My Pulmonologist is well known and highly thought of...not a rookie. He sent Apria a prescription for the Respironics Auto BiPap SV. A week ago. We heard nothing but BS from Apria until today. They said they did not know where the unit was, they were looking for it. I smelled a rat. Just like the final week before I went to Colorado in June.
I told the local manager I would be calling corporate tomorrow, seeking Adult supervision for the Sacramento Apria Branch because they could not figure out where my SV was at.
Are you sitting down? It has not even been ordered. Something called the ADC, Area Distribution Center has to..."OK" it. I may be wrong on a couple of "facts" here, but they are what I was told.
Apria has this ADC meeting to see if they think they have liability from you getting what YOUR DOCTOR prescribed. I really like the lady I am working with and she was blindsided too. I will look for another DME.
We have all seen some doctors prescribe items that might not be the best for us. I agree. But if you go to google, type in my Doctor's name, then search with the word Doctor in it, there are 13,600 hits. If you see 13,600 hits with Apria, it will be 13,599 complaints.
SO, if you have anything ordered with Apria, and they cannot tell you when it will be in, your paperwork, like mine, may be sitting around waiting for the ADC committee to review it. I made their day. They don't have my paperwork anymore.
As I told Apria, you are not qualified to sit in judgement of my prescription, your job is to fill it. You are NOT qualified to pass judgement on my doctor. And the reason he didn't make a case for getting me the equipment is because he does NOT HAVE TO!! I fired Apria and told them I will be calling Medicare and Tricare to complain about their behavior.
I think I am just about the only person on this forum to stand up for Apria over the last year or so, but this ADC thing is too far out for me.
Gotta find a new DME, nationwide.
Apria ADC may overrule your doctor.
Apria ADC may overrule your doctor.
Installing Software is like pushing a rope uphill.
I have Encore Pro 1.8.65 but could not find it listed
under software.
I LOVE the SV.
I have Encore Pro 1.8.65 but could not find it listed
under software.
I LOVE the SV.
Apria is the worst DME you can have, usually you don't have any choice in the matter because your insurance carrier "dictates" you must use them.
Why is that?
Well because Apria is a huge conglomerate who only cares about the whores on wall-street like Cramer and profits.
When a script for an Adapt SV comes across the order board they see their costs for a machine rise from $1500 to about $4500. Again they are in a profit-making business, so if that means using a "legal" loop-hole to cop out on supplying you with the machine you need they will exercise it.
I believe you have traveled to the Boston hospital to the experts in that field for CSDB diagnosis in obtaining that machine. Now your DME won't fill the order due to a legal loop-hole.
My suggestion:
Visit your attorney and have them draft a little letter to Apria and your insurance, I would also file a complaint with the FDA.
In short, I would commence with procedures to sue their ass off.
You are also close to Sacramento, get ahold of Josh Bernstein of KCRA explain your story to him, he'd love to expose the slime-ball tactics of Apria.
http://www.kcra.com/kcrainvestigates/71 ... etail.html
I used to have Apria, they are POS in my opinion.
Why is that?
Well because Apria is a huge conglomerate who only cares about the whores on wall-street like Cramer and profits.
When a script for an Adapt SV comes across the order board they see their costs for a machine rise from $1500 to about $4500. Again they are in a profit-making business, so if that means using a "legal" loop-hole to cop out on supplying you with the machine you need they will exercise it.
I believe you have traveled to the Boston hospital to the experts in that field for CSDB diagnosis in obtaining that machine. Now your DME won't fill the order due to a legal loop-hole.
My suggestion:
Visit your attorney and have them draft a little letter to Apria and your insurance, I would also file a complaint with the FDA.
In short, I would commence with procedures to sue their ass off.
You are also close to Sacramento, get ahold of Josh Bernstein of KCRA explain your story to him, he'd love to expose the slime-ball tactics of Apria.
http://www.kcra.com/kcrainvestigates/71 ... etail.html
I used to have Apria, they are POS in my opinion.
someday science will catch up to what I'm saying...
The problem is probably your Medicare.
