Crapria is not always as bad as I thought

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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bwexler
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Crapria is not always as bad as I thought

Post by bwexler » Fri Sep 19, 2014 10:18 pm

I had an interesting conversation this afternoon with a CSR at my insurance company.
One of the topics was," do I really have a perpetual rental on my ASV machine with Apria".
After a nice long hold while called Apria, she told me that I am on a 15 month rent to own, and the insurance is not really paying Apria $393 per month as stated on my monthly disclosure from the insurance company.
The actual amount being paid requires top secret security clearance prior to disclosure, and then they have to kill you.

I was also trying to find an in network sleep doctor who actually knows something about CPAP and ASV therapy. I did not do as well on that score.

And on getting a replacement filter for my O2 Concentrator, she agreed paying for a new concentrator instead of a new filter did not make sense. But she had no solution.

Well, enough for one day.

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chunkyfrog
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Re: Crapria is not always as bad as I thought

Post by chunkyfrog » Sat Sep 20, 2014 5:08 am

The person behind the desk may want to help you, but until they do, the effect is the same.
Apria's business model precludes "service".

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Janknitz
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Re: Crapria is not always as bad as I thought

Post by Janknitz » Sat Sep 20, 2014 10:11 am

After a nice long hold while called Apria, she told me that I am on a 15 month rent to own, and the insurance is not really paying Apria $393 per month as stated on my monthly disclosure from the insurance company.
The actual amount being paid requires top secret security clearance prior to disclosure, and then they have to kill you.
Bull hockey! If you have a co-payment you MUST know what your insurer is paying in order to confirm your share. If it's Medicare those rates are published. You should be receiving explanation of benefits (EOBs" which tell you exactly what your insurance pays.

Insurers never pay the fictional charges DMEs put on their bills. They are pure fantasy, a game that is paid.

Otoh, if you walked into Crapria without insurance, they'd be happy to sell or rent you a CPAP for the full fantasy price--about $5k when all is said and done. They are just so nice that way.
Last edited by Janknitz on Sat Sep 20, 2014 9:41 pm, edited 1 time in total.
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bwexler
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Re: Crapria is not always as bad as I thought

Post by bwexler » Sat Sep 20, 2014 10:53 am

Yes I fully agree. I do get an explanation of benefits , but since I have zero copay, it displays the fictional charge ($393) and only an * in the columns for amount allowed and amount paid by insurance. These * are not limited to Crapria, all my medical expenses are shown the same way. So my EOB is basically worthless. I do get a separate EOB for Meds which does give a proper breakdown since I do have a copay for drugs.
I have requested a call back from the CEO or president of the insurance company, to express my concerns. When I get sufficiently riled up I will start calling my favorite congress men and senators (Boxer and Feinstein), maybe on Wednesday.

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LSAT
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Re: Crapria is not always as bad as I thought

Post by LSAT » Sat Sep 20, 2014 11:06 am

Just curious...since you don't have a co pay...why do you care what the insurance company pays the DME. They have a contract that was negotiated between them. From what I can tell, the DMEs are not getting rich on what insurance companies pay...and it's getting worse.

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bwexler
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Re: Crapria is not always as bad as I thought

Post by bwexler » Sat Sep 20, 2014 11:36 am

With Craprias reputation I don't want them ripping off the insurance company. Last year the insurance company reduced several benefits. That cost me about $500 out of pocket this year compared to last year. I expect more of the same this year.
Most folks on Medicare indicate 10 months rental on DME then they own it. I finally discovered mine is 15 months. What if I wanted to switch insurance at open enrollment. That would cause me to start fresh with the new company and a new rental period, maybe with a copay. If it were the common 10 months I would own it now.

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Islandwoman
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Re: Crapria is not always as bad as I thought

Post by Islandwoman » Sat Sep 20, 2014 12:08 pm

Interesting, mine is 13 months with Medicare. Not very consistant.

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Re: Crapria is not always as bad as I thought

Post by Guest » Sat Sep 20, 2014 12:24 pm

Islandwoman wrote:Interesting, mine is 13 months with Medicare. Not very consistant.
Oh yes it is with Medicare. It has always been 13 months.

Janknitz
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Re: Crapria is not always as bad as I thought

Post by Janknitz » Sat Sep 20, 2014 9:38 pm

Generally Medicare is 13 months but there's some glitch to allow certain rentals to be 15 months--I can't remember what the criteria is.

And I don't think you need to worry if your insurer is a secondary payer to Medicare. Medicare sets the allowable rate--you can be certain Medicare pays not a penny more than the fixed rate, and your insurer is responsible only for the remaining 20%. However, a "preferred provider" for your insurer may further cut the insurer a break on the remaining 20% in order to get volume from that insurer.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm