Question about DME

[captainsensible]

Hi

I have been using CPAP since earlier this year, and to give a little background, swapped my original mask for a Dreamwear Nasal Mask, and was sent the mask, with the package of nasal cushions in different sizes - I opted for Medium and have used it since then, keeping it clean and not had any issues.

A few weeks ago, the DME sent an email saying 'Hey, your deductible might be kicking in again soon, why don't you order some new stuff' (marketing kind of stuff clearly!) and as my deductible had been maxed out this year, I thought what the heck, and asked for a replacement mask.

I was sent a new replacement mask, which was fine, but they also sent 6 extra medium sized nasal cushions that I had not asked for! Now I thought this was a little out of order, considering the unit cost of these. Ok, my deductible is maxed so my coinsurance would be used but would still be in the region of $50 assuming a unit cost of $40 per nasal cushion (note, they are c. $22 each on Amazon!).

So I contacted the DME via email to query this, stating that I did not ask for them, or need them. They finally called me this morning, and left a voicemail, and stated the following (paraphrased):

"six nasal cushions were sent to you, it is what is asked by the insurance and the doctors. What they say is that for every other week, you should be switching out the nasal cushion to get the optimum feel for that mask."

Now this sounds like total garbage to me, and sharp practice - but I wanted to get a second opinion before I called them back and told them so.

Sorry for the long first post, but I would really appreciate some other thoughts on this. Thanks!!

[LSAT]

Total garbage !!!!!

[JimW159]

"six nasal cushions were sent to you, it is what is asked by the insurance and the doctors. What they say is that for every other week, you should be switching out the nasal cushion to get the optimum feel for that mask."

The statement is actually true, but not exactly.
1) The standard replacement schedule consensus between the various stakeholders (insurance, manufacturers, DMEs, and medical) is pretty much as stated. You will note I do not include the patient as a stakeholder in the decision, though - from the viewpoint of the various parties, he/she hardly matters.
2) The DME preempted your decision on replacement primarily to prevent your using an alternative source for supplies, such as Amazon as you mentioned. Unfortunately, the DME's relationship with the various stakeholders virtually eliminates any support from any of them for your position.

Consequently, be certain you have not entered into any preemptive agreement with the DME that establishes an automatic replenishment schedule. You may find one very difficult to get out of. Also, you may find going to another DME problematical depending on your insurance's network and the cost of going outside of it. The advice most here would give (I feel this is correct, but not with absolute certainty) would be to arm yourself with a level of skepticism when dealing with DMEs - the patient is almost always alone in their relationship with them, you will have few friends to stand with you on the barricade against the DME horde.

[Okie bipap]

Remember, the DME and the manufacturer make money when you buy more equipment. On the bright side, you will not need to buy anything else but filters and possibly a head gear for quite some time.

[chunkyfrog]

Automatic refills are illegal under Medicare.
Private/pirate insurance . . . I just said it.

[Hopeful50]

Two replacement cushions per month are the medicare standard, but my Dreamwear nasal cushions tend to last me at 3-4 months each before the leaks begin to increase. I do like to keep at least one spare one of everything (humidifier, hose, mask, etc.) on hand, but Medicare's replacement schedule is overkill.

The day I received my CPAP, the DME rep encouraged me to sign up for "auto replacements" but I declined. In the overwhelm of info overload, you may have agreed to the auto replacements without realizing it. If so, a phone call to the DME can get you off that list.

Good luck!

[captainsensible]

Thanks for the replies.

I definitely have not agreed to any automatic replacements and I will probably keep the extra cushions I have been sent (as rightly pointed out, I won’t need any for years based on my current usage!!).

Being sent things I did not request is what irked me most, particularly when I did not even say I used a medium sized cushion, only a medium sized frame! The one thing it has taught me is not to go to the DME any more.

[Okie bipap]

When I switched DMEs last year and went to an on-line supplier, they sent me items I didn't order and didn't need immediately after I sent them my information. I called them and they arranged for UPS to pick them up at my house. After several calls saying it was time to order supplies, I had them place me on their do not call list and I have had no problem with them since then. I order supplies when we need them, not when they think I should order them.

[lindalrc]

The replacement frequency on any silicone that contacts skin is very variable - related to the individual. My husband can get a month out of a silicone cushion. When I was using them (use a fabric mask now), they would start leaking after about 2 weeks. There IS an interaction between skin and silicone. You need to replace when your leak rate goes up (assuming other things such as head colds and stretched out headgear are not interfering). So - as always - best to self monitor.

[chunkyfrog]

My P10 pillows start failing me at 3 weeks,
so I swap for a new set.
Life is to short to waste on fighting tired equipment.
The only silicone I have kept using for over 2 years are the "girls",

[ChicagoGranny]

assuming a unit cost of $40 per nasal cushion (note, they are c. $22 each on Amazon!)

Your insurance company has a negotiated price with in-network DMEs. It's highly likely to be considerably less than $40. You can call the insurance company and ask them what the negotiated price is and what amount you are responsible for.

Or, you can wait for the paperwork to come through.

[SewTired]

They sent you a 3 month supply. If your copay is more than you could buy them on Amazon, call them up and tell them you are sending them back and you will not pay any bill regarding the cushions.