Here's what's required for you to qualify for a respiratory assist device with a back up rate, which would include an adapt.
http://www.edssafeguardservices.eds-gov ... .09.15.pdf
A plain old diagnosis of OSA won't do it. You have to have a something like, a progressive neuromuscular disease, severe COPD with documented high carbon dioxide blood gasses, or central sleep apnea, with proof during a documented sleep study that CPAP or a Bipap without rate won't fix it.
Medicare will only do what's necessary to treat you, not give you the Cadillac if it's not required, no matter what your doctor says.
You usually have to have tried a bipap without backup rate, and have been proven to still have low sats, and high CO2 before they'll pay for a back up rate at all.
In short, if your current bipap auto is treating you sufficiently, you just plain don't qualify for reimbursement for an auto sv, and they can't legally even put it out and continue billing for your bipap without back up rate.
They can disobey your doctor, or go against Medicare guidelines, give you a very expensive piece of equipment for free, and risk losing their Medicare providers license.
No contest.
Here's what's required for you to qualify for a respiratory assist device with a back up rate, which would include an adapt.
http://www.edssafeguardservices.eds-gov ... .09.15.pdf
A plain old diagnosis of OSA won't do it. You have to have a something like, a progressive neuromuscular disease, severe COPD with documented high carbon dioxide blood gasses, or central sleep apnea, with proof during a documented sleep study that CPAP or a Bipap without rate won't fix it.
Medicare will only do what's necessary to treat you, not give you the Cadillac if it's not required, no matter what your doctor says.
You usually have to have tried a bipap without backup rate, and have been proven to still have low sats, and high CO2 before they'll pay for a back up rate at all.
In short, if your current bipap auto is treating you sufficiently, you just plain don't qualify for reimbursement for an auto sv, and they can't legally even put it out and continue billing for your bipap without back up rate.
They can disobey your doctor, or go against Medicare guidelines, give you a very expensive piece of equipment for free, and risk losing their Medicare providers license.
No contest.
Snoredog...I like your style. I did not think about suing Apria...the Cardilogist said to avoid stress. I don't like suing people. The lawyers get all the money.
I have already confirmed, with our host, he has one on the shelf and as soon as I get past one more hurdle tomorrow, I hope to have it winging its way west.
I had not thought about the $$$ side of it, but YOU are correct. My doctor is the Medical Director for Timberlake. He is out of town, so they are going to consider ordering it first thing in the morning. WHY? $$$$. They have to be sure their profit margin will be met.
ALL THAT BEING SAID, I WILL FILE A COMPLAINT WITH MEDICARE AND TRICARE ON BOTH OF THEM LATER TOMORROW. If they are putting profit ahead of our care, that is fine, but take them off the list if they won't take care of patients.
I had not seriously thought about the $$$ angle because of the tap dancing Apria was doing over "their liability" for putting that unit in my home. I told them the DR. has the liability, not the DME. They are there to procure medical items, not sit in judgement on my doctor. I called my doctors office
tonight, telling them what Apria did.
But Snoredog is about 90% right...it is all about the dollars. If Apria merely follows the doctor's orders and they think the machine ordered is a borderline incorrect prescription...should they change it? Refuse it? Plead liability issues and stall the patient until they go elsewhere??
If all of you who have had issues with Apria would write to your insurer, you
would have writer's cramp for nothing.
Fidget...My first Sleep Study said I had Central Sleep Apneas, Cheyne-Stokes Respirations, PVCs and I forget how many apneas I had per hour.
My second one was 28 events per hour...Central sleep events.
I have two sleep studies with documented central sleep apneas and one with Cheyne-Stokes Respirations and PVCs. I don't need a cadillac. I need a unit that will keep me breathing when I quit. My wife could write a letter I guess, on how many nights she used to wake up when I would quit breathing.
And Medicare is not my final authority. Tricare For Life is.
Medicare is the bare minimum on everything, but I earned Tricare and would like to have stayed, but the government thought it was helping me by putting me on medicare. Most of what I get is through Tricare For Life.
I am not sure what you mean about a "bipap without a backup rate".
My oxygen sats are fine...about 98% of the time. My wife has seen my pulse ox in the low 80s many times when I am concentrating. I forget to breath.
