apnea world. She is a respiratory therapist though, so it seems odd. Thanks again.

[OpalRose]

sleepytimegal,
Don't worry so much over having a cold and using nasal pillows. A lot of us have nasal congestion and have suffered with colds and find that the nasal pillow mask
works quite well and keeps your nasal passages clear.

I don't agree with your DME on not using Cpap during a cold. You should try to use it as much as you are able, if not, you will feel worse by morning.

As far as mask replacements go, Medicare allows a new mask every 3 months, but during the first 30 days, the DME should let you try different masks to see what you like, but they do have the right to ask you to return one, to try another.

If you want to keep your nasal pillow mask, then you will have to wait the 3 months to get Medicare to pay for a different mask, or you can just order from an online vendor and pay for it yourself. They will give you a 30 day trial, and if it doesn't work out, send it back.

[sleepytimegal]

Opal Rose, Thanks for your reply. It's so nice to get advice from knowledgeable people. You helped me understand the Medicare rules (which I didn't before) and I liked the advice about not panicking - people say I do that. My doctor did scare me, but I think I really needed to understand that since I was very severe I had to take it very seriously. I've only got a month to go before I reach 3 months, so maybe I'll go back to the DME then. Perhaps I should go when my assigned person is 'on the road.' One day a week she's not inhouse. Then I would get someone else whose opinion I would respect more. I'll talk to her about getting the FF mask and see if I can still hang on to the other. If I would have to buy one myself, I would be better off buying the nasal pillow style and having Medicare buy the FF mask - although I haven't check prices I'm sure the nasal pillow has to be cheaper. Thanks again. Sleepytimegal

[OpalRose]

Just a suggestion:
It's a good idea to check on your Medicare/insurance coverage. Call them yourself to confirm what is covered and the replacement schedule for supplies.

Don't believe anything your DME tells you. They don't always get it right.


Also, here is a thread discussing the same with a replacement schedule for supplies.
http://www.apneaboard.com/forums/Thread-...#pid163182

[PaytonA]

A new mask in 3 months is correct for Medicare and many insurance companies, however there is a slight wrinkle to that. You can only get new headgear every 6 months. So unless your new mask uses the same headgear as your old one (this is generally not true), you would still have to wait another 3 months (total of 6 months) before you could use the new mask.

Best Regards,

PaytonA

[Erato05]

I'm pretty new to using my machine but already went through something similar. First two masks didn't work well for me and I wanted to try a third one but Tricare wouldn't pay for it.
When I talked to the DME about getting another mask I could talk them into selling me one at a discounted rate since I was paying out of pocket. Maybe you could try and negotiate the price if your insurance doesn't cover it.

[sleepytimegal]

PaytonA, Oh, so maybe my DME did know what she was talking about, because I would need new head gear switching from the nasal pillows to the FF mask. When she told me I had to wait until Jan., that was 6 months after I got started with the pillows.

So I'm thinking if I wanted to get the FF mask now, I would have to say the pillows weren't working and turn that mask in. I guess I want my cake and eat it too. I want to keep the nasal pillows and just have the FF mask to use when I have a cold (because I have an AHI of 57 and my doctor told me not to miss a night). I guess Medicare probably wouldn't pay for me to have two. They would just say,'you need to just get the FF mask then.' I'm thinking maybe I might switch to the FF in Jan., as she said I could, and if I have to turn in the pillows, then I'll just buy them myself. They would be cheaper than the FF mask. I think that makes good sense. I guess I've got a plan now.

[Mike1953]

Medicare replacement schedule
Item (number) HCPCS Code Replacement Frequency
CPAP Mask
A7034 Every 3 months
CPAP Headgear
A7035 Every 3-6 months
CPAP Tubing
A7037 Every 3 months
Disposable Filter
A7038 2 new filters every month
Non-disposable Filters
A7039 2 new filters every 6 months
CPAP Chin strap
A7036 Every 6 months
Full Face Mask
A7030 Every 3 months
Oral CPAP Mask
A7044 Every 3 months
Humidifier Chamber
A7046 Every 6 months
CPAP Machine
E0601 Generally, every 3-5 years, or as necessary