Any military dependents using Tricare Prime here?

I am trying to figure out what Tricare's rules for CPAP/APAP are, best I can tell they seem to follow Medicare guidelines?

I expect to be DX'd with OSA this week (Sleep study is Monday night, results appt is for Wednesday). I am currently on Triwest (Texas) which will be changing from Triwest to United Healthcare Military and Veterans Services (UMVS) on April 1.

If I understand it all correctly, I'll be put on a 3 month trial, and then if I use the machine for X amount of time for X amount of nights, I will be kept on it? And they rent the machine for 13 months and then I own it? Does anyone know if this is correct? Does anyone know what happens when you PCS? (We PCS in 3 months...don't know where yet, we *hope* to have our assignment sometime this month, but it could be as late as the end of April before we hear. I expect the PCS will mean a change in Tricare regions, as most of our possibilities are not in the Triwest/UMVS region.) Do I have to give the DME here back the CPAP and then find a new DME at the next duty station? I read something somewhere last night that said they only BUY the machine for active duty soldiers and rent for everyone else. Ugh.

If you go up to the Search line and put in "Tricare Prime", there will be quite a few pages of links. I don't know if the answer to your question is in there, but quite a few forum members have Tricare and obviously some have the Prime version.


Den

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Thanks Den! I spent a few hours reading, and I learned a lot, so that's good. (Some I remember reading from doing Google searches about this) Didn't really find the answer to my questions, but Triwest opens in a few hours, so I'm going to call and see what they have to say. I keep seeing people refer to a 20% co-pay, and since I was delivered a nebulizer last week, I'm kinda curious if I'm about to get a bill for it. (If so, I'm going to be peeved, since I haven't even taken it out of the box, and my cold is pretty much over...which is the reason I was given it, sigh) For some reason when I posted it, I was thinking it was Saturday, and I didn't really want to wait two days for answers, but since I'm a blonde and the husband clued me in that it was actually Sunday , I'll be calling shortly for answers!

OK, just talked to Triwest, and here's what I was told:

(This *may* vary among regions, see note at the bottom)

Usually, the xPAP is rented for the 13 months, HOWEVER...if an authorization is put in, and approved, the machine can be purchased outright. Optigen.net IS approved as a DME, not just for supplies, but also for initial xPAP purchase/rental. With that in mind, I called Optigen (I see no point in a relationship with a local DME since I am moving in 3 months), and they were a world of help.

If my doc will not submit a request for purchase authorization, Optigen WILL, once I send the prescription to them. Optigen sends a local tech out to deliver the machine, teach you how to use it, fit a mask, etc, so even though they are an internet company, you have in-home help getting started with xPAP therapy. Optigen also sets you up on a quarterly (every 3 months) supply replacement schedule (I didn't ask what supplies) and sends you stuff automatically. They did say that Triwest usually requires the 13 month rental, whereas the other regions are more agreeable with purchasing, but I am *really* good at pestering, so I am fairly confident I will get the purchase approved.

I wanted to put this here for any other military folks who may have the same questions/concerns.

****Note**** I am an active duty dependent on Tricare Prime, and as such my DME is covered 100%/no copay. This may not be the case for retiree Tricare or Tricare standard, so please do check with your region before assuming you have no oop costs. (And at this point, I do not even know if I need xPAP, my sleep study is tonight. I am just trying to have my ducks in a row when I go for my results appointment on Wednesday.)

Just curious, but does Tricare only provide made in USA machines and masks?
(--Excluding anything ResMed, Circadiance, and whose knows what else?)
Someone local said that-but I'm not sure if it was BS or not.

chunkyfrog wrote:Just curious, but does Tricare only provide made in USA machines and masks?
(--Excluding anything ResMed, Circadiance, and whose knows what else?)
Someone local said that-but I'm not sure if it was BS or not.

I specifically asked both Triwest and Optigen about whether the ResMed S9 Autoset was covered, and both assured me it was. Optigen also mentioned the Respironics Sys1 machine. Hopefully links are allowed here, this is what Optigen has, and all of it is covered by Tricare: http://militarycpap.com/browseproducts.asp I don't know where any of them are made, so hopefully this helps some.

Thank you.
I thought I smelled beeswax.

I can tell you that I was prescribed a BiPAP machine while on active duty.. Recently retired, I have just received a bill from TRICARE Prime. It's a rental fee for the machine! I have a certificate of medical necessity and receipt stating the machine was purchased...... TRICARE told me they only rent the machines now because the new Obama health care plan is slowly forcing TRICARE to operate much like MEDICARE. Having served 24 years in the military I feel somewhat betrayed by my government.

If you have a receipt showing your machine was purchased outright, do NOT let it out of your sight!
Make copies, and start sending them out, and CC everyone. It looks like somebody is trying to pull a "fast one".
That could be a federal offense.