Maybe I am wrong Fidget, what I want is something that will keep me breathing even when I quit and my brain does not tell it to start breathing again. Will the Respironics Auto BiPap do that? Will the SV do it?
I don't want to wake up dead..pardon the expression.
My criteria won't be low sats and high CO2, I think it is the Central Sleep Apneas. I would settle for some alarm that would wake me up if I quit breathing.
"They can disobey your doctor, or go against Medicare guidelines, give you a very expensive piece of equipment for free, and risk losing their Medicare providers license." Sorry Fidget, I don't understand this at all. I would think the DME who goes to Medicare saying they want to provide a service to the patients, THEN sits and does nothing when their profit margin isn't good enough. I talked to a gentleman in Denver who worked for Apria. He said nothing bad about them, but their sheer size was what he talked about. They are so big they can't afford to use the expensive Home Fill II system much because they have to provide the same level of care to all patients. That does not make sense either. Don't they get reimbursed by Medicare, Tricare for Life, etc.??
No company can operate in the loss column forever. I don't want them too.
They need a profit, but they don't have to lie to customers, mislead them,
pretend they can't find a unit that was never ordered and so on.
BUT, whether Fidget and I like it or not, money and profit are the driving force. I have already spent a few thousand of my dollars for items the insurance would not get me. My little SPO 5500 proved my low pulse ox.
From there we went all the way to Denver and the implant in my heart. ALL because I put my money where my health is. I am selling some stuff so I
can afford the SV on my own if necessary.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): medicare, DME, Prescription
I have already confirmed, with our host, he has one on the shelf and as soon as I get past one more hurdle tomorrow, I hope to have it winging its way west.
I had not thought about the $$$ side of it, but YOU are correct. My doctor is the Medical Director for Timberlake. He is out of town, so they are going to consider ordering it first thing in the morning. WHY? $$$$. They have to be sure their profit margin will be met.
ALL THAT BEING SAID, I WILL FILE A COMPLAINT WITH MEDICARE AND TRICARE ON BOTH OF THEM LATER TOMORROW. If they are putting profit ahead of our care, that is fine, but take them off the list if they won't take care of patients.
I had not seriously thought about the $$$ angle because of the tap dancing Apria was doing over "their liability" for putting that unit in my home. I told them the DR. has the liability, not the DME. They are there to procure medical items, not sit in judgement on my doctor. I called my doctors office
tonight, telling them what Apria did.
But Snoredog is about 90% right...it is all about the dollars. If Apria merely follows the doctor's orders and they think the machine ordered is a borderline incorrect prescription...should they change it? Refuse it? Plead liability issues and stall the patient until they go elsewhere??
If all of you who have had issues with Apria would write to your insurer, you
would have writer's cramp for nothing.
Fidget...My first Sleep Study said I had Central Sleep Apneas, Cheyne-Stokes Respirations, PVCs and I forget how many apneas I had per hour.
My second one was 28 events per hour...Central sleep events.
I have two sleep studies with documented central sleep apneas and one with Cheyne-Stokes Respirations and PVCs. I don't need a cadillac. I need a unit that will keep me breathing when I quit. My wife could write a letter I guess, on how many nights she used to wake up when I would quit breathing.
And Medicare is not my final authority. Tricare For Life is.
Medicare is the bare minimum on everything, but I earned Tricare and would like to have stayed, but the government thought it was helping me by putting me on medicare. Most of what I get is through Tricare For Life.
I am not sure what you mean about a "bipap without a backup rate".
My oxygen sats are fine...about 98% of the time. My wife has seen my pulse ox in the low 80s many times when I am concentrating. I forget to breath.
Maybe I am wrong Fidget, what I want is something that will keep me breathing even when I quit and my brain does not tell it to start breathing again. Will the Respironics Auto BiPap do that? Will the SV do it?
I don't want to wake up dead..pardon the expression.
My criteria won't be low sats and high CO2, I think it is the Central Sleep Apneas. I would settle for some alarm that would wake me up if I quit breathing.
