Important things newbies need to check.

[Crazy Cat Lady]

Because of the information and help that I've received from this site I was able to discover a couple of things.

I picked up a REMSTAR Plus C-Flex machine from Apria with a constant pressure of 8.
I didn't know enough to have any questions.

I joined this site and read that I should request copies of my prescription and sleep study. I also
learned that a data capable machine was really important.

I contacted Apria and asked about an auto/data capable machine. They said I had one. I told them
mine only recorded compliance. They said the other data wasn't important.

I again asked about a auto/data machine. They said I couldn't get one as my doctor had ordered a
cpap with a prescription of 8 constant pressure. In order for me to have gotten an Auto the doctor
would have needed to prescribe an auto with a pressure range. I asked to see the prescription that
Apria got. They looked and said they didn't have it. Later told me that they had worked off an order.

After reading other people's Apria experience I looked at my invoice carefully.
On the invoice, I was billed for a CPAP Unit Remstar Auto A-Flex, Model #: DS550S with a serial #PO123456789F
The machine I received was a Remstar Plus C-Flex, Model #: DS250S with a serial #PO123456789F.*
So the serial numbers were correct but the models numbers were incorrect.
*Not the real numbers.

I called my Kaiser DME and reported the discrepancy. I also asked if she could get a copy of my
prescription as I had been waiting for it from medical records. I told her I would prefer to purchase
the machine online as I didn't have any confidence in Apria but I needed my prescription.
I got a copy of my prescription and guess what.

My original prescription was for a AUTO-PAP with a pressure range of 6 to 10.

Kaiser called Apria and I had the AUTO-PAP that day.

The first 2 weeks were terrible for me at the pressure of 8. Now that I have an autopap with software I spend my
time between 6 and 7 and that has made an incredible difference in me keeping the mask on.
There is a lot more to this, but I wanted to present just the facts.

So check you invoice against the machine you have. Also check your prescription and make sure you are getting the
correct machine with the correct settings.

CONCERNS:
How was it that my doctor's prescription could be changed? And who changed it?
How could Apria mistakely bill for the high end machine and give a low end machine?
I am concerned about others who might give up therapy because they were given the wrong machine and had their prescription changed.

[napstress]

I had a similar experience this week. Since I've started on it, I've been waking up after 2 hours. After getting up for water and to pee, I'd try to put the mask on, but I'd struggle with leaks. I'd put it on again and again and still not get it right. Finally, after 3 weeks, I was adjusting the head gear, only to find it was a size medium! The doctor had prescribed headgear in size small and told me to confirm with Apria when I picked it up that it was small. I did, and they assured me it was. I guess medium headgear is the default with a small mask, but still, I asked!

[Otter]

How was it that my doctor's prescription could be changed? And who changed it?

Only your doctor could change your prescription. It wasn't changed, it was misread or the details were deliberately ignored. If pharmacist did this he'd be drawn and quartered, but DME's are not as tightly regulated. Perhaps Apria crossed the line, though. If you'd find it entertaining, contact the FDA and see if they're interested.

How could Apria mistakely bill for the high end machine and give a low end machine?

Very profitably, if they don't get caught.

[mayondair]

This might be a new low in DMEs, Good thing you checked!

[Janknitz]

After reading other people's Apria experience I looked at my invoice carefully.
On the invoice, I was billed for a CPAP Unit Remstar Auto A-Flex, Model #: DS550S with a serial #PO123456789F
The machine I received was a Remstar Plus C-Flex, Model #: DS250S with a serial #PO123456789F.*
So the serial numbers were correct but the models numbers were incorrect.
*Not the real numbers.

I called my Kaiser DME and reported the discrepancy. I also asked if she could get a copy of my
prescription as I had been waiting for it from medical records. I told her I would prefer to purchase
the machine online as I didn't have any confidence in Apria but I needed my prescription.
I got a copy of my prescription and guess what.

My original prescription was for a AUTO-PAP with a pressure range of 6 to 10.

Kaiser called Apria and I had the AUTO-PAP that day.

Whoo, hoo, you go girl! Here's the scoop that you really need to know--in the case of self-contained HMO's like Kaiser, Crapria is NOT your DME, KAiser is. Crapria is the supplier. And in the case of HMO's (NOT other types of insuers) like Kaiser, Kaiser DOES pay Crapria more for an auto machine than they do for a CPAP. So this Crapria was trying to pull a fast one! I have no doubts that it was deliberate.

And this is FRAUD. F-R-A-U-D. They were defrauding Kaiser and you the patient, and probably have done it before and gotten away with it because most patients are clueless.

To my knowledge (in my Northern California Region, at least), Kaiser won’t even prescribe a non-data machine because THEY want to make sure that the treatment is optimal and effective—it saves Kaiser money in the long run.

