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+--- Thread: DME supplier only replaces parts for mask bought from them (Medicare/Insurance) (/Thread-DME-supplier-only-replaces-parts-for-mask-bought-from-them-Medicare-Insurance)
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RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance) - plakky - 05-31-2021
Sorry for the rant above...
Like probably everyone else with newly diagnosed sleep apnea, it's been confusing and frustrating and something I plain old just would rather not be dealing with. I'm lucky to have had excellent, caring medical care over the years and have been blindsided by the new experience with this particular DME supplier. I'm sure the individuals have done their best, and the whole Covid situation sure hasn't helped.
Again, I am so grateful this forum exists. Thank you!
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance) - OpalRose - 05-31-2021
plakky,
No problem with the "rant", we all do it. And dealing with DME's can be an eye opener.
I would like to clarify my response to you, as I was addressing your original question in your thread title... "DME only replaces parts for mask bought from them (Medicare/Insurance)
A DME will have on file the mask that you got through them. So when it's time to order your monthly supply or say replacement nasal piece (which is usually monthly), they are going to question you wanting a part from a totally different mask that you didn't purchase from them.
Now with that said, you can tell your DME you want to try a different mask when it's time for replacement (3 months), and they should have no issue with that. Then that mask would be on file for replacement parts.
http://www.apneaboard.com/wiki/index.php/Mask_Primer#Medicare_Replacement_Schedule
Also, be aware that folk on Medicare don't all have the exact coverage. Some can get everything totally free, and some like myself have a 20% copay on supplies. This all depends on your supplemental coverage.
In order to have piece of mind, call the number on your insurance card, and ask questions above your coverage. I've never let a DME tell me what my coverage is... it's up to you to find out before dealing with them.
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance) - plakky - 05-31-2021
OpalRose, lots of helpful information there, so thank you so much for your reply. I do have 100% coverage with my supplemental insurance, so that's one bright spot in all of this!
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance) - raylock1 - 05-31-2021
I have been supplied with various masks for the last couple of years. Medicare apparently pays for one mask and two cushions every 90 days. I have got cushions for masks that I didn't get through the DME and have got a mask and cushions for two different masks at the same time (one mask and two different cushions also different from each other). I don't believe that Medicare requires any particular mask or that any particular supplies must be supplied to be covered. There is always a possibility that your doctor wrote a very narrow prescription, in which case that would limit what they can give you. Most doctors just prescribe "a suitable mask" or some such broad wording. Check your prescription, to be sure. If you don't have a copy of the prescription, either the DME or doctor's office should provide a copy on request.
RE: DME supplier only replaces parts for mask bought from them (Medicare/Insurance) - plakky - 06-01-2021
Thanks for this information - it's ideally how I'd hoped my DME supplier would handle resupply. My doctor had to send my second prescription to them three times before they acknowledged receiving it - and he wrote "patient preference" for the mask.
Based on the wide variety of experiences in the replies above, it seems the DME's all have different policies on how/what they will provide for resupply despite what seems to be a very clear Medicare policy and schedule. I will be making some phone calls well before my next replacement date to find out exactly what I am entitled to.
Thanks to all who have taken the time to respond to my questions.