"They can disobey your doctor, or go against Medicare guidelines, give you a very expensive piece of equipment for free, and risk losing their Medicare providers license." Sorry Fidget, I don't understand this at all. I would think the DME who goes to Medicare saying they want to provide a service to the patients, THEN sits and does nothing when their profit margin isn't good enough. I talked to a gentleman in Denver who worked for Apria. He said nothing bad about them, but their sheer size was what he talked about. They are so big they can't afford to use the expensive Home Fill II system much because they have to provide the same level of care to all patients. That does not make sense either. Don't they get reimbursed by Medicare, Tricare for Life, etc.??
No company can operate in the loss column forever. I don't want them too.
They need a profit, but they don't have to lie to customers, mislead them,
pretend they can't find a unit that was never ordered and so on.
BUT, whether Fidget and I like it or not, money and profit are the driving force. I have already spent a few thousand of my dollars for items the insurance would not get me. My little SPO 5500 proved my low pulse ox.
From there we went all the way to Denver and the implant in my heart. ALL because I put my money where my health is. I am selling some stuff so I
can afford the SV on my own if necessary.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): medicare, DME, Prescription
Last edited by dllfo on Tue Aug 28, 2007 9:26 pm, edited 1 time in total.
Installing Software is like pushing a rope uphill.
I have Encore Pro 1.8.65 but could not find it listed
under software.
I LOVE the SV.
I have Encore Pro 1.8.65 but could not find it listed
under software.
I LOVE the SV.
Did your doctor do blood gasses on your current bipap settings that showed a CO2 level over 52, and an overnight oximetry that showed over 5 continuous minutes less than 89%?
If not, they CAN'T overide Medicare, and TriCare, which follows Medicare guidelines, and neither can your doctor, great though he may be.
Talk to Congress, they write the rules.
If not, they CAN'T overide Medicare, and TriCare, which follows Medicare guidelines, and neither can your doctor, great though he may be.
Talk to Congress, they write the rules.
-
Guest
The HCPC for the adapt is exactly the same as a rad with rate. It codes the same to Medicare.
dllfo, a bipap with rate is one, that like the adapt, or an s/t will trigger a breath at a set rate. You bipap auto doesn't trigger a breath. And you do probably need one. But your doc has to play the game. Tricare requires as much documentation as Medicare, and you have to wait, sometimes 6 weeks or more to get the approval.
snoredog you're dead wrong, bipap with rate is now coded as DME instead of a device "requiring frequent servicing". That means it now caps at 13 months just like every other piece of DME. It also cut reimbursement down. It used to be considered a mini ventilator. Ventilators are about the only equipment out there right now that won't cap, including oxygen equipment.
With Apria, they probably don't have them purchased for distribution yet. Apria has a massive contract with Respironics, and everytime something new comes out, it takes all the money crunchers on both sides to work out a new addendum to the contract, and yada, then they have to buy a few, and decide where they'll be needed, and so on, And, just like your local Honda dealer can decide not to carry a Suzuki, it's a for profit business, they can choose what equipment they have available.
Good luck, it's getting to be a dog eat dog world out there for medical stuff.
dllfo, a bipap with rate is one, that like the adapt, or an s/t will trigger a breath at a set rate. You bipap auto doesn't trigger a breath. And you do probably need one. But your doc has to play the game. Tricare requires as much documentation as Medicare, and you have to wait, sometimes 6 weeks or more to get the approval.
snoredog you're dead wrong, bipap with rate is now coded as DME instead of a device "requiring frequent servicing". That means it now caps at 13 months just like every other piece of DME. It also cut reimbursement down. It used to be considered a mini ventilator. Ventilators are about the only equipment out there right now that won't cap, including oxygen equipment.
With Apria, they probably don't have them purchased for distribution yet. Apria has a massive contract with Respironics, and everytime something new comes out, it takes all the money crunchers on both sides to work out a new addendum to the contract, and yada, then they have to buy a few, and decide where they'll be needed, and so on, And, just like your local Honda dealer can decide not to carry a Suzuki, it's a for profit business, they can choose what equipment they have available.
Good luck, it's getting to be a dog eat dog world out there for medical stuff.
I have to work with Apria. I'm a newbie, so I haven't gotten my first machine yet. I called Apria last week and the lady was very nice. They could only offer me the basic Respironics M Series CPAP, but they let me pick the Breeze nasal pillow mask. After I faxed them my prescription, they left me a message the next day to tell me that my stuff was shipped out via UPS and that it should arrive in 5-7 business days.
