Cigna/CareCentrix Concerns

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
mahler
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Cigna/CareCentrix Concerns

Post by mahler » Thu Sep 03, 2015 3:26 pm

Hi everyone!

I was just diagnosed with OSA and prescribed a CPAP Machine. I'm finding the whole process of actually obtaining the machine very confusing and am wondering if anyone has any tips that has dealt with Cigna and CareCentrix.

I did an at-home sleep test with a local sleep medicine clinic and was diagnosed with moderate sleep apnea. I called Cigna and they said to send my Rx to CareCentrix. I called CareCentrix and asked how the whole process works. CareCentrix said that I would have to get an APAP machine FIRST before I got a CPAP machine...even though my doctor's Rx calls for a CPAP machine. Is this normal?

Cigna also mentioned that CareCentrix would mail the machine to me, however I haven't even been able to try on a mask so how do I know which will be more comfortable for me? I'm a little afraid that they will send me something not of my choosing that is uncomfortable and that I'll be stuck with it.

Anyone else dealt with Cigna/CareCentrix in the Seattle area? Thanks for any input or for sharing your experiences with me.

Cheers,
Robbie

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LSAT
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Re: Cigna/CareCentrix Concerns

Post by LSAT » Thu Sep 03, 2015 3:37 pm

An APAP is a step up from CPAP...usually it is the other way around. Best to read the Announcements at the top of the main page.

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mahler
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Re: Cigna/CareCentrix Concerns

Post by mahler » Thu Sep 03, 2015 3:57 pm

Thanks for responding, LSAT. I read through the announcements but did not find the answer to my questions there. If I missed them, I do apologize for the inconvenience...

I'm not understanding why CareCentrix would say that I have to have an APAP for 90 days and then receive a CPAP, when my doctor has prescribed a CPAP. Do places tend to refer to CPAP machines as APAP? Maybe it's just a vocabulary issue that I shouldn't worry about.

The other concern was that I am not going to be able to try a mask before they send it to me. I'm wondering if anyone else has had that experience.

Things did not seem very well organized at the sleep study center and also at Cigna and CareCentrix so I may just be overly cautious and concerned for no reason.

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cancun
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Re: Cigna/CareCentrix Concerns

Post by cancun » Thu Sep 03, 2015 4:17 pm

mahler wrote:Thanks for responding, LSAT. I read through the announcements but did not find the answer to my questions there. If I missed them, I do apologize for the inconvenience...

I'm not understanding why CareCentrix would say that I have to have an APAP for 90 days and then receive a CPAP, when my doctor has prescribed a CPAP. Do places tend to refer to CPAP machines as APAP? Maybe it's just a vocabulary issue that I shouldn't worry about.

The other concern was that I am not going to be able to try a mask before they send it to me. I'm wondering if anyone else has had that experience.

Things did not seem very well organized at the sleep study center and also at Cigna and CareCentrix so I may just be overly cautious and concerned for no reason.
I understand your RX says CPAP, I think most doctors just automatically order CPAP as they aren't always that educated on CPAP issues. Be happy that you will be getting at APAP machine, you want one that you can adjust the pressures on. Call Cigna back and express your concerns to them concerning the mask and ask them what your policy covers as far as the machine and supplies so you will know that when you talk with CareCentrix again. I do have Cigna and even though I hate all insurance companies Cigna has been pretty helpful on the phone. I do not use CareCentrix though.

More experience forum members should chime in soon.

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Janknitz
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Re: Cigna/CareCentrix Concerns

Post by Janknitz » Thu Sep 03, 2015 4:24 pm

If you didn't have an in lab titration, they are sending you the APAP first for two reasons:

1) to have you self titrate at home (Kaiser does the same thing)
2) to prove your compliance before they furnish you with your permanent machine.

At least with Kaiser the home titration is one week and then they check your data to see if you are having any issues and adjust the pressures as needed. This sounds like Cigna just wants to leave you hands off with an APAP for 90 days (wow!) and then send you a fixed CPAP once they "determine" your pressure. That wide-open pressure used on APAP's for home titration can be rough for some people because the lower setting can make you feel like you are not getting enough air, and then you get blasted because it is slow to catch up with apneas and tends to raise the pressure too much.

There is one type of Philips Respironics machine that does a 30 day "auto-titration"--it starts out in APAP mode but gradually determines and dials in your fixed pressure. Someone who remembers the model number and model name will be along to tell us what that machine is called. Hopefully it's that machine if you have to be stuck with it for 90 days--it's a little more refined than a wide-open APAP.
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davecpap
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Re: Cigna/CareCentrix Concerns

Post by davecpap » Thu Sep 03, 2015 8:05 pm

I have Cigna/CareCentrix - its not a lot of fun dealing with the two of them.

Basically, you only need to talk to CareCentrix once the insurance authorization is approved. No need to talk to Cigna after this point. CareCentrix in turn picks a DME (durable medical equipment) provider for you that actually provides the medical gear. CareCentrix only handles the billing on behalf of Cigna.

