Yay! Another newbie DME post! Aren't you excited??

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
JustTia
Posts: 108
Joined: Wed Jul 02, 2014 7:35 pm
Location: Winston Salem, NC

Yay! Another newbie DME post! Aren't you excited??

Post by JustTia » Mon Jul 21, 2014 7:16 pm

I know, I know, I know. This gets talked to death. I am new, but I searched. I know it gets talked about. I debated about being that annoying newbie who posts something with an obvious answer if one just used the search function. But several pages into the search, I still hadn't found exactly what I was looking for, so here I am.

Ok, so - like a lot of xpap newbies, I didn't find this awesome, knowledge-filled xpap utopia until AFTER I had been set up with a DME and gotten my equipment. I made the usual newb mistakes; when I was presented with a slip of paper at my sleep study, on which I was supposed to select a DME for my machine and supplies, I knew absolutely nothing about *any* of them. Like a good sheep, I just shrugged and checked off "no preference". Big - no, HUGE - mistake. I got set up with Apria. Sigh.

Now, mind you, at first I was happy with this. I mean, it took two weeks from the initial sleep study before they even did the titration study, and then another entire MONTH before I got irritated and called the sleep center to find out what was the hold up. I still hadn't even seen or heard any results from the study other than a letter that simply said I had "severe apnea". Not even any technical language such as OSA, or any information about how many events there were, etc. I was completely in the dark. So, when the center told me that they had sent the order over to Apria and gave me their number, I was thrilled.

I called Apria, and they said that they were waiting for my insurance to approve it (I have United HealthCare, who are also slow as Christmas). So, I called my insurance company, who said that they had approved it two weeks previously. First annoyance. I called Apria back the next day. I was told that it was still waiting for insurance approval. I told the rep that the UHC had told me already that it was approved two weeks previously. The rep goes into her computer system, then comes back and tells me that I was right, it WAS approved. I could come in the next day for my "class" and to get the machine. I asked her how much it would cost me. My husband and I don't do credit cards, so I wanted to know how much money I needed in the bank before I walked in. She looked in the system, and said that I owed nothing because I have already met both my deductible AND my max OOP for the year. Had a couple of surgeries early this year that knocked that one out of the ballpark already, so that was good. The sleep study and everything cost me nothing. Woo-hoo.

So, the next day I showed up for the "class", which consisted of a resp tech, another guy, and me. We went through all the stuff about how the machine works, etc. She hooked up masks for us (a medium Mirage Quattro for both of us). Mine kept leaking and leaking, but she fiddled with it and got it so that it didn't leak while I was sitting there. Granted, it leaked like a sieve once I laid down with it, but that's another story and today I'm talking about something else. Anyway, she brought out the invoices for each of us to sign. On mine, it said that I owed $120.19. Uh, no. No, I don't. I pointed that out to the tech, and she said she would go double check that. She left the room, and came back about 10 min later. She said that I was right, and when she pulled it up in the computer it showed that my ins is paying at 100% now, so I owed nothing. She marked through the prices and balance owed and initialed them, then wrote a large note in the margin for the billing people. Said that billing would take care of it when they put it in the computer. Sounded good, hunky dory, and I was out the door with my machine (mine, no rental!) for no money out of pocket, as promised.

Things were, well...bumpy those first few days. I was back in there a couple of days later to get a new mask. None of the ff fit me, we tried a bunch, open packages lying around everywhere. I was starting to feel bad, lol. Finally settled on Swift fx for her, with a chin strap to make sure I don't mouth breathe. Except there was no chin strap in my size (just call me Tiny Head, I guess). It would have to be ordered. So, again I walked out with my new stuff and paid no money.