It's only been 2 days, but I expect it to get here without a problem. From what I've read about Apria, it all depends who your branch is. Some branches are much better managed than others. I know a California one sucks, while another may be great. I guess you have to get lucky with that. My insurance company is CIGNA.
Sam
It's only been 2 days, but I expect it to get here without a problem. From what I've read about Apria, it all depends who your branch is. Some branches are much better managed than others. I know a California one sucks, while another may be great. I guess you have to get lucky with that. My insurance company is CIGNA.
Sam
-
gecko1977a
- Posts: 116
- Joined: Sun May 07, 2006 4:53 am
- Location: Central and NW Ohio
- Contact:
I gotta agree with ya Sam, it IS THE BRANCH. When i need supplies, I WILL NOT call the toll-free number and talk to a call center rep. I will call the branch office in Lima, OH and talk to them. I get what i need and quick.samofny wrote:I have to work with Apria. I'm a newbie, so I haven't gotten my first machine yet. I called Apria last week and the lady was very nice. They could only offer me the basic Respironics M Series CPAP, but they let me pick the Breeze nasal pillow mask. After I faxed them my prescription, they left me a message the next day to tell me that my stuff was shipped out via UPS and that it should arrive in 5-7 business days.
It's only been 2 days, but I expect it to get here without a problem. From what I've read about Apria, it all depends who your branch is. Some branches are much better managed than others. I know a California one sucks, while another may be great. I guess you have to get lucky with that. My insurance company is CIGNA.
Sam
I finally got thru to them that I only need just the seal and foam insert for my FP 432. I was getting a whole new mask each time!!
I too have CIGNA, and they pay 100% DME with the plan I have at work.
_________________
| Mask | Humidifier | |
 |  |
Sam...Fidget...I had a LONG post about working with DMEs. Boring. I saved it to MS Word for reference.
After 3 straight mistakes, resulting in no service to me, I go to the boss, ask them who their "go to" person is and work with that person. Don't hesitate to go to corporate HQ if you have a pattern of errors. I write all of it down. Names, date & hour I called. I document it. For all you know, the person messing up your orders is doing the same for others and until you tell the boss, how is he to know? PM me if you care to hear more.
As for DMEs in general, it is money. Some of the employees like helping people, but for the boss, it is $$$. He has to be able to pay the salaries.
We are talking with Pacific Pulmonary Services. They aren't as big as Apria, but they are good to work with, so I am told. And nationwide, sort of. My next two stops for surgeries (right now) are in LA and San Francisco, so I am in good shape with them.
One of my stress areas is fear of not waking up. DUH!! My wife whacked me last night because I had quit breathing. HOW she knew is beyond me, with 2
Respironics Auto BiPap machines going, but somehow "Dr. Mom" does it. How bad do you think her stress level is? If you went to bed every night hoping your spouse didn't quit breathing. I think I quit breathing at night once or twice a month, based on how many times she nudges me, telling me to breathe.
Fidget, I AM going to Medicare and Tricare to see what a DME is responsible for. If I am asking too much, I will apologize and shut up. If the DME is shirking their responsibilites to stay current and provide the best health care,
then I write it up and present it to Tricare or Medicare or Congress.
If I order an E bottle of oxygen from Fidget and I get it, I am happy. If the company Fidget works for sends me a bottle of heliox, I am not happy. Real simple.
After 3 straight mistakes, resulting in no service to me, I go to the boss, ask them who their "go to" person is and work with that person. Don't hesitate to go to corporate HQ if you have a pattern of errors. I write all of it down. Names, date & hour I called. I document it. For all you know, the person messing up your orders is doing the same for others and until you tell the boss, how is he to know? PM me if you care to hear more.
As for DMEs in general, it is money. Some of the employees like helping people, but for the boss, it is $$$. He has to be able to pay the salaries.
We are talking with Pacific Pulmonary Services. They aren't as big as Apria, but they are good to work with, so I am told. And nationwide, sort of. My next two stops for surgeries (right now) are in LA and San Francisco, so I am in good shape with them.