So, please, please, please, promise me that you will file TWO formal complaints tomorrow. One with Kaiser (yes, they already know about it, but if you file a formal complaint in writing they MUST follow-up and make sure it doesn’t happen to anyone else) AND with whatever state regulatory agency in your state regulates DME’s.

And, if you are a Medicare Advantage patient, you should file a formal complaint with Medicare as well.

Please follow up on this—it’s important that others don’t get stuck because they are not fortunate enough to access this site and know what the heck is going on.

[Breathe Jimbo]

I, too, strongly encourage you to file formal complaints. This was clearly fraud.

[Lizistired]

That must be a nice job perk for the staff there when they want a new machine!
Glad you found this site, welcome!

[Janknitz]

I might add that I think you said that you are on the Big Island and the sleep lab is on Oahu--is that correct? So Crapria really thought that they could get away with it because most outer island patients don't visit the sleep lab at Oahu too often for in person follow-up care.

Here in my Northern CA Kaiser, they ask us to bring the entire machine in to the clinic to check compliance and or problem solve issues, so they'd clearly notice if you had the wrong machine. But I doubt they are making you fly all the way to Oahu with the machine for a check--maybe you just send in the card or Crapria downloads the card to send them? So Crapria can really get away with providing a cheaper machine and the sleep lab staff at Kaiser may never notice. Kaiser should be checking the serial numbers of all the machines issued to outer island patients to see if Crapria does this switcheroo on a regular basis (I'll bet anything they DO!).

I'm sure they will try to pass this off as an inadvertent error, or claim that the local Crapria was out of autos, but Kaiser should really check other machines issued to see how often this "mistake" occurs.

Somebody should be in deep doo doo!

[Crazy Cat Lady]

Thanks for all your feedback. I did leave a message with the Kaiser manager yesterday and she got back to me today.
Wants to see all my paperwork. So I've been putting it all together with pictures to drop off tomorrow.
And I discovered another invoice I hadn't checked thoroughly.

I switched from a full face mask to nasal mask about a week ago.
Invoice and billed for
1 CPAP Kit Nasal ComforterGel Blue, Model 1070039
1 CPAP Headgear Comfort Premium, Model 1033678
1 CPAP Mask Nasal ComfortGel B, Model 1070043

What I received was
S EasyLife Mask w/Hgr, DOM
HCPCS A7034, A7035

So again, their billing doesn't match what I receive.

This is just raising my blood pressure.

[Janknitz]

Hi CCL, It's good that Kaiser is following up on your case, but I hope you will still file a formal complaint and when it asks what you think should be done to bring the matter to resolution, I hope you suggest that they check other machine serial numbers from Crapria to determine if this is a widespread issue, particularly on machines provided to outer Island Kaiser members. If you file a formal complaint, then Kaiser has to document its response to state and federal authorities, and this can't be swept under the rug as an isolated incident if it is not.

The mask discrepancy is probably not as critical. Kaiser (at least the Northern California Kaiser and I would suspect yours as well) has a "formulary" of masks and I'm pretty certain that Kaiser (your DME) pays Crapria (the supplier) one flat fee for any mask provided. So it doesn't matter much what they provide money-wise, but they are supposed to fill your RX properly. If I want a different mask here, I have to ask the sleep lab to change my RX, and they send it to the centralized Kaiser DME dept which forwards a purchase order on to Crapria.

When I got my first set up, they sent the wrong mask and I had to go through a whole rigamarole to return it. They did send out the correct mask before I figured out how to return the original mask through their “don’t have any human contact with us” procedure (another perk for Crapria doing business with Kaiser is that Crapria doesn’t have to do any of the human interaction except when they demand payment when they already have your credit card on file WITH authorization to apply it to the co-pay!). The manager whined to me that they had already sent out a “free” mask to me—their agreement with Kaiser includes a mask in the initial set-up. If they are unhappy with their profit margin from Kaiser that's THEIR problem, not mine. I'm sure it's very profitable, just from volume alone.

I prefer the Swift FX mask and it's not on the Kaiser "formulary" so I can't get it through Kaiser I'm sure this is part of their contractual agreement with Crapria. Kaiser will order only a limited formulary of masks so that Crapria can purchase wholesale in volume and offer a substantial discount to Kaiser (as indicated by my 20% co-pay, which shows me that Kaiser pays less to Crapria than places like Cpap.com retail the masks for). It's a win-win for Kaiser and Crapria, but not for me because I have to hunt elsewhere to get the mask that works best for my needs.

By the way--Happy Birthday!

[napstress]

Hmmmm... I was wondering why my doctor suggested I go with a company other than Apria, even though it would cost me $300.00 more. She said I'd get more personalized service from the other company. I decided to go w/Apria b/c I couldn't imagine circumstances under which I would spend $300.00 merely for service.

It's been a week and they still haven't contacted me about the small headgear having arrived.