High Noon at Apria

[geoDoug]

Well, today was THE MEETING.

To catch up:

I first got my CPAP from Apria on 3/16—just over 4 months ago.

After that, I did a bunch of independent research (mostly here) only to find out that Apria gave me a low-end machine. After a LOT of ping-pong and standing up for myself, I finally got what I want.

Well, suffice it to say that standing up for myself by walking down to the Apria office unannounced may have gotten their attention. I got a call the next day to set up an appointment to see an RT shortly thereafter.

I’ve called Aetna several times, trying to get a detailed schedule of how often they will pay for parts. Despite several attempts, I can't get a straight answer from them. It’s always a wishy-washy, “well, as soon as it wears out…” Time to change approaches. I left a couple of messages for the RTs at Apria, so I can tell them that I’m going to expect to have this at our meeting. They never called me back. Part of my notes was writing down a detailed list on an index card of what I want to know the frequency of coverage on.

Which leads us to today's meeting...

The good news: I now have my M-Series Pro with heated humidifier! (Note the updated hardware graphics below...) In the last week, I also obtained a smartcard reader from two-factor and installed encorepro (before I plugged in the reader--seems to be reading it. But I digress.)

Now for today's weirdness:

Despite my best attempts, the RT also wouldn't give me a straight answer about when Aetna will cover things. He wouldn't even even offer to find this information out. This was surprising to me, since Apria is in the business of overcharging insurance companies. My knowing this information increases how often I take advantage of my insurance--without the unnecessary paperwork of denied claims.

My other mission was NOT leaving until I knew it’s a new machine. I know that the "blower hours" can't be reset, even though the user information can. So I planned to insist that we power up the machine, go into the clinicians menu, and then look at that information. Again, the RT steadfastly REFUSED to even humor me and verify this information. So I had to check it out on my own at home. (Answer: blower hours=0. This is a Gud Thing.)

The most interesting development today: In my last phone conversation with Apria, they specifically told me that insurance would not pay for an integrated humidifier. Based on that conversation, I shelled out the $150 at cpap.com. That humidifier arrived promptly. However, today I got a new humidifier with my machine from Apria. In other words, Apria actually did something right. Kinda. Sorta. Problem is that since they told me that insurance wouldn't cover it, I now have two identical humidifiers. I called cpap.com, who has said they will take it back as long as it's unused, even though the box has been opened.

You know what? You shouldn't feel like you've just been through a blender on high speed after you see a medical specialist.

At least I'm close to the end of this chapter.

This and all of the background entries are cross-posted at my blog at mootepointe.haydoug.com.

[rested gal]

Very interesting readying, Doug. And an interesting blog site, too! Thanks for the updates!

[darthlucy]

The most interesting development today: In my last phone conversation with Apria, they specifically told me that insurance would not pay for an integrated humidifier. Based on that conversation, I shelled out the $150 at cpap.com. That humidifier arrived promptly. However, today I got a new humidifier with my machine from Apria. In other words, Apria actually did something right. Kinda. Sorta. Problem is that since they told me that insurance wouldn't cover it, I now have two identical humidifiers. I called cpap.com, who has said they will take it back as long as it's unused, even though the box has been opened.

Based on my experience today, I wouldn't assume that just because Apria gave you the HH that it's covered by insurance. I'd verify that first, or you might find yourself looking at a hefty bill from the DME for the HH.

[geoDoug]

Based on my experience today, I wouldn't assume that just because Apria gave you the HH that it's covered by insurance. I'd verify that first, or you might find yourself looking at a hefty bill from the DME for the HH.

They'd never get away with it. I didn't leave this morning until I went over the receipt with a fine-tooth comb. This is the one that has a big fat zero in the "patient responsibility" column and a zero at the bottom line. If they tried to bill me, I'll shove that back in their face.

Do I dare ask what your experience today was?

Doug.

[darthlucy]

Based on my experience today, I wouldn't assume that just because Apria gave you the HH that it's covered by insurance. I'd verify that first, or you might find yourself looking at a hefty bill from the DME for the HH.

They'd never get away with it. I didn't leave this morning until I went over the receipt with a fine-tooth comb. This is the one that has a big fat zero in the "patient responsibility" column and a zero at the bottom line. If they tried to bill me, I'll shove that back in their face.

Do I dare ask what your experience today was?

Doug.

[socknitster]

Gooey-D,

I'm glad things are looking a little better for you. How do you like the new machine? You really need to switch dme. Although, I hear that can be a real trial all by itself. Good for you for standing up for yourself!

