Switching insurance while in maint. phase restarts rental?!?

Hello,

I've been a hose head for 9 years now and just recently switched insurance companies for the first time and the lack of billing transparency is driving me nuts. I got a new CPAP with my old Aetna insurance through Apria in August of 2014. I've since found out that Aetna does a 10 month rental ($58/mo) and then the account goes into a maintenance phase with charges every 6 months ($58 again). Apparently, I was supposed to get the option to take ownership of the machine after that 10 month period but that must've been buried in the legalese and I never got a notice about it. Fast forward to 2017. We switched to Cigna and on a whim in February I thought it a good idea to go ahead and update my insurance information in my Apria account. In late March I logged into my Cigna account to look at a claim for my daughter I and saw two charges to my Flexible Spending Account for $128 each from CareCentrix for "DURABLE EQUIP." Having no idea what the charge was for, I called CareCentrix. CareCentrix had no record of them filing the claims and they told me to call Apria when I mentioned having a CPAP machine with them from my old insurance. When I called Apria billing I was told that because my rental with Aetna was never converted to ownership the rental effectively reset when I switched to Cigna and they were within their rights by the contract they have with Cigna to bill me for allowed rental period . When I pointed out that I thought it was bs for them to charge me a "new" rental fee for a used machine the lady said she would put in a request with her supervisor to have the machine converted so that I own it and I would hear something by mail at some point in the future. I asked her about the two $128 charges and she basically told me to pound sand. I stewed on that for a couple weeks and it continued to eat at me so I called Cigna today hoping they would go to bat for me since it will eventually cost them money when I burn up my deductible. The Cigna rep told me that it was clearly the case that I had a remaining balance on my machine from my Aetna insurance and transferred me to CareCentrix so I could find out how much remained. This time I got an awesome rep. at CareCentrix (Tiara). Since she couldn't find any record of a bill due or a claim on my account she called Apria on my behalf and then let the lady at Apria have it when she started giving us the run-around. Unfortunately, Apria "accidentally" hung up on us after Tiara demanded to talk to a supervisor in the billing department. So, I called Apria back on my own and this time the billing department claimed they had no record of having charged me $128 twice this year and could only tell me that the account now showed that I owned the machine. When I pressed for more information she would only tell me that CareCentrix is 100% responsible for billing with Cigna. She tried to call CareCentrix but the CareCentrix phone tree wouldn't let either of us hit the numbers required to get to their billing department. Apria told me to have a nice day at that point.

So, great, now I probably own my machine but I'm down $256 and nobody can explain why. I know from reading other posts that people have had similar billing experiences when switching in the middle of a rental period, but I'm curious if anyone has had to deal with this in the "maintenance" phase?

I know of one forum member who had Aetna and the "maintenance" thing. She has some stories about her dealings.
I can't remember for sure her forum ID. I think she finally told them where to go and got a new machine privately.

I take it Apria had your Flex account number to bill?
That's why we tell people to never, never, ever give Apria a credit/debit card no matter how much they insist.
Never give them any way to automatically get money from you.
There is a reason we refer to them as "Crapria"...

Little did I know when we moved to Cigna that my FSA with them defaulted to "Auto Pay" for claims. Lesson learned. I'll be doing manual reimbursements in the future. Apria drove me crazy when I was with Aetna because I could never understand what I was being billed for when I got my first and second machines. However, my deductible, co-insurance, and negotiated rates with them were so low with the old insurance that I never took the initiative to figure out what the heck was going on. Reading posts here is where I found out about the 10 month capped rental and perpetual maintenance fees.

I am so grateful I no longer have to deal with those poopyheads at Apria.

Forum member Drowsy Dancer is who I was thinking of. I did a search of her posts using "Aetna" to get these.
I think that there have been a handful of others in the same boat but she's the one I remember being the most vocal.

search.php?st=0&sk=t&sd=d&author_id=55096

I'd be looking to do a little "Reverse Charges" Since they have no record of the bill then I'm sure they won't mind if you get your money back. I'd call your FSA and dispute the charges like you would with a credit card company. Wish you the best of luck with the mess they made.

