Apria

[ApriaRT]

Hello to all! I am a RT with Apria Healthcare in Virginia. I have been involved with sleep for 20 years now and have been using cpap myself for the last 3 years. I am new to this site and have been reading through to see what cpap users are saying about Apria. I will tell everybody that Apria is working very hard to improve our overall service to sleep customers. I would like to hear good or bad and I am open to suggestions to improve our service to you. How can we better serve you? What would you like to see done to improve your experience with us? One last note, I cant fix the billing process and I can assure you that dealing with insurances and receiving payment from them is just as painful for us as it is you!

[sleeplessinaz]

Hello ApriaRT!!! I have Apria here in Arizona thru Cigna PPO. LOVE APRIA!! Not have had any problems with them so far!!! Good to know that you want to make things better for the CPAP patient. We are growing in number and we do want to be involved with our therapy. Have fun here ---
Carrie

[rested gal]

Welcome to the forum, ApriaRT. I (and I hope others) appreciate your coming here to ask for suggestions to improve service. If you've been reading ahead of time on here, I suppose you already know it will help to have a thick skin.

I've always felt that when it comes to some of the large DME chains, there can be tremendous differences in the "service" and support from one office to another. Apria, Lincare, whatever... I've seen some people report on this board that they were very pleased, sometimes pleasantly surprised after reading of how it can go wrong, and others report things didn't go well at all.

The fact that you've come here at all and are asking -- well, to me that's a good sign about the branch you work at, or at least about your own personal desire to make things better.

My suggestion (and perhaps you already do this at the branch you work for) is stress to new CPAP users that they can come back and swap for a different mask again, again, and again during the first month. Don't wait for the person to call with mask woes...and hope that no news is good news (not that I'm saying YOU do that.) I do think it's important for any DME to not assume they're wearing the mask fine just because it "fit" for a few minutes in the office, when really they've not been able to use it at all once they actually tried to sleep with it on. Encourage them, before they leave the office, to bring the mask back to swap for a different one if they have problems. Yeah, put that idea in their heads! Swap again, and again, and again, if need be during that first month.

The other thing I'd suggest is give out only machines that record AHI and LEAK info...not just "compliance" (hours of use) data. Not because the average patients would be one whit interested in seeing their own data the way so many of us on this message board are. Do it so that you, the DME, can download the person's data before the end of the first week of use. Look especially at the detailed nightly LEAK data (not just the "average" leak over time.)

I've seen some horrendous leak rates on the data of several people who had no idea they were losing just about all their treatment air out into the bedroom every time they used their CPAP. They "slept" through Large Leaks that went on and on and on. Those people are not going to call you to say, "Hey, I may be mouthbreathing during sleep". or "I think my mask is leaking too much." They don't even know it themselves, or think whatever air they're feeling blowing every which way outside the mask (besides the normal vent) is just part of being on CPAP.

I don't think questions about "leak" during followup phone calls would really give the DME a clear picture of what's happening either. The new people simply don't know what's "normal" in what they hear and feel, and what isn't. So... I think looking at their detailed data during the first week could nip a lot of problems in the bud and help the new user get treatment going well more quickly.

Take a look at each new person's detailed data during the first week. Don't wait for the 31st - 90th day "compliance" checkup time. Get their treatment going right EARLY on, so there's a chance they might actually start feeling better and decide, "You know, I hate using a mask, but this CPAP thing really does seem to be helping me."

Yeah, it would be a major pain to start doing first week downloads of EVERY new patient's data. Talk about taking up time, and time is money. It would also be quite a dent in the profit to stop giving out "just hours of use" recording machines.

But, you asked... so, there I went.

[ApriaRT]

Thanks for the feedback and I couldnt agree with you more Rested Gal! I dont want to give away any specific details on what we are doing to improve compliance but I will tell you that compliance and outcomes data is the future of our industry. To your mask comment, absolutely in the first 30 days is our opportunity to get the right mask on the customer, if changes need to be made, we as the provider need to drive it and thats where the appropriate follow up needs to be performed so we catch these things early on. To your ahi/leak machines comment, sometimes we are bound by our payors requirement to provide a certain type of unit because they want to keep their cost down. I do see this changing in the future however. Thanks again for the feedback, it is appreciated!

[Wulfman]

Thanks for the feedback and I couldnt agree with you more Rested Gal! I dont want to give away any specific details on what we are doing to improve compliance but I will tell you that compliance and outcomes data is the future of our industry. To your mask comment, absolutely in the first 30 days is our opportunity to get the right mask on the customer, if changes need to be made, we as the provider need to drive it and thats where the appropriate follow up needs to be performed so we catch these things early on. To your ahi/leak machines comment, sometimes we are bound by our payors requirement to provide a certain type of unit because they want to keep their cost down. I do see this changing in the future however. Thanks again for the feedback, it is appreciated!

