Necessary DME vs. Auto-shipped because insurance will pay?

[brightcrow]

My DME supplier auto-ships me 6 nasal cushions for my P10 mask every 3 months, in addition to other scheduled supplies. The DME supplier's pamphlet suggests replacing them every 2 weeks. I haven't been replacing them nearly that often. I wash them in gentle detergent daily, and soak them in diluted vinegar weekly. Resmed's User Guide make no recommendation for replacement.

Despite my strong suspicions, I need to know if this is this a recommendation based on hygiene or is if it's based upon what my insurance will cover. I'd happily switch more often if it's a health issue (I have enough sinus problems already)!

Also, can you point me to a replacement schedule for other supplies and equipment actually based on hygiene and/or safety?

[Wulfman...]

My DME supplier auto-ships me 6 nasal cushions for my P10 mask every 3 months, in addition to other scheduled supplies. The DME supplier's pamphlet suggests replacing them every 2 weeks. I haven't been replacing them nearly that often. I wash them in gentle detergent daily, and soak them in diluted vinegar weekly. Resmed's User Guide make no recommendation for replacement.

Despite my strong suspicions, I need to know if this is this a recommendation based on hygiene or is if it's based upon what my insurance will cover. I'd happily switch more often if it's a health issue (I have enough sinus problems already)!

Also, can you point me to a replacement schedule for other supplies and equipment actually based on hygiene and/or safety?

It's essentially based on keeping your DME's cash flow intact. It's probably based on an extreme set of circumstances and along with what the insurance will pay for, but many of the users on the forum have reported that they get much longer use out of their supplies than what is "recommended".
Most of the forum members who use insurance replacements do not use an automatic resupply and order as needed.
Some of us just pay out-of-pocket and bypass the insurance/DME rigamarole.


Den

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[bwexler]

I am too fickle to get supplies auto shipped. I may have moved on to a totally different mask an no longer need supplies for the last one.
Medicare no longer allows auto shipments. They now require you to approve each order.

Get backups of each item you use according to your usage requirements and then tell the DME not to ship anything without your approval.

[palerider]

My DME supplier auto-ships me 6 nasal cushions for my P10 mask every 3 months, in addition to other scheduled supplies. The DME supplier's pamphlet suggests replacing them every 2 weeks. ...

Despite my strong suspicions, I need to know if this is this a recommendation based on hygiene or is if it's based upon what my insurance will cover.

it's based *purely* on the DME maximizing their profits.

I'm still waiting on my first p10 pillow to wear out, I've been using it for a bit over a year and a half... I've got spares, I just want to see how long this one will go

[LSAT]

All you need to do is say..."stop shipping". In fact Medicare does not allow auto shipments. You need to call when you need something. Most supplies last a long time. Hoses last at least a year, masks the same. I know someone that was in the same situation as you. He had at least 12 hoses plus other supplies in his closet.

[brightcrow]

I'm still interested if anyone knows of a hygiene-based replacement schedule.

I should also request a written eligibility schedule. But even that won't tell me whether they'll charge me $150 for 6 itty-bitty rectangles of foam filters for my Airsense 10 if it's not scheduled, which I'd have to pay out of pocket at the full rate. Sometimes my insurance covers it, and then they double-charge me, with a nightmare billing system which I believe intentionally obscures the charges by breaking each one down into non-descriptive segments that can't be followed by any reasonable adult, including their own employees. I literally cry in frustration every time I have to deal with them on the phone.

I'll start making a point of calling them monthly and checking for what I'm eligible for. Usually I need something it's not time to get, or else it's time for something I don't need. I figure having spares is good, but having 10 nasal pillows and 6 more again in three months is excess profits for them I don't like.

[LSAT]

I'm still interested if anyone knows of a hygiene-based replacement schedule.

Your hygiene or mine? Everyone's schedule would be different. When it wears out or breaks, it needs replacement.

[BlackSpinner]

Hygiene schedule - wash when needed.