About two weeks after getting the cpap, I got a call from an Apria rep, saying that they needed to put a credit card on file with my account in order to finish processing and setting it up. She also said that there was an outstanding balance of $120.19 that needed to be charged. I disagreed and said that my insurance was paying at 100%. She looked it up in her computer, and sure enough I was right, but that she couldn't fix it. I would have to call the billing department to get that fixed. I said that I was not comfortable sharing my card information for them to "keep on file" until that was cleared up. She said that was fine, and we hung up. I immediately called the billing department, and the rep that I spoke with there ALSO looked it up in her computer and saw that what I was saying was correct, and that I owed nothing. Meanwhile, I'm checking in with my insurance and sure enough, they are showing patient obligation for all of this stuff as $0. Again, I said I wasn't comfortable giving them my card info until they had the insurance status correct and the balance owed cleared off. Again, this was A-ok with the rep.

Two days after that I got another call from an Apria rep. My chin strap was FINALLY ready to ship (after two and a half weeks of waiting). She also said it was time for new hoses and filters, if I wanted those as well. I asked her if there was any charge for that. She looked in the computer, and said there was no charge, since my insurance was paying 100%. I said, fantastic! Go ahead, I'll take them. She said they needed a credit card on file before she could ship them out. I specifically asked if anything would be charged to the card. Oh, no ma'am, we just need it on file in order to ship out your orders. You don't owe anything for this, so there's no charge. Finally, a little hesitant and against my better judgment, I gave them my debit card info.

Two days after THAT, guess what happened?? A charge on my card for $2.88. I didn't authorize any charges. And besides, in all the discussions that dollar amount NEVER came up! I was livid. And get this - later that day a bill for $120.19 showed up in the mail.

Is $2.88 a lot of money? Well, no. But they are being jerks about getting the money back to me. I've called every couple of days for a week now and keep getting told that they are waiting for the insurance to send over verification that they are paying at 100% so that they can clear the balance owed AND refund my $2.88. WHAT??? I called my insurance co and asked them about this, because I wanted to expedite the process and get that balance cleared out before they charge my card for $120.19 that I didn't authorize. UHC rep said that they sent over that verification on 7/14. These people, not sure which ones, are seriously jerking me around now and I'm done. Clearly, every single person I have spoken with at Apria could see in their computers that I owe nothing, yet every single one of them failed to FIX IT. If they can see that I owe nothing, then why do they still need "verification"? Very frustrating. And while $2.88 isn't much, I don't trust Apria with my financial info and I'm really uncomfortable. I check my bank balance every single day in case they have dinged it for $120.19.

So, now that I've vented finally to people who may possibly understand, here's my dilemma. I'm definitely switching from Apria. I own the machine, it's not a rental, I'm done with them. They won't remove my card from their "file", so I'm going to report the card lost and get a new one so they can't charge me again. And now I'm looking for a new DME.

Local providers who are in-network for me are Lincare, Advanced Home Care, and Sleepmed Therapy services. I know that I've seen some negative reviews for Lincare here and Googling. Not so sure about the other two. One other option is to use Edgepark online, which I already use for diabetic supplies. I've seen mixed reviews for them in my diabetic groups, but I have personally not had any problem with them (nothing nearly like what has happened with Apria). I know that with local providers, they get the data off the machine and send it in to the doctor/insurance. I know that I have a modem on the back of mine that sends info back to Apria, I believe. So, if I go with Edgepark there isn't that local office to handle that. However, when I called the sleep center I found that the nurse practitioner that I'll be seeing there regularly for follow-up is able to retrieve the data from the sd card. Not sure how that works with informing UHC about my compliance, though? Is it the doctor, or the DME who reports compliance statistics to insurance? WWYD in my shoes? I definitely want to keep insurance happy because my supplies will be free for the rest of the year. Don't want to screw that up. But don't want to be stuck with a crappy DME, either. Need a happy medium.

_________________
Mask: Swift™ FX For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 set to auto, pressure 5-15, Premier style chin strap
Board culture. Learn it. Embrace it.

