There is no separate insurance or Medicare billing code for the individual small, medium and large nasal pillows included with the full Swift FX nasal mask package. If they are billing for an entire mask, (that is billed as one unit), this includes mask, headgear and the 3 nasal pillows that came with the mask, because that's the way the manufacturer ships them.
I think Bingo is correct in saying that they either ought to:
1. Give Bingo all the complete, unopened mask package, including the 3 sizes of pillows...
or
2. At least replace the remaining 2 pillows with the same size as Bingo uses.
Anything less than this is fraud, IMHO.
If (for instance) Bingo uses the medium nasal pillows, and the DME removed the small and large pillows from the package, this tells me that they are retaining the small & large pillows for their "own purposes", which may include giving them out to other patients (theft and redistribution) or worse, giving them out to other patients and also billing insurance a second time for the distribution of those nasal pillows when they are given to other patients (insurance fraud).
But, then again, I hear all the horror stories of DME shenanigans every single day it seems-- I've become rather intolerant of this ongoing attempted fraud that many DMEs perform on a regular basis.
This is very similar to the practice with some DMEs of handing over a used, older technology CPAP machine to a patient, then billing insurance or Medicare for the complete cost of a brand new modern CPAP machine. This happens A LOT, and it's fraud also.
"The system" is too stressed to police these issues in a proper way. On Apnea Board, we promote "patient empowerment", and along with that empowerment comes "patient responsibility". Part of our collective responsibility is to help police these abuses within the system ourselves. It's only costing us in the long run with higher insurance premiums or Medicare taxes if we allow these DME companies to scam the system with our money.
The DMEs are counting that the patients will just grow weary of "trying to fight the system" and simply drop any complaints out of sheer exhaustion. Nobody wants to call up the insurance company and complain because it's likely to take an hour or two on the phone with several call-backs and clueless phone reps that just want to get you off the line. So, we're kind of alone in this. Then the DME wins, and we end up paying more and more for health care.