[chunkyfrog]

BC:
Daily washing is more than sufficient for hygienic purposes.
Changing cushions or pillows is mostly needed for the ability of the silicone to seal.
Some can make their silicone last for months. (Especially if they have to)
Others need fairly new silicone to maintain seal, due to skin chemistry, water hardness, etc.
I decide each month what I really need, allowing for extras--"just in case".

[palerider]

But even that won't tell me whether they'll charge me $150 for 6 itty-bitty rectangles of foam filters for my Airsense

and, you're not getting them for less than a dollar each on ebay, for why?

I literally cry in frustration every time I have to deal with them on the phone.

why are you doing this to yourself, and giving these people money?

[chunkyfrog]

why are you doing this to yourself, and giving these people money?

Exactly! If ANYONE ELSE is in your insurance company's network, check them out.
You do not have to use the same DME for your mask, supplies, and machine;
and you can change any time--unless you are under the thumb of an HMO--and they are paying.
If your deductibles and copays are outrageous, you may save by buying online.
Usually, insurance coverage structure is designed to be of no help at all with cpap most years.

[Wulfman...]

Overpaying or paying ridiculously inflated prices JUST to meet or add to the deductible makes absolutely NO SENSE.

That's one reason I never used my employer's insurance to buy my supplies when I was working......the deductible was fairly high, so I just bought everything I needed from online sellers like https://www.cpap.com out-of-pocket and saved LOTS of money. I could order a couple of hundred dollars of mask cushions or headgear or other supplies in a year and had lots of years worth of supplies stocked up. And, in minimum orders of $100 or more, the sellers typically pay the shipping.
Even buying new machines out-of-pocket was less than the deductible ( $750.00 ).
And, I didn't have the headaches of dealing with lousy DMEs where they could screw up orders, over-charge, send the wrong items, etc., etc.

DO THE MATH!


Den

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[brightcrow]

I'm confused Den. I don't know where you got the idea I'm overpaying just to meet or add to my deductible. In fact, my individual insurance is covering almost all these supplies, one big reason why I haven't sought out an alternative up to now. I just don't like their business model, their shady practices, their poor customer service, and frustrating, unresponsive representatives.

Chunkyfrog, thanks for the information. SleepMed is the only business with a couple local reps, although once I got my equipment, the national offices supplied me by phone and mail, and they also took care of my insurance billing, no easy task for me. I'll check with my insurance company about alternatives.

I'm under the impression that plastics and synthetic materials can absorb bacteria or fungus despite cleaning, which is why I assume that much of this needs to be replaced periodically for hygienic reasons. Maybe I'm all wrong. I sure wish I knew what entity to trust to learn more about the specifics of these issues. Can't trust the suppliers, don't want to tip off the insurance company, doctors don't have the time or knowledge. Maybe Resmed, but they rely on DME business, and obviously if they cared to make replacement recommendations, they would have done it in the user guides.

[palerider]

I'm under the impression that plastics and synthetic materials can absorb bacteria or fungus despite cleaning, which is why I assume that much of this needs to be replaced periodically for hygienic reasons.

If I were you, I'd do some googling on that topic and see what you can find.

as to 'needing' to replace parts.. when I started in 09, I read stuff from people about how often they got new mask cushions and new hoses, and stuff... I didn't know any better. but I figured "ok". I got a spare mask cushion on ebay, because people talked about how delicate the things are, and they'd fall apart and stuff...

*five years later* that spare cushion was still in its plastic bag, unopened, because the first one was still working fine, it wasn't quite as pretty... instead of crystal clear it was a bit cloudy, but it still gave me a low leak rate at night. in that time, I'd had to replace the elbow a couple times due to bad design (the third one had a better design and didn't break.) and the forehead piece broke it's little clicker, so I put a bit of felt in there to keep it from unscrewing on me... but the cushion? still going strong.

now, I'm at about a year and a three quarters on a p10 pillow... still waiting for it to quit performing acceptably. I've got spares, and now and then I'll swap one in to see if I'm missing something.... but it doesn't make any difference, so I go back to the first pillow, at this point, more out of curiosity to see how long it'll perform acceptably than anything else.

the majority of bugs that can get on your mask are coming from you, anyway. and your immune system is handling them... or you'd be sick.

