In person Fitting Required for new CPAP for 20 year user

[Hobot]

Hi- I am in the US. My CPAP has been acting weird sometimes and I was just in for my annual check up earlier this month and the doc wrote a Rx for a new machine. But insurance won't pay until the end of November. (5 years) That's fine, but the Durable Medical place i usually go to is insisting on an in-person fitting for the new CPAP. I just want a new version of something similar to what I have - a normal auto CPAP. And I want to use the current hose style I use now (I went for a fitting for that less than 4 months ago). I have been using a CPAP religiously for 20 years.

I want to know if it is typical to have an in-person fitting required? I am not trying to be difficult, but I will be out of state visiting family at the end of November through the end of the year and I have paid all of my insurance out of pocket already and I really would like to get it before year end. And don't think I should have to pay for a plane ticket. The Rx is already in place, and I can go in person over the next month and am willing to wait until the end of November to have it shipped or will have my daughter pick it up. If the consultation with the supplier has to occur after the end of November, I don't know why it can't be over the phone. What if I was in Europe or something and my CPAP broke?? This seems artificial and silly - and yes, I realize that is often the case in this area. Any comments/suggestions?

[knothead]

I don't understand "fitting" a cpap or hose to you.
I order on the phone for my supplies, hoses, mask, cushions etc...never once had to have a fitting... sounds kinda messed up to me.

[D.H.]

First of all, I would usually suggest the same brand that you already have. You seem to be satisfied with it, so I suggest sticking with it.

Second, I noticed that you said "the DME that you usually use." If they're being difficult, you might want to consider taking your business elsewhere.

Also, do you still have one of you prior CPAPs and is it in working condition? If the current one is not functioning properly, consider using the older one until you get the replacement.

[LSAT]

Check with your insurance to see if they require a "fitting". Also check to see what other DMEs are in your insurance network. Ask your current DME for copies if the prescription and tell them you are going somewhere else and see how fast they come into line.

[Catnapper]

I recently got a new machine. The DME told me that they had to document for Medicare that they instructed me on the use of the machine. They had me sign a document that they did that.

Other insurances may have different requirements, and my DME could just possibly be making up stuff and also making sure they got paid for an in-person visit. I have little faith in my DME, but I feel stuck with them.

Catnapper - Joanie

[chunkyfrog]

My DME is close enough where going in is not a big deal.
Of course, when I picked up my Airsense for Her, I already knew how to run it!
Including the "clinician's" menu.
At one point, the tech asked, "What do we do?"
I explained that most folks don't know what I know--(but wouldn't it be nice if they did?)

[PaulKTF]

I only needed to be fit for a mask once- and that was when I first started using my machine.

[SewTired]

It could be that your insurance company has a contract that is similar to Medicare. You are REQUIRED to go for a 'fitting' when you get a new machine paid for by Medicare. It is not an option - it is part of the Medicare contract that requires educating the patient on the machine. Some DMEs slide it through, but if they have had a bad audit, they do everything by the book.

When I got my machine, I just signed the document that said I were educated on it, and left. She already knew I knew a lot because we had to go through the same darn thing with my brother's bipap and I was having none of it.

[chunkyfrog]

Nobody gets paid for the extra work; but if they don't do it, they might not get paid.
Ask a lot of questions, talk a lot, use up a lot of their time.
Get your money's worth.

[Hobot]

First of all, I would usually suggest the same brand that you already have. You seem to be satisfied with it, so I suggest sticking with it.

Second, I noticed that you said "the DME that you usually use." If they're being difficult, you might want to consider taking your business elsewhere.

Also, do you still have one of you prior CPAPs and is it on working condition? If the current one is not functioning properly, consider using the older one until you get the replacement.

Thanks - you are right, I would be fine with the same brand. And I don't have the old one. It wasn't really working at all - sometimes it wouldn't turn on or turn off -- it was more than 7 years old when it was replaced 5 years ago. The doctor isn't certain mine isn't working right; she just indicated if I have concerns that it is not consistent in its pressure, she can't determine if it is - it would have to go through extensive testing and she didn't think that was worth it.

[Hobot]

Thanks everyone - I will check with my insurance company about whether they require it. It just makes no sense to me. I can have an "e" visit with my internist if I think I have pink eye and receive a Rx but can't handle a phone call with the DME. They are told what pressure to set the machine at and how it should be run. I know how to turn off the ramp, etc. My problem is that I can't find another DME in this other state that is in network. Thanks again!

[D.H.]

A "fitting" really only makes sense for a mask. You don't need a new mask just because you're getting a new machine (except in very rare cases).

The mask should be replaced if is becomes uncomfortable, leaky, discolored, or takes on a strange odor. I also say it should be changed twice a year, but not everybody agrees with that.

[SewTired]

Thanks everyone - I will check with my insurance company about whether they require it. It just makes no sense to me. I can have an "e" visit with my internist if I think I have pink eye and receive a Rx but can't handle a phone call with the DME. They are told what pressure to set the machine at and how it should be run. I know how to turn off the ramp, etc. My problem is that I can't find another DME in this other state that is in network. Thanks again!

Your internist gets paid for the "e" visit. The DME does not and probably requires you to sign something that acknowledges that you were there. The home health people that come here for my brother said a lot of the annoying factors are because signatures are required to reduce fraud (on both sides). When you are paying out of your own pocket (not using insurance at all), then much of the busywork disappears.