What is approved Medicare FFM list?

[Lanco]

I'm waiting to hear from OptimRX to see which FFM's are approved for Medicare.  I don't know if it's up to Medicare or United Health Care which ones are covered.  I have AARP MedicareComplete United Health Care.

Let me guess, they use list price rather than an online supplier sale price and then I pay 20% right?  I have been told they will send the mask and bill me the 20%.  I don't believe it.  Is this for real?

My guess is that my Apex Wizard 220 FFM is not on the approved list.  I can get this online for $65.  It works perfect. 0 leak rate.  Great for side sleeping.  If it's covered it would only cost me $13.  The cushions are cheap too, only $16, so figure 20% of that is $3.20 from an online supplier.

After fighting with my backup mask, a Quattro FX I'm not that much interested in experimenting with another Resmed mask.  This thing is the worst.  It leaks, it slides, I wake up with the bottom cushion in my mouth.  Or maybe there are some that might work for me.

[Crimson Nape]

The only approval that I'm aware of is FDA Approval.    Masks can't be sold in the U.S unless they are.    I've never seen any other approval list.     Someone please correct me if there is another one.

[OpalRose]

I don't believe Medicare has a list of approved masks.

You should call them directly and ask what the procedure is if you buy from a DME or online and what your coverage is. Find out what your copay is.

There are many different Medicare Advantage Plans and coverage is not the same from one to the other.

[CapeMayDan]

I do not know the answer to your question but if you have a mask that is working for you and you want the same mask, have your Doctor write the exact name on the script. The DME is supposed to comply with that.
Also if that Wizard mask works for you , then you are blessed. I have 10 masks in a drawer that do not work for me and a year trying different masks. Lucky You.

Dan

[justMongo]

This sounds like a post from 2016 where a person was told by a DME:  "That's a premium mask.  You have to pay extra for that one."
It was an illegal attempt to push the person to a mask where the DME would make a greater profit margin.

http://www.apneaboard.com/forums/Thread-...#pid173320

[OpalRose]

Interesting....I "attempted" to order my P10 mask from DME last week.  I have ordered this mask from same DME for the last 2+ years without issue.

Now the DME tells me that they can no longer sell me this "premium" Resmed mask, and then attempted to sell me two other masks that they had in stock.  The crazy sales person also told me they were no longer selling ResMed products.  

I won't go into detail of my response to them, but am now searching for another DME.  

[justMongo]

On July 1st 2016, CMS went to an approved bidder system similar to what they did on diabetic test strips.
To "win" an approved bidder contract, DMEs are limiting what they will sell.

The stupidity of CMS in creating such systems to save a few Dollars results in junk being pushed on patients that likely lessens compliance.
I lost my DME on 7/1/16. Found one in TN who had won a competitive bid contract. They are in the process of buying up small DMEs and selling their inventory. Soon we will have no place to acquire supplies like masks.

[Mosquitobait]

Lanco, Medicare does not restrict the masks you get. It's your DME who does. Medicare has a limit on how MUCH they will pay per category. If the mask in question is more than what the DME will accept for assignment, they can refuse to sell it to you with Medicare as the payee. Which means it's 100% out of your pocket, so you may as well go to an online retailer.

Yeah Mongo, the competitive bid contract situation is bad for many patients. It's getting better in some areas, but basing all upon cost alone usually results in disaster.