One of my stress areas is fear of not waking up. DUH!! My wife whacked me last night because I had quit breathing. HOW she knew is beyond me, with 2
Respironics Auto BiPap machines going, but somehow "Dr. Mom" does it. How bad do you think her stress level is? If you went to bed every night hoping your spouse didn't quit breathing. I think I quit breathing at night once or twice a month, based on how many times she nudges me, telling me to breathe.
Fidget, I AM going to Medicare and Tricare to see what a DME is responsible for. If I am asking too much, I will apologize and shut up. If the DME is shirking their responsibilites to stay current and provide the best health care,
then I write it up and present it to Tricare or Medicare or Congress.
If I order an E bottle of oxygen from Fidget and I get it, I am happy. If the company Fidget works for sends me a bottle of heliox, I am not happy. Real simple.
Installing Software is like pushing a rope uphill.
I have Encore Pro 1.8.65 but could not find it listed
under software.
I LOVE the SV.
I have Encore Pro 1.8.65 but could not find it listed
under software.
I LOVE the SV.
your checklist doesn't even include Complex Sleep Disordered Breathing (CSDB) or CSR listed which is what the AdaptSV is scripted for.fidget wrote:The problem is probably your Medicare.
Here's what's required for you to qualify for a respiratory assist device with a back up rate, which would include an adapt.
http://www.edssafeguardservices.eds-gov ... .09.15.pdf
A plain old diagnosis of OSA won't do it. You have to have a something like, a progressive neuromuscular disease, severe COPD with documented high carbon dioxide blood gasses, or central sleep apnea, with proof during a documented sleep study that CPAP or a Bipap without rate won't fix it.
Medicare will only do what's necessary to treat you, not give you the Cadillac if it's not required, no matter what your doctor says.
You usually have to have tried a bipap without backup rate, and have been proven to still have low sats, and high CO2 before they'll pay for a back up rate at all.
In short, if your current bipap auto is treating you sufficiently, you just plain don't qualify for reimbursement for an auto sv, and they can't legally even put it out and continue billing for your bipap without back up rate.
They can disobey your doctor, or go against Medicare guidelines, give you a very expensive piece of equipment for free, and risk losing their Medicare providers license.
No contest.
It has the requirement for Central Apnea which would include a Bipap S/T.
I don't think dllfo has a plain old "OSA" diagnosis or he wouldn't have traveled all the way to Boston Beth-Israel from Sacramento for a diagnosis, that would have been done in Sacramento.
dllfo: What was the final diagnosis from Boston?
someday science will catch up to what I'm saying...
I can understand why you wouldn't want to consider a lawsuit... our society is way too litigation-happy, HOWEVER; since it sounds like you're getting seriously jerked around by these people, it might be useful to insinuate that if they don't give you what you want, there will be legal consequences...
Contacting any national or state agency that regulates this type of thing may also be helpful, as well as any of those "consumer watchdog" type programs like Snoredog mentioned.
There is a reporter here in Salt Lake City who does stories like that--consumers getting screwed around by various businesses--and your story sounds like one that would interest people who cover those kinds of stories.
Good luck!
Contacting any national or state agency that regulates this type of thing may also be helpful, as well as any of those "consumer watchdog" type programs like Snoredog mentioned.
There is a reporter here in Salt Lake City who does stories like that--consumers getting screwed around by various businesses--and your story sounds like one that would interest people who cover those kinds of stories.
Good luck!
_________________
| Mask | |
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Perplexity is the beginning of knowledge.
-Kahlil Gibran
-Kahlil Gibran
Has there ever been a case reported on this forum where someone sought outside help - a lawyer, a reporter, a government agency, Congress, a state attorney general - and prevailed against a sleep lab/doc, DME or insurance company?
Rooster
I have a vision that we will figure out an easy way to ensure that children develop wide, deep, healthy and attractive jaws and then obstructive sleep apnea becomes an obscure bit of history.https://www.youtube.com/watch?v=0ycw4uaX ... re=related
I have a vision that we will figure out an easy way to ensure that children develop wide, deep, healthy and attractive jaws and then obstructive sleep apnea becomes an obscure bit of history.https://www.youtube.com/watch?v=0ycw4uaX ... re=related