Pissed at ADP (Canadians/Ontario)

kluzo · Post by **kluzo** » Wed Feb 06, 2008 9:48 am

This is messed up here in Ontario. I get a script for a cpap & I start looking around for different cpap machines. I do a web search and found 4 or 5 different web stores (cpap.com hands down best priced) I get set up with a trial machine which ends up being and S8 Vantage with a HC150 humidifier and at least a decent ResMed FF. After investigating through a bunch of different machines I call my local rep to get a price on the S8 Vantage and they can't/won't sell it to me because I may not likely qualify for it. ?????? HUH ?????? I have sleep apnea, sever according to the sleep study, but they insist that the S8 elite with EPR will do the same or close to the same as the Vantage. So I get a quote for a machine that I really don't want and will have to pay $1200 - $1300 out of pocket money (original quote was missing humidifier) and this quote included the $780 deduction that ADP would cover. Now this is where I get pissed off at the ADP. Because cpap.com is not on their supply list I do not qualify for the reimbursement but would have been saving them approx $300! (for the S8 only as I doubt they would reimburse for the humidifier/mask/software & card reader.) So like any smart person would do... I placed my order today with cpap.com and I am getting what I want for the same out of pocket money as I would have spent to get something I didn't want.

blah, blah, blah.... I am sure the vets of this site has seen similar posts to mine so I will simply finish off by saying

THANK YOU EVERYONE
For all your input. It has made a big difference to hear everyone’s opinion on questions I didn't even have to ask.... they were already answered here.... somewhere.

NOTE: I found in the "Collective Wisdom", I believe...could a been in a post as well, to use mouth wash to clean hose & humidifier. Crest has one out now that has no alcohol in it. Good to kill the germs/bacteria in your hose/humidifier.

sharon1965 · Post by **sharon1965** » Wed Feb 06, 2008 10:41 am

hey kluzo
i hear ya, my friend

my machine cost less than $600 on cpap.com, including the HH

medigas billed ADP and greenshield for $1200, plus the $200 they billed greenshield for my mask upgrade...and i STILL had to pay $300 myself...it is absolutely shameful how they rip us off...expensive lesson, but now i've learned it well

and don't even get me started on the bull.... about apap guidelines!!

glad you decided to go it alone, kluzo...you'll certainly get better care that way!!

thanks for the update...best of luck
sharon

gordogolfer · Post by **gordogolfer** » Wed Feb 06, 2008 11:30 am

As I mentioned in another post I got a machine I didn't want as well. However with my company plan I paid nothing for it including the mask I wanted. I will continue to obtain masks in Ontario as in my case my plan allows a new mask every 6 months.
When I am able to buy a new machine (I think it is 5 years under the plan guidelines) I'll get it Ontario for free then sell it on CPAP Auctions and buy what I want from CPAP.com

dieselgal · Post by **dieselgal** » Wed Feb 06, 2008 12:03 pm

Last March when I started cpap I called my insurance and mentioned that we could get the equipment for much less if we purchased online but they also said that would be considered out of area and if I went that way I would have to purchase myself, then turn in a claim and if they paid it would only be at 70%. So you can't save your insurance company money even if you try. I finally just let them purchase me the S8 Elite which I really like. The only thing I would get if I just had the bucks would be an AUTO but I am doing fine without that.
What frustrates me is the knowledge that insurance pays people more than they should and get less for it which affects me longterm.

Guest · Post by **Guest** » Wed Feb 06, 2008 12:43 pm

dieselgal,
This is why I am some what mad at ADP. I don't have any insurance of any sort for this kind of thing. IF I did, I would have still bought from cpap.com and submited the bill to get my 70% back. WHY, well the apap is around $2,000 (so I am told by my rep) and that is not including the mask or humidifier, but I am sure it comes with a very very nice travel bag, BUT I am told I would not fit the criteria of getting an auto cpap. When inquired about purchasing the software & card reader they said they didn't know if they could sell it to me. I am sure you can reading between the lines on that one!

"The only thing I would get if I just had the bucks would be an AUTO but I am doing fine without that."

This is more or less why I am baffled at ADP. I can get the machine I don't really want (but, like yourself, I am sure it would work fine and serve it's purpose) OR get what I want and it all costs me the same. However if you want to get your auto you would have to get it from cpap.com because of the strict requirements to qualify for an apap is apparently stupid. I don't know what they are but I am guessing Sharon has a bit better idea of that.

kluzo · Post by **kluzo** » Wed Feb 06, 2008 12:53 pm

my bad, forgot to sign in again

sharon1965 · Post by **sharon1965** » Wed Feb 06, 2008 6:11 pm

[quote="Anonymous"]. However if you want to get your auto you would have to get it from cpap.com because of the strict requirements to qualify for an apap is apparently stupid. I don't know what they are but I am guessing Sharon has a bit better idea of that.

frapilu · Post by **frapilu** » Wed Feb 06, 2008 8:16 pm

So are you guys saying that with ADP we're allowed a new mask every 6 months or is that from your healthinsurance? I've paid for every single one of my masks for the past 5 years. Sure my work health insurance reimburses me but why go to my insurance if ADP is supposed to be paying? As far as I know, ADP paid a portion of my ancient cpap almost 5 years ago and that's it.

So if it's ADP, how do I get them to pay a mask for me? For my cpap, the DME took care of it all. Should they also be taking care of masks?

Sigh.
France

sharon1965 · Post by **sharon1965** » Wed Feb 06, 2008 9:34 pm

no frap
private coverage for the mask upgrade
adp only covers part of the machine, and the crap standared mask that comes with it

frapilu · Post by **frapilu** » Thu Feb 07, 2008 5:06 am

Thanks Sharon. My health insurance refuses to specify how often I'm allowed masks. It just says "reasonable". So who knows what's reasonable? Oh well, I've been ok on mask replacements. In fact, it's my own fault that I go far too long with each mask.

France

sharon1965 · Post by **sharon1965** » Thu Feb 07, 2008 11:01 am

france
i can't believe they won't tell you what your specific replacement schedule is...can't your RT tell you? she's the one who told me exactly what greenshield will cover and when

frapilu · Post by **frapilu** » Thu Feb 07, 2008 11:27 am

Access Therapy (otherwise known as Medigas) knows nothing about what my company's health insurance policy is. I pay Access Therapy full price for the stuff I buy from them then I submit a claim to my health insurance. They have nothing to do with each other.

I've never had a problem having a mask replaced but the only time I ever tried replacing a mask in less than a year, I got a doctor's note. I had gotten my HC406 nasal mask and perhaps 6 months later, my nasal congrestion got to the point that I really needed to bite the bullet and get a full face mask. So I got a note saying that because of nasal congestion, I needed a full face mask.

I've asked various people at the health insurance company but they all go to the same document that tells them "reasonable".

France

kluzo · Post by **kluzo** » Thu Feb 07, 2008 12:28 pm

How much more "reasonable" can you get when you have your doc's note saying so????

Insurance companies have NO problem on taking your money but they just HATE getting you what you need.

Mask