They don't have the masks I want to try

[atruvirgo]

When I complained to my insurance (Premera in WA State) about my DME, they said they don't have any problems with who I want to go to.

Unfortunately Cigna has negotiated a sole source DME provider through Apria. From my understanding, if you want Cigna to pay anything for CPAP related DME, you MUST use Apria.

-craig
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Same here...Blue Cross contracts with APRIA...so I am stuck!

Debbie

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME

[new2]

Most dme's will order any mask you want as long as it has the right "codes". I found this out when I tried to get a new hybrid and my dme said they might lose money because the medicare office reversed some codes on the hybrid and made them apply for new ones. It looks like they finally got them and I can get another hybrid July 1.if I want.
Since the bravo mask has it's codes, any dme can order it for you and they know insurance will pay for it.
Apria is a different story. I read on a forum (apria's , no less and the post was since removed) Apria centers get paid extra money to give only certain products like the swift. someone working for apria should expand on that , in case there's more to it. It was a year ago that I saw it explained in a question forum and instead of answering the question, it was deleted.

[Slinky]

Keep in mind that Respironics, Resmed and Fisher & Paykel (the most prolific mask manufacturers) will replace tried and refused masks FREE to the local DME supplier for just filling out the required form and returning it to the manufacturer w/in 30 days. You might need to "remind" Apria that you are aware of that return policy by "the big three". Of course, that is not much help for a Hybrid or a mask from another manufacturer but ....

[Craig-Tx]

Most dme's will order any mask you want as long as it has the right "codes".

My problem with Apria isn't their refusal to get a requested product, but more a problem with their customer service.

Their "Mask Fitting" that they billed the insurance for consisted of me looking at a few select masks and holding them. I was not allowed to try breathing through a mask as part of the fitting. This happened twice. The second time, after complaining about it and was told that it wouldn't happen again.

In the beginning of April, I ordered a Twilight Aura NP. Of course they had no idea what it was, but with a bit of effort, I was able to get them to order it. About a month later I got a package on my door. It was a new UMFF mask that I did NOT order. In the last month, I have requested three times for them to refund the billed amount to Cigna. I have also yet to receive my Aura (It's coming up on 2 months now.) I understand it was "backordered". Well, I understood once I called them and asked them where it was. They have NEVER called me to inform me that a product would take longer than expected. The only way I ever get information is when I call them.

About a week ago, I was told the Aura would be delivered on the May 31st. It's June 2nd now and I haven't heard anything.

[fidget]

Apria does not recieve extra money for using preferred masks. There is however a contract with certain vendors, depending on the region for better pricing for masks, which, in a way, I guess means extra money, since, to most insurances, a mask is a mask is a mask, and the allowable is what will be paid. If you provide a mask that you contract to purchase for $30 and are reimbursed for $120, that makes more dollar sense than a mask that you buy for a patient from a vendor you have no purchasing contract with, and you have to pay full retail of, say $135, and the patient's insurance will still only reimburse that same $120. That's the reason Apria isn't providing the Hybrid till the coding changes. The last one I got in for a patient, we were reimbursed $45, due to the codes, and our cost was $135.

DMEs don't stay in business long if they lose money. They have every right not to carry products they would lose cash on. Such as the Twilight Aura. There are contracts present already with the big names, not for the smalled indie companies.

The reason it's taking so long, is that there is no contract with that company. They have to put in a request for a special order from the region, which has to put in a request through national purchasing, there has to be an account created with that company, then it has to go through the chain again to be ordered, then it has to be logged into the system, a price created, codes created, channeled back to the region, and then, if corporate approves it, you'll get it.

It's a national huge business. You couldn't walk into a Toyota dealership and order a Buick, and have it sitting in the lot, same thing. You don't walk into a Burger King, and order a Big Mac. You have every right to have whatever mask you want, they have every right to carry only the products they're going to make a profit on. If you want something different, shop for it, and feel free to purchase it.

[Slinky]

The only problem w/that explanation is that many of the smaller DME suppliers don't seem to have the same problem Apria does w/providing a mask from a non-mainstream mask manufacturer. As far as pricing I doubt very much the smaller DME suppliers get better pricing than a company such as Apria dealing w/so much larger volume.

I would think it is more the expense of paperwork that Apria doesn't want to encounter, the complicated manner local Apria offices must go thru to obtain something not usually handled by the regional and national offices. Like the higher up the chain the more narrow minded are the people involved. Apria has some good local RTs whose hands are often tied by the Regional and National offices.

[cpapnewby]

In Sept last year, I asked my local Apria branch for a Hybrid and they gave me the runaround. I know for sure the Hybrid had HCPCS codes then. In fact, I recall reading somewhere that it had a higher reimbursement than other masks.

My feeling that Apria probably also gets a fat discount on the CPAP machines if they buy the masks made by companies such as Respironics.

Jim

[fidget]

You're pretty much wrong on the coding in September, as you can see below directly from the DMERC website.

Coding decision Effective dates Comments
From 6/16/06 To 2/18/07
E1399 OR A9999 OR A7033 OR A7035 USE E1399 FOR MODEL HYB500. USE A9999 FOR MODELS HYB511, HYB513, HYB515. USE A7033 FOR MODELS HYB521, HYB523, HYB525. USE A7035 FOR HYB530.

The E1399 HCPC code is the miscellaneous code, that won't be paid without extensive documentation. The A9999 code is the same.

Not worth the paperwork, so the decision was made to not carry it.

