Wanting to change masks under Medicare system

[DBBCPAP]

I just started using a CPAP last month and have found problems with my DreamWear mask.  During my sleep study, the tech found that the Brevida mask worked the best for me.  However, my DME provider for Medicare does not carry the F&P and is not interested in getting one.  In fact, I have only found a provider that is 90 miles away that will even would order one.  It's not clear to me how I can get the new mask under the Medicare system now that I'm connected with the local DME provider.  Any thoughts?  It seems like I should be able to switch providers for the accessories when I am due a new mask from Medicare, but I was told I would have to wait until I owned the machine after 13 months to do that.  Any suggestions on how I can get a new one without paying for it myself?

[OpalRose]

Your DME should be willing to let you try a different mask if it’s within the first 30 days, but if Medicare already paid for your mask, they won’t pay for another for 3 months.  

If your DME won’t order the mask you want, then check with other DME’s who your insurance contracts with in your area.  You will need a copy of your prescription.

Also, call your insurance and check what your coverage is if you were to purchase a mask online.
Most online suppliers offer a 30 trial of masks minus the shipping costs.  See the Supplier list at top of page.  

As far as having to wait 13 months to switch DME’s to buy supplies, well they are giving you a line of crap.

If your happy with your machine, and you meet compliance requirements, stick with them for the 13 months, then you will own the Cpap, but you can use any DME for supplies.

[Walla Walla]

Have your Doctor write on a prescription that you require the Brevida mask. The DME is required to issue you the mask on the prescription and will have to order it.

[Sleeprider]

I just started using a CPAP last month and have found problems with my DreamWear mask.  During my sleep study, the tech found that the Brevida mask worked the best for me.  However, my DME provider for Medicare does not carry the F&P and is not interested in getting one.  In fact, I have only found a provider that is 90 miles away that will even would order one.  It's not clear to me how I can get the new mask under the Medicare system now that I'm connected with the local DME provider.  Any thoughts?  It seems like I should be able to switch providers for the accessories when I am due a new mask from Medicare, but I was told I would have to wait until I owned the machine after 13 months to do that.  Any suggestions on how I can get a new one without paying for it myself?

Call the number on your Medicare card and ask the questions:
My DME will not order the mask I want. Can I order CPAP supplies and mask from a supplier other than the one that sold the CPAP machine?
Does Medicare require a 13 month lease to own in my case, or can the machine be purchased once compliance is demonstrated?

Let us know what you find out. I think the purchase of the CPAP is separate from replenishment orders of consumables.

[DBBCPAP]

I just started using a CPAP last month and have found problems with my DreamWear mask.  During my sleep study, the tech found that the Brevida mask worked the best for me.  However, my DME provider for Medicare does not carry the F&P and is not interested in getting one.  In fact, I have only found a provider that is 90 miles away that will even would order one.  It's not clear to me how I can get the new mask under the Medicare system now that I'm connected with the local DME provider.  Any thoughts?  It seems like I should be able to switch providers for the accessories when I am due a new mask from Medicare, but I was told I would have to wait until I owned the machine after 13 months to do that.  Any suggestions on how I can get a new one without paying for it myself?

Call the number on your Medicare card and ask the questions:
My DME will not order the mask I want. Can I order CPAP supplies and mask from a supplier other than the one that sold the CPAP machine?
Does Medicare require a 13 month lease to own in my case, or can the machine be purchased once compliance is demonstrated?

Let us know what you find out.  I think the purchase of the CPAP is separate from replenishment orders of consumables.

Thanks for the replies.

In talking with Medicare, it is clear that Medicare will allow the return of the mask and purchase of a new mask if the original one is not functioning properly.  At a minimum, I need to get a return receipt.  The other option is to wait the prescribed time that Medicare allows for the replacement of the mask.  The time period allowed for that replacement is not necessarily clear from the information that my DME has - is it 3 months or 6 months?  HCPCS code #A7034 allows for 3 months, code #A7035 allows for 6 months.  A7035 is for just the head gear, A7034 is the mask and headgear.  My original mask was supplied under the A7034 code.  Thus, I should be eligible for a complete new mask at three months.  So, I should be able to have the mask replaced immediately, but for sure after 3 months.  Now to get the DME to agree!

Thanks for your help.

[dmeRT]

the quick easy answer is a new mask every 6 months. (what comes in the bag is the cushion, frame, and headgear)

so you can get the cushion monthly, frame every 3 months and headgear every 6 months.

to receive a completely different mask with all the parts, you're looking at every 6 months.


your current cpap will need to be rented out from the same company for the 13 months but supplies you can get from anyone. unless your in a competitive bid area where you'd be limited in the DME's available. medicare requires any DME that dispenses supplies to patients, to have a copy of the original sleep study and order to obtain authorization to provide you with supplies.

If your current DME doesn't order in F&P masks then your kinda outta luck with that DME and will have to look elsewhere, doesn't matter what's on the script.

[DBBCPAP]

to receive a completely different mask with all the parts, you're looking at every 6 months.

Well, Medicare cautions callers that the info given over the phone may not be correct........but, they did tell me, for my specific case, that I could get one in 3 months.  The reason I believed them is because my first mask was, according to Medicare, supplied by Medicare under the code A7034.  The guidelines say that code allows 1 every 3 months.  Doesn't that make sense?

[dmeRT]

technically the A7034 code is for the frame of the mask. the headgear is code A7035. usually they are billed out separately even when they both came in the same bag.

If a new supplier gives you a complete new mask in 3 months that includes A7034 and A7035 and bill both codes to medicare. they run the risk of not being reimbursed for the A7035 because it would be too soon.

all depends on if the original DME charged an A7035 code when you got your dreamwear.

[DBBCPAP]

technically the A7034 code is for the frame of the mask.  the headgear is code A7035.  usually they are billed out separately even when they both came in the same bag.  

If a new supplier gives you a complete new mask in 3 months that includes A7034 and A7035 and bill both codes to medicare.  they run the risk of not being reimbursed for the A7035 because it would be too soon.

all depends on if the original DME charged an A7035 code when you got your dreamwear.

Yes, they did as you said - billed head gear separately even though it came in the same bag.  So is my only option if I want it within 3 months to have them order and bill the F&P mask that comes WITHOUT the head gear (400BRE132) and make do until the 6th month at which time I could get the head gear strap?

This does not sound like the way it should happen but......

Also, what are the issues of asking my DME to order a mask he doesn't stock?  Is that a big deal?  He says he cannot do that.

Thanks for the responses

[dmeRT]

It is quite possible that he cannot order in that particular mask.  Might be restricted by his company as they probably get better "deals" using a certain brand of mask.  so his company probably limits him to only giving out certain masks.  

Ask if you can purchase the headgear separate.  Or find it yourself online...  let insurance pay for the A7034 and you buy the A7035.  you'll still need to find a provider that will supply the Brevida though.