United Healthcare Replacement Schedule?

[fredmertz]

I have United Healthcare and I called today to ask what the replacement schedule was for various parts of the CPAP machine.

All they could tell me was that I can get a new machine every three years. They have no schedule for masks, tubes, filters, nasal pillows, etc.

I was told they can be replaced when they "wear out".

Does anyone have any experience with UHC to know when they will allow replacements?

[BostonGal]

I can't wait to hear the answer to this. I called UHC 2 weeks ago and got the same info. The DME said 3-6 months. Well, which one is it? Why is it so hard to get correct information?

[ems]

Is United Health Care your primary insurance company?

Or, do you have Medicare with UHC as your supplement?

[retrodave15]

I have united through my employer, 1 cushion or pillows every month, mask, hose and humidifier chamber every 6 months. Your plan may vary, I looked mine up at work in the big book that the HR office had.

[do57672]

I have UHC and after doing some investigating I found that I can get filters each month, cushions or pillows twice a month, tube and mask (without headgear) every 3 months, and humidifier tank & mask with headgear every 6 months. I found the schedule online after the insurance company wouldn't tell me. I called my DME and asked and they said well yes that is correct but we don't advertise that to customers.

[fredmertz]

Is United Health Care your primary insurance company?

Or, do you have Medicare with UHC as your supplement?

My primary.

[lilythecat]

I'm on medicare. Pillows, 2 per month. Hoses, head gear every three months. Filter every 6 months. Machine every five years. That's at least what they tell me. Hope that helps.

[firefoxsilver9]

i recently got UHC through my employer and i'm wondering how soon i can (if my plan is eligible) to get coverage for my CPAP needs. I have the Choice Plus Plan B.

[joelrk35]

I am on Medicare as primary insurance. Just received a letter from my DME that stated that Medicare will cover replacement cpap supplies only when "the supply item(s) is no longer able to function." We must also "document the functional condition of the item(s) refilled in sufficient detail to demonstrate the cause of the dysfunction that necessitates replacement (refill)." "It is unclear what this means in conjunction with the replacement of CPAP and Bi-Level supplies, which should be replaced before they break so that you have uninterrupted use of your equipment."

My DME is trying to get clarification from Medicare on what this all means. I realize that DME's have been making lots of money by abusing the system for their own benefit and not the patients needs. However, if the above changes take place it will impact the patients health which is very important to all of us Sleep Apnia patients. Sounds like "Obamacare" running rampant.

[dgalvin66]

I have United Healthcare also. It all depends on which plan you have. On my plan I can get: a new machine every 2 years, a new mask every 3 months, 2 new cushions every month, 2 filters a month(6 filters every 6 months), a new hose every 6 months and a new humidifier tank every 6 months.
The only thing that I am in a fight with the new DME over is wether I get a full mask with or without headgear every 3 months or 6 months, for the last 12 years with UHC and a different DME I was getting a new mask with headgear every 3 months and it was always covered, but the new DME refuses to try running it or even asking the insurance and UHC will not send me anything in writting telling me to have the DME call to verify.
Not really a big deal as the head gear can easily last.

UHC has in the past covered DC power supplies for my CPAP and has stated that they would pay for the new one for my S9 but the new DME refuses to order it without having this in writting from UHC. They said they would order it if I would sign an agreement to pay in full if they have any issue getting paid from UHC which I will not sign because I am afraid that they would not bill it correctly and not get paid as a result and then expect me to pay almost double what I could purchase it for on my own from the site sponsor.

So you need to contact UHC directly and speak with someone about your plan and what coverage you have to get your answer. As you see from all of uour responces there are alot of different answers from everyone that has a plan with United Healthcare.
Fred if you get your insurance from your employer you should be able to speak to your benefit/HR department and get help with finding the correct info.

[5thumbs]

I have United Healthcare and recently got an Resmed S9 w/ humidifier, and a resmed mask (liberty). So far I've only had to pay $170 and I got a $50 rebate from Resmed! After 5 weeks I had some leaks and my DME (Sleepquest) provided me with 3 sets of pillows and 2 cushions and some filters and they told me it was covered! I have to wait another 6 weeks (3 months total) for a new mask and hose. So my coverage is similar, but not exactly like do57672's.

[TiredTooLong]

I have United Healthcare through work. I have 1500 deductible and UHC says that DME is part of the deductible and so I bought my equipment myself, so it looks like I decide on my own schedule. At least until 65 which is 1.5 years away and then I'll have both.

[Kenneth P.]

employer,UHC..They are self-insured..Mask&filter's every 6 month's.Tank,hose,etc every yr..Wil cover new machine every three yrs..

[chunkyfrog]

United Healthcare, like most other insurance companies, has a variety of plans.
Some plans may even be custom tailored to the contracting employer.
Even under Medicare, I believe the plans vary from state to state.
There may be changes from one year to the next.
It is a lot like the crooked card games the State Patrol is on the lookout for at every fair and carnival.
You need to get the coverage info tied to YOUR policy.
You have to be a consistent pain until you get the documentation you need.
This is what I did, and the BCBS phone reps now just tell me what I need to know,
because they know I will NOT give up.

[retrodave15]

You need to get the coverage info tied to YOUR policy.
You have to be a consistent pain until you get the documentation you need.
This is what I did, and the BCBS phone reps now just tell me what I need to know,
because they know I will NOT give up.

Call the customer service number on the back of your card. Be courteous, the person working there is like everyone else - just trying to make it day by day, ask very direct questions:

How often can I replace my CPAP mask?
How often can I replace the mask cushion, seal or nasal pillows?
How often can I replace the tubing?
How often can I replace the humidifier chamber?

If they cannot answer, ask to be transferred to a supervisor.
If they do answer, get the name and operator number.

Be nice, but persistent.

A really good friend of mine works as a CSR for a large insurance provider, Nice gets you answers, being mean and nasty can get you hung up on with some providers.

Dave