So My Insurance is Cigna, they farm out the durable medical equipment billing to CareCentrix. CareCentrix hooked me up with American HomePatient - who actually provides the equipment.

I've found it easiest to just talk to CareCentrix for supplies. When I call American HomePatient for replacement supplies, they need to send an authorization request to carecentrix - and they never receive it. When I call CareCentrix for supplies - they send an order to American HomePatient - for some reason that always works.

I would find out from CareCentrix what DMEs in your area they contract with. When I initially called CareCentrix, they told which DME I would use - I insisted on them giving me a list of providers, which they will only do over the phone. I went to a couple and looked up reviews online - settled on American HomePatient after I went through the list.

American HomePatient had me come in and fit me for a mask - they had a bunch of free samples from the manufacturers for me to try out. So far its gone well.

You want an APAP machine BTW - it will adjust the pressure to the minimum you need. I couldn't stand CPAP until I got an APAP machine. APAP machines (generally) collect good data on your therapy - being able to look and see that the machine was helping me breathe convinced me to keep using it while I was getting accustomed to xPAP. Before when I had straight CPAP and no data, it was easy to get discouraged.

Your doctor can write an rx for an APAP. Better to do it now than later, they may be unwilling to trade your machine later on.

CareCentrix won't send you anything. They contract with a 3rd party to do that (the DME). If you get a mask you don't like, you can do an exchange in first 30 days or so for another mask. I would work on figuring out who your DME is and finding a good one in your area that contracts with CareCentrix. In parallel, read about the various APAP machines available - you'll want one of the two below if the full data interest you. I was able to get an RX for APAP (ANY doctor can write the RX - I asked my family doc to) and then I took to DME and insisted on the "AirSense 10 Autoset"

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mahler
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Re: Cigna/CareCentrix Concerns

Post by mahler » Thu Sep 03, 2015 11:53 pm

Thanks so much, everyone for the information. It's making more sense hearing it from you all.

Dave, appreciate you sharing some insights on Cigna/CareCentrix! A coworker has also recommended the Airsense 10 Auto and I've seen a lot of others recommending it on forums. Hopefully I can make that one happen.

Thanks again!

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curems
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Re: Cigna/CareCentrix Concerns

Post by curems » Fri Sep 04, 2015 4:49 am

mahler wrote:Hi everyone!

I was just diagnosed with OSA and prescribed a CPAP Machine. I'm finding the whole process of actually obtaining the machine very confusing and am wondering if anyone has any tips that has dealt with Cigna and CareCentrix.

I did an at-home sleep test with a local sleep medicine clinic and was diagnosed with moderate sleep apnea. I called Cigna and they said to send my Rx to CareCentrix. I called CareCentrix and asked how the whole process works. CareCentrix said that I would have to get an APAP machine FIRST before I got a CPAP machine...even though my doctor's Rx calls for a CPAP machine. Is this normal?

Cigna also mentioned that CareCentrix would mail the machine to me, however I haven't even been able to try on a mask so how do I know which will be more comfortable for me? I'm a little afraid that they will send me something not of my choosing that is uncomfortable and that I'll be stuck with it.

Anyone else dealt with Cigna/CareCentrix in the Seattle area? Thanks for any input or for sharing your experiences with me.

Cheers,
Robbie
I'm new to working with Cigna/CareCentrix also but my experience has been completely different. My doctor handles all of the Rx ordering so I don't have to get involved in that. In my case, I did a home sleep study, only mild apnea (AHI=10) but I also have high BP. I had my titration in the sleep lab. My doctor handled all the precert requirements and orders directly from the DME. She also has a weekly sleep clinic for mask fittings. I've attended the clinic twice and have gotten 3 masks in my first 30 days. CareCentrix called the first week to check in and again at the end of the 30 days to confirm my compliance. The DME called at the end of the 30 days to ask how it was going. I explained that I was still having a lot of trouble finding a mask that would work but that I had hit the 30 day mark and have my follow up next week. He suggested I talk with my doc and if the doc can help me find a mask that we are certain will work, to call back and explain the situation and they will see what they can do to give me one more. The machine itself was ordered by my doc - as I understand it, at least some docs order a particular machine so that they can follow everyone on the same system.

As for the APAP vs. CPAP I found this in Cigna's DME provider manual:
"Auto-titrating PAP devices are to be provided to patients that have been diagnosed via a home sleep test, and CPAP devices are to be provided to patients diagnosed via a facility based test, unless otherwise ordered by the patient’s physician." Your doc may have ordered a CPAP for titration but the DME was following Cigna's guidelines unless the doc pushed for a CPAP rather than APAP.

Hope the process gets easier for you.

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pratzert
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Re: Cigna/CareCentrix Concerns

Post by pratzert » Fri Sep 04, 2015 7:41 am

curems wrote:
As for the APAP vs. CPAP I found this in Cigna's DME provider manual:
"Auto-titrating PAP devices are to be provided to patients that have been diagnosed via a home sleep test, and CPAP devices are to be provided to patients diagnosed via a facility based test, unless otherwise ordered by the patient’s physician." Your doc may have ordered a CPAP for titration but the DME was following Cigna's guidelines unless the doc pushed for a CPAP rather than APAP.