Cpap.com is a really great business to do business with. Good for them for taking it back. They took back an unopened mask for me once when i got one for free after already placing an order. That made me a loyal customer.

jen

[Guest]

Jen,
Isn't it amazing how good fair service makes loyal customers? When will the other DMEs wake up?

[oceanpearl]

Jen,
Isn't it amazing how good fair service makes loyal customers? When will the other DMEs wake up?

Apria doesn't need to wake up. THEY HAVE SOLID EXCLUSIVE DEALS WITH SEVERAL MAJOR INSURERS!

[Snoredog]

you need to look up and find the Medicare replacement schedule, that is what Aetna follows, you get something real stupid like a new hose once a month, new cushion every month new chin strap every 3 months, new mask every 6 months.

Pretty soon you'll have a whole drawer full of unused crap. They don't want to tell you because if they have to follow the schedule Apria will make less money (they have a contract with Aetna) and Aetna doesn't want to tell you that schedule either because it means they will have to shell out more money for equipment.

But go here and scroll down to the very bottom, it will list out the frequency they will have to replace your equipment.

http://www.billmyhealthinsurance.com/me ... hines.aspx

[6PtStar]

Hey, what happened to the "disposable filters". Last time I looked at the list it said 2 every 30 days. Now it does not list them. Only thing I saw is non-disposable filters (2 every 6 months). I can go longer than 6 months on 1 non-disposable filter but the didposable ones go away pretty quick.

[geoDoug]

you need to look up and find the Medicare replacement schedule, that is what Aetna follows, you get something real stupid like a new hose once a month, new cushion every month new chin strap every 3 months, new mask every 6 months.

Thank you a MILLION times!!! This is EXACTLY the information I needed!!! God, you people are incredible. Where do I send the roses? You just saved me a TON of heartache, since I figured my next step was to call Aetna, get a rep on the phone, and immediately say, "Let me talk to your boss." Then go to their boss if necessary, and on, and on. Then the Dear Wife suggested to me last night to try to get hold of the powers-that-be who set the reimbursement schedule at Aetna, to try to find out if that information actually exists and, if not, try to educate them.

I'm glad things are looking a little better for you. How do you like the new machine?

Thanks for asking. I used it last night for the first time. I forgot to look at all of the settings before using it. Oops. The "auto-mask" feature was on. Completely freaked me out for two seconds before I said to myself, "Grrr...Remember to change that setting tomorrow."

You really need to switch dme.

Don't think I haven't tried. In the middle of this round, I called around to at least 5 or 10 DMEs, unable to find one that is in my insurance network. (My insurance doesn't cover out of network. It's an EPO, which is sort of the best of both worlds of the PPO and HMO. Then crap like this happens.) After the current mess is over, I'm going to look around again. The long term benefit will of decent customer service will be more than worth it.

Doug.

[Stefernie]

Isn't it amazing how good fair service makes loyal customers?

SHOCKING, isn't it?

Now, can anyone talk my DME into upgrading my machine for free?

[geoDoug]

Hey, what happened to the "disposable filters". Last time I looked at the list it said 2 every 30 days. Now it does not list them. Only thing I saw is non-disposable filters (2 every 6 months). I can go longer than 6 months on 1 non-disposable filter but the didposable ones go away pretty quick.

You're talking about the white ultra fine filters, right?

Take this with a big old lick of salt: Part of my conversation with the Apria RT yesterday was that Aetna pays for one/month, but that I can get a six month supply (count=6) at a time. The conversation then went like this:

Me: "So it falls under 'All needed supplies' then? If that's the case, why is there only one in the package?"
RT: "Yes, it does. That's a sample. You need a separate specific prescription for them."
Me: "Uh-huh. So even though this is a needed supply, I have to get another prescription."
RT: "Yes."
Me: [With an incredulous look on my face] "Uh-huh. Okaaaaay..."

[6PtStar]

geoDoug, Yep, the ultra fine filters, they used to be on the billmyinsurance list. Just to make sure I went and looked at the old list I had saved and there were there. Also noticed the allowable on the old list for non- disposale filters was 1 every 180 Days (6 months) now it says 2. Is medicare changing gears in mid stream?

[socknitster]

Doug, not trying to rub salt in the wounds, here but that is utterly ridiculous. You don't need a scrip for air filters. My company (rotech) calls me once a month and asks me if I want the things that I am eligible for. Shocking isn't it!

Then they send whatever I agree to take off their hands. I get new filter every month, new hose (if I wanted it, which I don't--once they are done offgassing and aren't leaking, they are fine, just got one as a backup!)

I now think I need to nominate Rotech for DME of the year award after hearing these stories!

Jen