Mil2, bad news for ya....Tricare has always operated under Medicare guidelines for retirees. You'll find also, more and more doctors are refusing patients because of ultra low and ever decreasing re-imbursment rates. The Obama administration had language in the original Affordible Care Act bill (house version) that forced everyone except on active duty onto Obamacare. The House struck that language, and Obama signed the bill eventually anyway. Then, the administration tried to pass a bill to increase Tricare premiums by up to 3000% annually, in another effort to make Tricare unaffordable and force everyone onto Obamacare that way. That didnt pass the senate, thank goodness. Then, the contract with Triwest was up for renewal/bidding, and TriWest had a very good record. Triwest had good accounting, paid on time, good cutomer service, easy online services, and were under budget. They bid against United Health Scare, who had a terrible record, bad financials, poor service, and guess what.....Triwest lost! The administration awarded the contract to United, who had a higher bid, bad service, and a terrible reputation. You know why? This will make you wish you never served....they want to make veterans healthcare sooo terrible that veterans will voluntarily give up thier well deserved and hard earned health benefits to stand in line behind illegal aliens for their healthcare (Obamacare). I know this is a little off topic, but you can see that veterans have few friends nor little support in Washington. Fair winds and following seas, welcome to the retiree rat race.

Hello, I see this is a few years old but I thought I would post current info for others. I found this post because I searched for Tricare Prime coverage for my CPAP mask that needs replaced. My current DME gave me a Micro Mirage and I truly dislike it so much that I wanted to throw it across the room. My usual and always if possible CPAP mask will be the FP Flexifit407. I am comfortable while using it, I don't have much in leakage issues and it doesn't leave marks on my face.

The Micro Mirage is totally opposite the 407. I feel like I am suffocating with the mirage and I can't adjust it to fit well enough to stop the leaks either. If it's too tight it hurts very bad and leaves dents in the side of my nose but I still have leaks. Any adjustment looser from tight is still a problem with leaks and I still have discomfort on my nose, but with less indents. The feeling of suffocation never stops and I find myself tearing it off my face in the middle of the night.

My current DME told me the only mask my insurance would cover was the micro mirage and they didn't seem willing to go any further to investigate it. They are the ones that originally gave me the Flexifit407 and say they don not carry the mask anymore. They did tell me I could return the micro mirage to them and they would not bill Tricare for it. So, I am doing just that on Monday.

So, I asked my PCP for a RX for the Flexfit407, she obliged and I ordered 2 already online by paying out of pocket. I did call Tricare this morning and explained my problem. He told me I could get an RX for the particular mask I wanted and look for a national DME that carries the mask. Apria, they carry the mask and they are national, and they are contracted with Tricare for coverage.

What a breath of fresh air, I scanned the RX to PDF, emailed a copy and they are getting started on it right away. I am so happy I won't have to pay out of pocket again, for as long as they carry that particular mask.

Anyway, I hope this helps anyone looking for information on coverage. Just call Tricare and ask them what you need to do for yourself and your region.

LearningCPAP wrote:Hello, I see this is a few years old but I thought I would post current info for others. I found this post because I searched for Tricare Prime coverage for my CPAP mask that needs replaced. My current DME gave me a Micro Mirage and I truly dislike it so much that I wanted to throw it across the room. My usual and always if possible CPAP mask will be the FP Flexifit407. I am comfortable while using it, I don't have much in leakage issues and it doesn't leave marks on my face.

The Micro Mirage is totally opposite the 407. I feel like I am suffocating with the mirage and I can't adjust it to fit well enough to stop the leaks either. If it's too tight it hurts very bad and leaves dents in the side of my nose but I still have leaks. Any adjustment looser from tight is still a problem with leaks and I still have discomfort on my nose, but with less indents. The feeling of suffocation never stops and I find myself tearing it off my face in the middle of the night.

My current DME told me the only mask my insurance would cover was the micro mirage and they didn't seem willing to go any further to investigate it. They are the ones that originally gave me the Flexifit407 and say they don not carry the mask anymore. They did tell me I could return the micro mirage to them and they would not bill Tricare for it. So, I am doing just that on Monday.

So, I asked my PCP for a RX for the Flexfit407, she obliged and I ordered 2 already online by paying out of pocket. I did call Tricare this morning and explained my problem. He told me I could get an RX for the particular mask I wanted and look for a national DME that carries the mask. Apria, they carry the mask and they are national, and they are contracted with Tricare for coverage.

What a breath of fresh air, I scanned the RX to PDF, emailed a copy and they are getting started on it right away. I am so happy I won't have to pay out of pocket again, for as long as they carry that particular mask.

Anyway, I hope this helps anyone looking for information on coverage. Just call Tricare and ask them what you need to do for yourself and your region.

I forgot to note that I am Retired Military Dependant with Tricare Prime. Tricare pays 80/20 for me and I am in the South Region.

Some Flexfit 407 supplies on Amazon...no prescription reqd.
https://www.amazon.com/s/ref=nb_sb_ss_c ... IRVXNODWNE

LearningCPAP wrote:I forgot to note that I am Retired Military Dependant with Tricare Prime. Tricare pays 80/20 for me and I am in the South Region.

I refuse to give repeat business to any DME who won't order the supplies or equipment I want. Glad this worked out for you.

If you or others have future problems give Verus a try they also accept Medicare & Tricare and will mail you the supplies you need. Google Verus for their contact info. I know the number has been posted in this forum before.

Interesting price comparison.....Mirage Quattro FF Mask (Example)
Verus....$264
cpap.com....$176
Amazon...$95 (No prescription)
https://www.amazon.com/Mirage-Quattro-F ... ge+quattro