Hope the process gets easier for you.
Hi curems.

I have never seen that bit of information from the Cigna DME Provider manual. How in the world did you manage to find that?

When I was first diagnosed with Apnea with an in-clinic sleep study, my Sleep Doc prescribed an AutoPap machine, but I could not get the DME (Evil Crapria) it supply it and I ended up buying it on my own dime.

I wish I had been armed with this information to help in the argument I had with Crapria.

I always envisioned a gathering in the Crapria office at the end of each day, where the employees all get on their knees and bow while worshiping the "Dollar" gods and chant the Mantra "The customer is always wrong.... the customer is always wrong....Screw the customer."

I feel my blood pressure spike whenever I have to talk to them about supplies.

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JasonK94Z
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Re: Cigna/CareCentrix Concerns

Post by JasonK94Z » Fri Sep 04, 2015 8:33 am

My wife once worked at CareCentrix as a coder. She quit, and she quit for good reason. That company is a train wreck!

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curems
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Re: Cigna/CareCentrix Concerns

Post by curems » Fri Sep 04, 2015 1:39 pm

pratzert wrote:
Hi curems.

I have never seen that bit of information from the Cigna DME Provider manual. How in the world did you manage to find that?

When I was first diagnosed with Apnea with an in-clinic sleep study, my Sleep Doc prescribed an AutoPap machine, but I could not get the DME (Evil Crapria) it supply it and I ended up buying it on my own dime.

I wish I had been armed with this information to help in the argument I had with Crapria.

I always envisioned a gathering in the Crapria office at the end of each day, where the employees all get on their knees and bow while worshiping the "Dollar" gods and chant the Mantra "The customer is always wrong.... the customer is always wrong....Screw the customer."

I feel my blood pressure spike whenever I have to talk to them about supplies.
I really can't speak to questions about customer service -- I think it can vary greatly and the rules that staff are required to abide by can be quite onerous I'm sure. Like everywhere else, you can find caring and helpful customer service reps and total jerks.

I found the manual here: http://www.carecentrix.com/providerreso ... manual.pdf

I've been very fortunate that my doctor's office has taken control and handled everything for me. Sometimes it's just a matter of the doc knowing what needs to be presented. Of course, I haven't had to contact them yet about supplies!

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Re: Cigna/CareCentrix Concerns

Post by pratzert » Thu Oct 15, 2015 11:27 am

Hi curems.

Thanks for sharing the info.

I guess the most important words I saw on the dispensing of machine guidelines QUOTE:" Auto-titrating PAP devices are to be provided to patients that have been diagnosed via a home sleep test, and CPAP devices are to be provided to patients diagnosed via a facility based test, unless otherwise ordered by the patient’s physician.":UNQUOTE is the last part "unless otherwise ordered by the patient’s physician.".

My sleep Doc always prescribes an Auto machine. But that did not stop Crapria from sending me a regular CPAP machine in the beginning. I ended up buying an APAP machine with my own dime and sending the CPAP back to Crapria.

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Re: Cigna/CareCentrix Concerns

Post by curems » Thu Oct 15, 2015 4:17 pm

pratzert wrote:Hi curems.

Thanks for sharing the info.

I guess the most important words I saw on the dispensing of machine guidelines QUOTE:" Auto-titrating PAP devices are to be provided to patients that have been diagnosed via a home sleep test, and CPAP devices are to be provided to patients diagnosed via a facility based test, unless otherwise ordered by the patient’s physician.":UNQUOTE is the last part "unless otherwise ordered by the patient’s physician.".

My sleep Doc always prescribes an Auto machine. But that did not stop Crapria from sending me a regular CPAP machine in the beginning. I ended up buying an APAP machine with my own dime and sending the CPAP back to Crapria.
Sorry that happened pratzert. It does go to show that while sometimes the doc is at fault, sometimes the insurance co. is at fault, sometimes CareCentrix and sometimes the particular DME. It doesn't make it better but at least you know it was the DME who messed up. I hope things improve for you.

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nezi

Re: Cigna/CareCentrix Concerns

Post by nezi » Fri Dec 04, 2015 4:20 pm

dealing with this now. same thing. we got the cpap machine from apria which is located in a town almost an hour away. The doctor wants to switch to a Bi-v and sent in a new rx. People at Apria say they didn't get a rx and have them refax. People at apria state, we will have a therapist call you. If you don't get their call, back to step one. on the phone today for over 2 hours being shuffled around from apria to cigna then hung up on. Terrible terrible service. I couldn't image being an elderly person trying to deal with this.

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Julie
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Re: Cigna/CareCentrix Concerns

Post by Julie » Fri Dec 04, 2015 4:29 pm

Hi, your problem is likely with Apria, whose reputation here is really bad. You need to be really tough with them... Cigna is probably not the problem. If you can go to Apria in person and demand your stuff you might have some luck... let us know how it goes.