[Wulfman...]

I'm confused Den. I don't know where you got the idea I'm overpaying just to meet or add to my deductible. In fact, my individual insurance is covering almost all these supplies, one big reason why I haven't sought out an alternative up to now. I just don't like their business model, their shady practices, their poor customer service, and frustrating, unresponsive representatives.

Chunkyfrog, thanks for the information. SleepMed is the only business with a couple local reps, although once I got my equipment, the national offices supplied me by phone and mail, and they also took care of my insurance billing, no easy task for me. I'll check with my insurance company about alternatives.

I'm under the impression that plastics and synthetic materials can absorb bacteria or fungus despite cleaning, which is why I assume that much of this needs to be replaced periodically for hygienic reasons. Maybe I'm all wrong. I sure wish I knew what entity to trust to learn more about the specifics of these issues. Can't trust the suppliers, don't want to tip off the insurance company, doctors don't have the time or knowledge. Maybe Resmed, but they rely on DME business, and obviously if they cared to make replacement recommendations, they would have done it in the user guides.

It wasn't a statement necessarily directed at you, it was just a blanket statement, in case others are reading, too.
And, it depends on the insurance coverage, whether it applies to your situation, etc.
I was just trying to give an example that if a person has a deductible or fairly high one, it doesn't make much sense to pay the bulk of it on highly over-priced items just to use up that deductible. If a person had a $750 deductible and the DME was charging the insurance $300 per mask, when the online prices for those masks were $100 - $175, that doesn't make monetary sense. You're still going to pay the $750 out-of-pocket before the insurance starts paying a share of it.......and you could buy lots of supplies for $750. Then, there's still going to be some co-pays.

For years, I read people making statements on the forum like "My insurance pays for........."
Well, yes and no. The person pays their insurance premiums and others are paying their insurance premiums, too. So, some of it is that person's money and some of it might be other peoples' money. The idea is that the "pool" of money covers things over and above what the individual may or may not be able to pay on their own. Things that get charged to insurance providers are usually overpriced, although they may be paid at a "negotiated" amount, too. So, the real costs are really unknown for the most part. We've all heard of or seen for ourselves in hospital billings something like an aspirin being charged at something like $20, when we know how overpriced that is. Would they let us supply those aspirins for less? Heck no. Same things are true for other things itemized on hospital bills. About 5 years ago, I spent about 5 days in the hospital for pneumonia. The total bill came to over $24,000. I went back and roughly computed what my insurance premiums had been and deducted from my paycheck for the previous years and if I would have saved that money in a savings account, I would have easily been able to pay for all of the hospital bills out of my own savings.
But, with medical insurance like that, if the hospitalization would have amounted to hundreds of thousands of dollars, I would have been pretty short trying to pay for it myself. That's where the "pool" of other people paying their premiums comes into play. Some are going to need it and some are not.

But, to get back to this particular example, I chose to pay for my own "consumables" with regard to my CPAP therapy out-of-pocket, rather than using the money I paid in on premiums or that others have paid towards their insurance premiums. So, I guess I've helped contribute to what others will benefit from their insurance payments. I also figured that if I was buying this stuff out-of-pocket, I would take better care of them and they would last longer. They have. My masks, seals, headgear, hoses, filters, and machines have lasted for years and years. In nearly 11 years, I only have one item that can't be used anymore.......my first set of headgear. It lasted four years and was pretty ratty by the time I replaced it in 2009. My first mask seal lasted more than six years but it's still "usable" to some degree. I have many replacement and spare items for when they're needed and I have been rotating in some newer masks and headgear over the last few years, but everything I started with is still being used. I have a stockpile of many items for future use (if I live that long).
I clean things "when necessary", but I don't over-clean them as that tends to wear them out faster.


Den

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