How often will insurance replace CPAP equipment?

I've had my equipment for 3 or more years. As I stated in another post, no one on earth has talked to me about condition, the condition of my equipment, or whether I should ever have a follow-up study. Having said this, it should be obvious that I don't know how long to go before asking for replacement equipment.

My CPAP device is working fine. I have purchased two masks on my own to supplement the original one. Do I have a right to ask for a new mask periodically?

Thanks in advance.

My ins (BCBS) pays for a new mask (my choice) every three months, hoses as needed, & filters every month.
Call your ins provider and ask what their replacement schedule is.
joanna

Check with your Insurance company and your DME. Between the two they should be able to tell you the frequency that the insurance company will cover replacement of your equipment.

For me the below holds true and is pretty much standard.
The CPAP: replace after 5 years.
Mask: a new one every 3 months
Headgear: every 6 months

Medicare and my Insurance (BC/BS) will replace my mask every 3 months but won't replace the headgear but once every 6 months. The catch to this is that they won't sell the mask seperate from the headgear so actually a mask every 6 months. Will replace the CPAP after 5 years unless it breaks and can't be repaired. Same for the humidifier. Humidifier chamber every 6 months. Hose every 3 months. Two fine filters a month and one sponge filter every 6 months.

However, my DME had a hidden clause in my contract that said they don't supply small items so for 13 months I have gotten one mask and no hoses, filters, etc. Whin I inquired about a replacement humidifier chamber (the leaky intergrated one) they said medicare set the payment at $16 and their cost was $45 so I could not have one. They did call the other day and tell me I was now eligable for a second mask. This is how the system works.

Jerry

I guess my DME is just eating the cost of the headgear, 'cause I get new mask and headgear no questions/no problems every three months.
and still no dme bill...
Hope you have the same luck vrgsph.
joanna

Thanks for the input so far.

My experience with my old insurance (Cigna) was really weird. I was scheduled for a sleep study by my doctor's office. I attended the study one week and received a box on my porch the next. It contained a mask, machine, and accessories. I had no contact with my doctor about it, I had no choice, and that was that. I did call my doctor's office a couple of weeks later to ask about a humidifier. The nurse said no problem. A couple of days later, I had another box on my porch.

In one regard, I guess this is great service. In another, I am complaining that I had no input in the whole matter. In fact, I've been seeing the same couple of partnered primary physicians since diagnosed. I don't think we have ever talked about my cpap needs.

I changed jobs a year ago and it just occurred to me that I have not incurred any expense for CPAP with this new insurance. Since I am thinking about getting another mask, I figured why pay for it myself.

I just checked my coverage and I have a $300 co-pay per year.

My wife just called our insurance and found that I have 24 units per year for DME. It was explained that masks are considered 1 or 2 units, a hose is 1 unit, and a CPAP machine might be 12 or more units. In any regard, I can use the 24 units each year.

I take out a good deal of money for Flex-Benefits each month. I do this in anticipation of CPAP stuff, dental, vision, etc. Since I fully intended to pay for my CPAP myself, I will just use my Flex-Benefits to pay for the Co-Pay and then see what type of regimen I can get on to have my masks covered on a semi-annual basis.

Again, thanks for waking me up to something that should have been obvious. I suppose I needed to be my own best advocate for my CPAP needs.

Boy, you Americans get it good (if you're insured, at least).

Here in Australia, I get $750 off a new machine every 3 years (MUST be purchased in Australia, not over the internet from the US - at the grossly exorbitant markups, even for Australian products like Resmed). There is NO payment for ANYTHING else - masks, parts etc.

Grumpy (as usual) GrizzlyBear