User avatar
sc0ttt
Posts: 396
Joined: Sat Apr 26, 2014 10:05 am
Location: East Bay San Francisco

Re: Yay! Another newbie DME post! Aren't you excited??

Post by sc0ttt » Mon Jul 21, 2014 7:23 pm

I've been seeing more and more of this "credit card on file" stuff for medical providers. Our family blood lab required it and we had to sign a form saying that whatever insurance didn't cover would be charged automatically to the card... worrisome because of stories exactly like yours and because frequently the insurance company rejects the first bill anyway for any number of reasons that are really the provider's fault.

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: 14-cm wg, Model 460, Serial Number: P10175579 4E22 SleepyHead v0.9.6 (testing)

User avatar
JustTia
Posts: 108
Joined: Wed Jul 02, 2014 7:35 pm
Location: Winston Salem, NC

Re: Yay! Another newbie DME post! Aren't you excited??

Post by JustTia » Mon Jul 21, 2014 7:32 pm

sc0ttt wrote:I've been seeing more and more of this "credit card on file" stuff for medical providers. Our family blood lab required it and we had to sign a form saying that whatever insurance didn't cover would be charged automatically to the card... worrisome because of stories exactly like yours and because frequently the insurance company rejects the first bill anyway for any number of reasons that are really the provider's fault.
Exactly! And this might not be AS big a deal if I were using a credit card because I could just pay my normal CC payment until they put the refund back on the card. But we don't use credit, so the card that I have is my check card. So when they just randomly decide to withdraw some funds, something else important is likely to bounce and I get charged $35 a pop for overdraft charges. Not cool.

_________________
Mask: Swift™ FX For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 set to auto, pressure 5-15, Premier style chin strap
Board culture. Learn it. Embrace it.

library lady
Posts: 1116
Joined: Wed Feb 05, 2014 11:10 am
Location: Rochester, MN

Re: Yay! Another newbie DME post! Aren't you excited??

Post by library lady » Mon Jul 21, 2014 7:45 pm

I have no experience with any of these DMEs that you mention; I use an independent DME. However, since you're already using a DME for your diabetic supplies, if you are comfortable with that one I'd suggest using them for CPAP supplies as well. One-stop shopping when you need to get supplies for both!

_________________
Machine: PR System One REMStar 60 Series Auto CPAP Machine
Mask: AirFit™ F10 Full Face Mask with Headgear
Additional Comments:  Sleepyhead
Now using AirFit F10 mask; Quattro Air is backup mask. RemZzzz mask liners with both.

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Yay! Another newbie DME post! Aren't you excited??

Post by palerider » Mon Jul 21, 2014 7:45 pm

hmm, I wonder if you could pop down to the store and get one of those prepaid visa 'gift cards' and use that

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

Janknitz
Posts: 8410
Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: Yay! Another newbie DME post! Aren't you excited??

Post by Janknitz » Mon Jul 21, 2014 7:51 pm

I know that I have a modem on the back of mine that sends info back to Apria, I believe.
WHY would you have a modem? You say the insurance paid for your machine outright, so there's no need for compliance data. If your doctor wants Efficacy data, all you have to do is print it out and take it in to the office.

One possible exception is whether or not your insurance company requires compliance data to pay for supplies. So ASK them if that's the case, and if so, for how long. I'm guessing Crapria just stuck it on your machine in order to charge you MORE.
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

User avatar
archangle
Posts: 9294
Joined: Sun Mar 27, 2011 11:55 am

Re: Yay! Another newbie DME post! Aren't you excited??

Post by archangle » Mon Jul 21, 2014 8:21 pm

Always file a formal dispute with such charges with the credit card company. Do it inwriting with the credit card payment. That triggers some legal issues.

Credit card companies don't like these disputes and will lean on the merchant. If a particular merchant gets too many disputed charges, the credit card company will fine them.