Since there's only ONE insurance code (E0601) for CPAP, I question that statement. The insurance provider is going to pay the SAME amount for a very basic machine as they do for the most advanced Auto-CPAP under that one insurance code. Cheapest machines and masks make more profit for the DME businesses.

But, welcome to the forum.

Den

[Guest]

My sister works for Apria. I happen to know, they just raised the cost of their machines to 275% in order to make profits. I understand there's a lot of paper shuffling and what not, but that seems a bit ridiculous to me.

[jules]

Not all insurance companies have the same contracted rate with a DME. They may all be billed the same amount for the same code, but they do pay differing amounts based on the contracts they have. This is part of the problem.

For example, if insurance Company X pays the DME $200 - 300 less than Company Y pays the DME, I bet that the patients who have Company X's insurance are less likely to get that nice top of the line machine like we all want than the patients who have insurance from Company Y.

[slapmeawake]

I deal with Apria in Va and I have to say I have not had good experiences at all. As a new patient I was sent out the door with a mask and a machine(basic no data capabilities!!!) Everything I have learned I learned here on CPAPTALK. I was given false information, outright lied to and completely different information from person to person within Apria. I was given a used machine which I had to track down myself. I was told you couldn't change out masks, once you wore them it was yours. I was told my insurance wouldn't cover the newer AFlex machine I wanted and I had to get the CFlex one. My insurance is no help either. I think it is a conspiracy to keep prices high and therefore profits for Apria high and premiums high for health insurance. As you can tell I am very disgusted with the service I am receiving. The last visit I finally saw a real RT. I had been seeing a clinician, who I was told was a RT only to find out he wasn't. The RT gave me her card so now I guess I can call her. My first visit to her she was 20 min late, not good first impression. I am still struggling after 2 years with my therapy!!!! Other than suggesting different masks I don't see where anyone at Apria has tried to help. We, as newbies, don't know what to look for or what to ask. I have been shuffled back and forth from Apria to Dr. So the first thing I would tell you ApriaRT is stop lying to patients. I know this is a corporate decision about the fees etc. but the things you can control you should. You should put up a sign that tells patients they have a 30 trade out policy for new masks and put that lie to rest that you can't trade in. You should let patients know their rights as far as what equipment they are entitled to. Do you people even stop to think how much anguish you have caused your patients with shoddy care and lies? I have been through the mill with Apria and I don't hold out a lot of hope that you will change but I'm willing to listen to a first hand account of how they plan to make things better for patient care. Good luck, you'll need it to regain my trust and a lot of other patients trust also.

[kebsa]

Sounds like a complicated system to say the least! I generally like the private health system we have here in Australia- we don't have to worry about pre approval for surgery etc as long as it is not cosmetic and you have served any waiting periods as a new member (usually 2yrs at the most for things like hip replacement, generally 12 mths for most) then if our surgeon says we need the treatment thats it!

having said that, our system is not so good when it comes to things like cpap machines, my carrier pays a maximum of $500 which is more like $350 US at the moment and that is for machine, mask, the works! considering masks range from $230 to $300 and even the cheapest bare bones blower is around $695. IF i want to avoid the costs the only other option is to get referred to a public hospital but i would have been waiting for 18months to get the first sleep study done and i am not so sure how they would have dealt with me when it turns i need a more expensive type of machine though!

some day some genius may come up with a system that can deal with health care that doesn't involve trying to figure out what we can cut out to afford what we need and doesn't involve so much jumpin through hoops that we feel like pennys prancing poodles in some kind of mad vaudeville act! At least it seems as though at least one person in one company is at least listening to your views

[packitin]

I went to Apria, because the doctor gave me a sheet with recommended DME's and the local Apria office was one that was closest to my house. I didn't know anything about equipment and machines. But, luckily, I had become a member of this forum, and so frantically read all I could absorb in a short time. I told the RT there that I was a forum member and was trying to learn a lot in a short time.

In all honesty, I think he was glad I didn't know much. He gave me a (used) machine (m -series with cflex), placed a mask on me to try, and the rest was all paper work. He made an appointment for 2 weeks, and told me we would evaluate my progress. I later asked if I could try out a Resmed. He said they do not carry those, and that I had a perfectly good machine that would offer me great therapy. Well, by that time, I had been learning a lot. I insisted I wanted to try a Resmed Autoset II. They placed me on the phone with a supervisor in another city about 70 miles away. She and I "discussed" sleep therapy for some time. Mostly it was about patients should not change the settings unless the doctor prescribed it. I told her that all my friends (that's you) did so. After some more discussion, she said she would try to find me a Resmed to try out. Well, after several weeks, I got one. I decided I wanted to keep it.

