United Health Care, Apria, and rental/Purchase

[JimW159]

Apria said I would need my old study and RX since it is for lifetime and a new script from my general doctor saying I need a new one and continued CPAP is needed. I am trying to get into a sleep lab but I am on about a 4 month waiting list before I can even see the doctor. Right now i am trying to get into CMMC in Lewiston but I might call MMC in Portland and see if they have anything sooner.

So I'm gonna guess you don't have your old study?

If, as our Guest suggests, you do not have a copy of your old studies you should get in touch with the sleep lab that did your diagnostic and titration studies. They are required to maintain them in their records for several years; they are also required to send you copies if you request. These would support your case in your visit with your PCP and provide valuable information to your next sleep doc. When you get them, take care to scan them and maintain secure backups so you have them readily at hand should you need them. I also agree with Pugsy in her comment; if you are happy with your decision it was the right one. Good luck.

[elfranzen]

I have the old study and I have an apt with my new Doc on Feb 6th. But I am super happy my new CPAP will be here tomorrow. Woohoo.

[Janknitz]

You should be super happy you don't have to deal with Crapria, either!

[elfranzen]

Got a call back from Apria and they said United health would not approve a new CPAP until i have another study done. I am so happy that I got one from Cpap.com and my treatment has already started again. If I waited for insurance it would be another 4-5 months before I could start again. Do you think I can still get supplies without a new study? I am going to call my local DME and see if i can get a mask and filters since me Deduticable is covered for this year.

[Pugsy]

Do you think I can still get supplies without a new study?

Doubtful because those supplies are tied to a sleep apnea diagnosis which UHC is wanting you to do another sleep study to get.

But if you don't ask the answer is always "no"...so might as well ask.

[chunkyfrog]

Since you still have the old study, and an upcoming appointment with a sleep doc,
the doc may be able to override UHC's insistence on an additional study.
(((If that statement is actually from UHC, and not a fabrication from Crapria)))
The doctor needs to understand your unwillingness to go without therapy even ONE night.
If your self-paid machine is mentioned, refer to it as a "loaner".
It is none of their business anyway.

[palerider]

Do you think I can still get supplies without a new study? I am going to call my local DME and see if i can get a mask and filters since me Deduticable is covered for this year.

cheaper at amazon/ebay.

[D.H.]

I have UHC, but not all UHC plans are the same. This was my first UHC CPAP. My out of pocket for everything (including the three-month rental/compliance period) was $51.00, the amount billed was $2,382.42. Some of the difference is the "plan discount." I had already met my deductible.

Of course, just because you have UHC doesn't mean you have the same plan. Also, you will need to meet your deductible if you have not already.

[chunkyfrog]

UHC like all other insurance companies, has hundreds of plans, designed specifically to fit the client's (employer's) specifications. DH's insurance is unlikely to be the same as anybody else's, unless they work in the same place. You need to get a statement of coverage from your insurance company or your benefits manager. The DME has no access to this information until they file the claim, which is then too late.

[D.H.]

Saving money and avoiding the "hassle" factor. Pretty much a win-win in my book.

Yes, the difference is the deductible! However, if you expect to meet the deductible next year anyhow (and your benefits are similar to mine), then I would go with them.

[Pugsy]

the difference is the deductible! However, if you expect to meet the deductible next year anyhow (and your benefits are similar to mine), then I would go with them.

Well yeah...but maybe his crystal ball is like mine...a bit foggy and we have no idea what expenses we might have next year in terms of anything that would count towards the deductible.
Plus the exact deductible amount he had was never mentioned. For all we know yours is $500 and his is $5000. That's a big difference and maybe the chances of his meeting his deductible are slim.

I kinda figured he was an adult and could do the math and make an educated decision on what he thought was best for him right now in terms of figuring up out of pocket expenses and compare the known amount now to a maybe amount next year.

Besides....not having to deal with the Crapria BS is worth a lot of dollars. He gets exactly what he wants right now and avoids a lot of hassle.

Another besides....he's already bought it and is using it right now and didn't want to wait. He's a happy camper right now...doesn't really matter what any of us would do ...does it?
Why not just be happy that he is happy?

I am so happy that I got one from Cpap.com and my treatment has already started again.

[elfranzen]

I have someone else that is getting a CPAP that works with me. He has had the study done and UHC is telling him he has to use Apria. He has made his deductible this year($1,500)(copay 80/20) but will reset at Jan 1. Apria is telling him that his deductible will not reset as he has to rent it for 10 months and then it will be paid for. When I called UHC they said that wasn't true. I told him to make sure he can give back the CPAP in Jan if that wasn't true. As it will be cheaper for him to just buy one out of pocket.

Side question. I know they bill for pap and humidifier when they are separate but what do they do when they are together(airsense 10) can they bill for both or can they only bill for the PAP.

[Pugsy]

They will still bill separately for the humidifier and the blower even though with the ResMed it is built in.
So far there isn't any HCPCS code for the machines with built in humidifiers that I am aware of.
I have always wondered what would happen should someone fail compliance (thinking Medicare) which buys the humidifier up front and only the blower gets turned back in....so the person pays for the humidifier up front (1st month and it's a separate charge)...but the humidifier gets turned in with the blower. In the past the person kept the humidifier because those are considered non returnable items like a mask.
Now I don't know how UHC does the humidifier...is it an up front purchase like Medicare or is it all part of the "rent to own"?
Since I have Medicare...I have often wondered how it would be handled.. I buy something and then I have to return it with the blower...but I paid for it the first month...doesn't seem fair and I would probably pitch a hissy fit just because I could.

[LSAT]

I have someone else that is getting a CPAP that works with me. He has had the study done and UHC is telling him he has to use Apria. He has made his deductible this year($1,500)(copay 80/20) but will reset at Jan 1. Apria is telling him that his deductible will not reset as he has to rent it for 10 months and then it will be paid for. When I called UHC they said that wasn't true. I told him to make sure he can give back the CPAP in Jan if that wasn't true. As it will be cheaper for him to just buy one out of pocket.

Side question. I know they bill for pap and humidifier when they are separate but what do they do when they are together(airsense 10) can they bill for both or can they only bill for the PAP.

I have UHC as a Medicare Advantage Plan and they do rent to own... but check it out.
Yes...They still are allowed to charge for both.

[Janknitz]

They will still bill separately for the humidifier and the blower even though with the ResMed it is built in.
So far there isn't any HCPCS code for the machines with built in humidifiers that I am aware of.
I have always wondered what would happen should someone fail compliance (thinking Medicare) which buys the humidifier up front and only the blower gets turned back in....so the person pays for the humidifier up front (1st month and it's a separate charge)...but the humidifier gets turned in with the blower. In the past the person kept the humidifier because those are considered non returnable items like a mask.
Now I don't know how UHC does the humidifier...is it an up front purchase like Medicare or is it all part of the "rent to own"?
Since I have Medicare...I have often wondered how it would be handled.. I buy something and then I have to return it with the blower...but I paid for it the first month...doesn't seem fair and I would probably pitch a hissy fit just because I could.

I've wondered what would happen if someone wanted to absolutely REFUSE the humidifier. Seems like it is fraud to force someone who doesn't want the humidifier to purchase it, considering it is a "comfort" item.