_________________
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Also SleepyHead, PRS1 Auto, Respironics Auto M series, Legacy Auto, and Legacy Plus
Please enter your equipment in your profile so we can help you.
Click here for information on the most common alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check for yourself.

Useful Links.

User avatar
JustTia
Posts: 108
Joined: Wed Jul 02, 2014 7:35 pm
Location: Winston Salem, NC

Re: Yay! Another newbie DME post! Aren't you excited??

Post by JustTia » Mon Jul 21, 2014 9:11 pm

palerider wrote:hmm, I wonder if you could pop down to the store and get one of those prepaid visa 'gift cards' and use that
That's a pretty good idea, actually. It might work. My worry, though, is the first time they try to charge something without permission and it gets rejected, will it affect their reporting my compliance to the insurance or anything. I think I'd rather just be done with them, you know?
Janknitz wrote:
I know that I have a modem on the back of mine that sends info back to Apria, I believe.
WHY would you have a modem? You say the insurance paid for your machine outright, so there's no need for compliance data. If your doctor wants Efficacy data, all you have to do is print it out and take it in to the office.

One possible exception is whether or not your insurance company requires compliance data to pay for supplies. So ASK them if that's the case, and if so, for how long. I'm guessing Crapria just stuck it on your machine in order to charge you MORE.
Actually, I do believe that the insurance does require compliance in order to continue to pay for supplies. And that's why I was posting this WWYD, since I'm not sure who reports my compliance to the insurance (though it seems natural that it would be the DME who does that). The doc can pull data from the sd card, but Apria stuck a modem on the back of the machine for their own data gathering as well. I spoke with a rep from UHC this afternoon, and she seemed a little unclear on the compliance reporting and what was necessary. She tried to check for me, but there was an ungodly hold time even for her (which kind of made me giggle, actually) with the clinician something-or-other she was trying to call and get more info from. I'm going to try calling again tomorrow and see if I can find out anything else.
archangle wrote:Always file a formal dispute with such charges with the credit card company. Do it inwriting with the credit card payment. That triggers some legal issues.

Credit card companies don't like these disputes and will lean on the merchant. If a particular merchant gets too many disputed charges, the credit card company will fine them.
I can do that. It wouldn't be the first time I had to dispute something. Last year my debit card number was stolen and there were a couple of charges that had to be disputed. I didn't do it right away because I was trying to figure out if this was an honest mistake or something they would quickly remedy. I'm finding now that they don't really give a flying flip about their customers, though.

_________________
Mask: Swift™ FX For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 set to auto, pressure 5-15, Premier style chin strap
Board culture. Learn it. Embrace it.

User avatar
hobbs
Posts: 872
Joined: Thu Jan 31, 2008 9:00 pm

Re: Yay! Another newbie DME post! Aren't you excited??

Post by hobbs » Mon Jul 21, 2014 10:43 pm

palerider wrote:hmm, I wonder if you could pop down to the store and get one of those prepaid visa 'gift cards' and use that
Get a Virtual CC number from your CC company; it is one time use only. Good for DMEs, satellite radio payments and other untrustworthy types.

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Yay! Another newbie DME post! Aren't you excited??

Post by palerider » Mon Jul 21, 2014 10:52 pm

hobbs wrote:
palerider wrote:hmm, I wonder if you could pop down to the store and get one of those prepaid visa 'gift cards' and use that
Get a Virtual CC number from your CC company; it is one time use only. Good for DMEs, satellite radio payments and other untrustworthy types.
go back and read where the OP said they don't use credit.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
JustTia
Posts: 108
Joined: Wed Jul 02, 2014 7:35 pm
Location: Winston Salem, NC

Re: Yay! Another newbie DME post! Aren't you excited??

Post by JustTia » Tue Jul 22, 2014 9:41 am

Latest update, after speaking with UHC this morning: The rep that I spoke to, who was a different rep from the one I spoke to yesterday, had also NOT heard of my having to report on compliance in order to continue receiving cpap supplies. She said that in their system I have approval for the cpap and supplies from June of this year until June of next year. All that I am required to do for insurance to cover those supplies is to order through a provider who is in-network. In June of next year, I will need to provide a new prescription for continued supplies. That's it. Just like with my diabetic supplies.