Then, later, I needed filters, and they had to order some, which finally came some time later in the mail.
I don't want to be too critical of the local office. I think their hands are tied, as they are obeying the orders that are handed down to them from the administrators in the controlling branches.

My recommendation is to be more sensitive to the lack of knowledge of the patients and help them through the adjustment period. Maybe the answer is to create some better publications when the patient first arrives, take a little more time explaining the inter-workings of the machinery, and how the settings work. Come clean with the patient, and give more explanations as to proper settings relative to what the sleep study gave - such as pressure settings, ramp, leakage, etc. The intelligent patient is going to find it out eventually, anyway, and this would alleviate the kinds of friction we have been reading about on this forum - those between patient and DME. And stop telling the patient that they are not allowed to make any changes - it is their machine, and they can do what they want.
Jay

[tvmangum]

My CPAP and supplies come from Apria in High Point NC and I could not be happier. They have answered every question that I have had in just a matter of minutes and have even come to my house to check my machine, mask, etc.

If I had one suggestion to make it would be to assign a patient to one RT instead of whoever is doing clinic that day. This would ensure continuity of care and not have to explain things multiple times.

All in all, my local office is much better than the other DMEs that I have dealt with over the years.

Now I'm just waiting for my CPAP "miracle" to kick in--4 months and I can tell no change in me.

[elader]

I had two very different experiences at two Apria branches in Maryland. One was awful in every way, even in follow up calls (NO! you are not entitled to a different mask, go away). The other couldn't have been better. You would think though as they are the preferred supplier for Cigna that when I call to order another mask at 3 months, I wouldn't get a 'why do you need another mask?' Uhhh, why do you think I need another mask??????

Some weird disconnect between Cigna and Apria and me - why cant they just replace stuff on a schedule. Why do I need to make a ten minute phone call every three months to get filters? Then one every six months for headgear and a humidifier tank... cant we just get a schedule set up??

[bjdare]

I started with Apria in January and am new to CPAP (since Dec 08). Apria provided me with the basic ResMed with C-flex and the Opus 360 nasal pillow mask. However, I had to PURCHASE the mask. I could not tolerate the nasal pillows and after two weeks went back to the Apria office thinking I could trade out the mask - in fact, I thought I was "trading" until the DME told me to keep the Opus. It was then I realized that I was purchasing the "new" mask. Due to a change in my employers insurance carrier I switched DME's from Southern Resp. to Apria - with Southern I could try as many masks as I wanted within the first 30 days - and without a purchase fee. I have since purchased another mask (FF) - this time through capauction.com and am sure that within the next 30 days I will purchase a data capable machine thru' capauction and kindly remove myself from Apria. Due to a high deductable on my insurance, to date I've paid Apria $407 - for two mask and two months rental on a BASIC ResMed machine...I'm pay $64.00 a month rental on a BASIC machine.

[carbonman]

ApriaRT, it is nice to know that someone is trying.

I have to deal w/the Big A.
My original RX was for a cpap w/cflex.
They tried to stiff me w/a regular cpap.
When I protested and said I wanted the cflex and
data capable, they stiffed me w/an Mseries plus.

As I got educated through this site, I got a new
RX from my Dr., specifically written for an Mseries Auto w/aflex.
They told me they don't exist.
When I protested, they suddenly discovered they did.

My insc. at the time required that I pay monthly rent.
I asked them to set the payments up on auto CC charge.
They never did figure out how to do that.
I just received a monthly bill through snail mail.

They tried to stiff me on the original RX,
they lied to me about the second RX,
and they are incompetent w/billing and operating procedure.
Would you trust them for anything??

I have been on cpap for 9mths.
I am 100% compliant.
I am my own best therapist.
I have my life back.

If Apria would have been my only means of support for cpap,
I would have quit.

I applaud your efforts and wish you luck, because you are
going to need it.

[Jason S.]

[quote="elader"]I had two very different experiences at two Apria branches in Maryland. One was awful in every way, even in follow up calls (NO! you are not entitled to a different mask, go away). The other couldn't have been better. [\quote]

I think Apria is my BC-BS in-service provider. I have tried anything yet but I hope they don't give me a hard time. I have the Comfort-Gel and I really want to try out the Mirage Quattro. My 3 months will be up in mid March.