Slinky, that's because the small DME's can just order it directly from the manufacturer. Branches can't. There is no purchasing budget for branches to purchase product directly from manufacturers. And there has to be a national account created for purchase, that's not always easily done. And it takes time, and lots of paperwork. It has to be built into the purchasing system. You can't just buy one of something. There are plusses and minuses to being involved with a large DME.

But the assumption that any business has to carry every product made is a false one. A DME is simply a business, and not a nonprofit organization.

We don't carry every brand of wheelchair, we don't carry every brand of hospital bed, we don't carry every brand of CPAP mask. That's the glory of capitalism, privately owned businesses can still make choices about the products they carry.

[Craig-Tx]

The reason it's taking so long, is that there is no contract with that company. They have to put in a request for a special order from the region, which has to put in a request through national purchasing, there has to be an account created with that company, then it has to go through the chain again to be ordered, then it has to be logged into the system, a price created, codes created, channeled back to the region, and then, if corporate approves it, you'll get it.

All that would make sense, however, The Aura was already in Apria's system. Apria orders everything by a "M" number. (Basically a product ID unique to Apria) Each product has a specific "M" number. The Twilight Aura NP is M034353. I was give it just a few days after I first asked about it. The RT had to look it up, but sure enough it was already in their system.

When I ordered the mask, I actually gave them the "M" number to order it. They were quite surprised a customer was ordering by "M" number.

Even if what was stated above was the case, I would have had no problem, if when ordering the mask, they stated that it would take some time due to ...

-craig

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CPAPopedia Keywords Contained In This Post (Click For Definition): Aura

[fidget]

All that means, is that at some time, somebody went through that whole process, and got one. That doesn't mean that there is a stock sitting on a shelf somewhere, there still has to be an order placed to the manufacturer, if it's not a commonly ordered item, and not on "par". There are order cycles, at the region level, and if you missed an order cycle, you have to wait for the next one.

Trust me, that whole process is just as frustrating to those of us trying to care for our patients, as it is to the patient.

[atruvirgo]

I also have APRIA...my biggest gripe is that they just hand me masks to try at home and they aren't properly fitted. Then when they don't work out I have to call my doctor and he has to write a script AGAIN and it starts all over! If I could actually try on a mask with pressure i wouldn't have a stock pile of un-usable masks. That seems like a waste of company money to me! Just fit the masks like you would a brace or a pair of crutchs or any other medical equipment! I try shoes on and walk around the shoe dept. before I buy them and they are alot cheaper and not worn as many hours. If I can stick my feet in shoes someone else might buy why not a mask???

Debbie

[atruvirgo]

All that means, is that at some time, somebody went through that whole process, and got one. That doesn't mean that there is a stock sitting on a shelf somewhere, there still has to be an order placed to the manufacturer, if it's not a commonly ordered item, and not on "par". There are order cycles, at the region level, and if you missed an order cycle, you have to wait for the next one.

Trust me, that whole process is just as frustrating to those of us trying to care for our patients, as it is to the patient.

Fidget just out of curiosity have you ever slept in a CPAP mask with air gusting up your nose and a mask whistling? If you have then you know first hand the frustration on the part of the OSA patient if not...first off you are lucky...2nd off...perhaps some of the insight recieved here from APRIA clients could serve to enlighten the company. No disrespect I work with the public also...BUT when your sleep is disturbed and you are at the mercy of the medical profession you feel somewhat powerless to control your destiny! I wish they could understand that a lot of money is wasted servicing patients with ill fitting masks because they are not taking the time to hear what we are saying. Trust the patient when they say, I have a narrow bridge or I have a small head! We know our bodies better than anyone! Thanks for listening!

Debbie

[jennmary]

I am all for free enterprize and understand that DME is a business....and may not be able to carry every single mask in the whole world. HOWEVER....and this is a big one. If you go to toyota and they dont have a buick you are not forced to then buy the toyota or have to pay outrageous amounts out of pocket. You are not told by your car insurance company that you HAVE to stay with that toyota dealership or they wont cover you in an accident. I get that a company needs to make money, but when they are the ONLY company that a persons insurance will cover then they should darn well try their hardest to make customers happy. But I guess if you have no competition you can treat your customers like crap....after all it is either take it or say to heck with insurance you are already paying for and go spend out of pocket.
Hope that made sense.

[bdp522]

Well said jennmary!

It also doesn't help when Apria makes me take a day off so the RT can come and fit me with a mask. They can't just mail it to me because "you have to be properly fitted". Then the RT gets here and has no idea how to assemble the mask! Both times I showed them how to assemble the masks. They then hand the mask back to me and tell me I know more about it than them. So I've been on xpap for almost a year and have yet to be fitted for a mask!
I realize that Apria has many branches and some may be very good, but that has not been my experience with them.

Brenda

[Craig-Tx]

All that means, is that at some time, somebody went through that whole process, and got one. That doesn't mean that there is a stock sitting on a shelf somewhere, there still has to be an order placed to the manufacturer, if it's not a commonly ordered item, and not on "par". There are order cycles, at the region level, and if you missed an order cycle, you have to wait for the next one.

Trust me, that whole process is just as frustrating to those of us trying to care for our patients, as it is to the patient.

Ok, As I said before, if it was supposed to take that long, they should have notified me. Let me know an approximate date.

In any case, The order cycle at Apria (at least my local branch) is every week. I placed the order in mid April. According to the National Cigna office at Apria, the order should have been placed around the 25th of April (± a couple of days, I can't remember the date they told me yesterday when I talked to them.) They were amazed that it has taken this long. They forwarded my call to the Logistics Manager of the local branch. He was apparently at lunch and I got his voice mail and left him a message.

So in your opinion, how long should I wait for him to return my call before I call back?