This means that Apria lied to me, about needing to report my compliance to insurance. Or possibly the tech was misinformed? At any rate, since the NP who will be doing my follow-up care at the sleep center can pull data off of the sd card, there is NO reason for me to have to continue using Crapria. I'm going to call Edgepark now and ask them some questions about switching over to them for supplies, and then I'm calling my bank to request a new check card, then calling Crapria to discontinue my service.

I double checked with the UHC rep, just like I did yesterday, because I don't want to do anything to mess up my insurance coverage of these supplies. The rep said, "I don't see how you could possibly do that. As long as your doctor continues to provide prescriptions and you order through an approved provider, you will continue to receive this equipment."

_________________
Mask: Swift™ FX For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 set to auto, pressure 5-15, Premier style chin strap
Board culture. Learn it. Embrace it.

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Yay! Another newbie DME post! Aren't you excited??

Post by palerider » Tue Jul 22, 2014 9:48 am

Tia, I'm by no means an authority on the whole morass of dealing with insurance companys, since I've done all my cpapping on my own without any doctor or insurance involvement (other than my pcp nodding with approval once or twice)

but... I've never read anything about an insurance company wanting compliance for anything other than the intial machine purchase... never for ongoing supplies, that just requires a Rx from almost anybody that has a rx pad.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
JustTia
Posts: 108
Joined: Wed Jul 02, 2014 7:35 pm
Location: Winston Salem, NC

Re: Yay! Another newbie DME post! Aren't you excited??

Post by JustTia » Tue Jul 22, 2014 10:06 am

palerider wrote:Tia, I'm by no means an authority on the whole morass of dealing with insurance companys, since I've done all my cpapping on my own without any doctor or insurance involvement (other than my pcp nodding with approval once or twice)

but... I've never read anything about an insurance company wanting compliance for anything other than the intial machine purchase... never for ongoing supplies, that just requires a Rx from almost anybody that has a rx pad.
Yeah...I suspect that the compliance thing is more directed at those who are renting their machines, maybe. My machine was purchased outright, though, so it makes sense that compliance would not be required beyond getting prescriptions for the supplies. I think that either the tech forgot that my machine was paid in full, or they implied that their little modem with the reporting capabilities was required, therefore retaining me as a customer because I think I have no choice. Either way, I'm done with them. Just got off the phone with Edgepark and I'm all set up to start ordering my supplies with them. AND it's already in their system that I've met my max OOP because of my diabetes supplies, so no back-and-forth with them "accidentally" charging me for supplies that insurance is paying for. Win-win. I can just throw in my "cart" the supplies that I want, and Edgepark sends a prescription request over to my doc. 3-5 days later, supplies show up at my door (allowing time for doc and ins to approve purchase). No more Crapria. Hallelujah.

_________________
Mask: Swift™ FX For Her Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 set to auto, pressure 5-15, Premier style chin strap
Board culture. Learn it. Embrace it.

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: Yay! Another newbie DME post! Aren't you excited??

Post by palerider » Tue Jul 22, 2014 1:08 pm

JustTia wrote:No more Crapria. Hallelujah.
\o/ win!

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
chunkyfrog
Posts: 34378
Joined: Mon Jul 12, 2010 5:10 pm
Location: Nebraska--I am sworn to keep the secret of this paradise.

Re: Yay! Another newbie DME post! Aren't you excited??

Post by chunkyfrog » Tue Jul 22, 2014 1:27 pm

I also fired Apria; didn't let them have any of my money, no numbers, no nothing.
My new DME doesn't need any of that--my insurance is enough.
Happy, happy.

_________________
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Airsense 10 Autoset for Her