NRA_Bear wrote:I'll be doing manual reimbursements in the future.

+1

Gryphon wrote:I'd call your FSA and dispute the charges like you would with a credit card company.

+1

NRA, I would fight that shit to the bitter end.

Gryphon wrote:I'd be looking to do a little "Reverse Charges" Since they have no record of the bill then I'm sure they won't mind if you get your money back. I'd call your FSA and dispute the charges like you would with a credit card company. Wish you the best of luck with the mess they made.

I also would file a complaint with your states Insurance Dept.
afaik each state has one and the Dept of Consumer Affairs.
I also believe they are licensed with the Dept of Health.

Keep notes on who you are talking with and when.

The dominoes finally fell into place with the people I talked to at CareCentrix and Apria. The last time I talked to Apria on my own they claimed that CareCentrix handled all billing for them when dealing with Cigna, so there were no bills/claims for them to review. Today the rep at CareCentrix started referring to the claim as an "authorization" and it apparently turned on some light bulbs for people. His exact words were, "Apria is self authorizing claims through CareCentrix for your APAP machine". So, when he called Apria with me on the phone they sent him to some department that handles authorizations rather than the billing department I've dealt with the last three times. The guy in that department first claimed I had a $171 balance but was then confused by why my insurance change caused their system to file claims for a machine from 2014. The Apria rep said he will forward the refund request to PPMC, no clue what that is, who should then send it to CareCentrix and then to Cigna and finally (hopefully) to my FSA. I'm not optimistic. I'm still trying to dig up the contract I signed with this Devil to see what the terms of the agreement actually are.

NRA_Bear wrote:The dominoes finally fell into place with the people I talked to at CareCentrix and Apria. The last time I talked to Apria on my own they claimed that CareCentrix handled all billing for them when dealing with Cigna, so there were no bills/claims for them to review. Today the rep at CareCentrix started referring to the claim as an "authorization" and it apparently turned on some light bulbs for people. His exact words were, "Apria is self authorizing claims through CareCentrix for your APAP machine". So, when he called Apria with me on the phone they sent him to some department that handles authorizations rather than the billing department I've dealt with the last three times. The guy in that department first claimed I had a $171 balance but was then confused by why my insurance change caused their system to file claims for a machine from 2014. The Apria rep said he will forward the refund request to PPMC, no clue what that is, who should then send it to CareCentrix and then to Cigna and finally (hopefully) to my FSA. I'm not optimistic. I'm still trying to dig up the contract I signed with this Devil to see what the terms of the agreement actually are.

The reason this happened to you is because no one before you filed a complaint. That is how these things get documented.

Usually, there are provisions in insurance plans for switching, especially when the switch is involuntary (such as changing jobs, same employer changing plans, COBRA ends). These provisions are for things like surgical follow-ups. If you had surgery, the new plan would have to cover a follow-up visit to that surgeon as if (s)he were in network for a reasonable amount of time after the switch. I would think that the same thing would apply to renting a machine to buy. That is they would have to continue where your old plan left off, and also cover the DME as if that DME where in plan (even if it's not).

---otherwise known as "grandfathering" . . .
Often called "being honest".
Small wonder the concept is foreign to some DME's.

When I got my ASV machine 3.5 years ago I went through a similar situation, almost.
About a year after I got the machine I called Crapria and asked when I would gain ownership. After bouncing around Crapria for a week or two they discovered I had been renting for more than 10 months and should now own the machine and go on maintenance. When I asked what the benefits of maintenance were and what would happen if I opted out of maintenance, I could see little or no down side to no "maintenance". After a brief debate I received an email indicating I owned my machine and would have no further obligations to Crapria regarding the machine.

2.5 years later I haven't noticed any issues that would have benefited from paying a maintenance fee.