Newbie here...Has anyone gone through Molina healthcare dual

[Guest]

Hello , I'm just starting the process of getting my Cpap. I have an appointment on Thursday for what I assume is a fitting (I had everything else done) I was wondering if there will be a prior authorization for my Cpap? The DME is under the same roof as my Appt. I just want to begin this journey already ! I had my sleep study in may and I fell through the cracks somehow.

[ChicagoGranny]

I was wondering if there will be a prior authorization for my Cpap?

Policies vary. Even within the same insurance company, policies will vary. Call your insurance company and ask. Don't trust your DME. The DME doesn't know your policy as well as your insurance company knows it.

[ChicagoGranny]

I have an appointment on Thursday for what I assume is a fitting (I had everything else done)

This could be for a mask fitting and to pick up your CPAP machine. You should know BEFORE you go.

What does your prescription say? You should have a copy and know what it says.

On Thursday, make sure your machine is an Auto machine by ResMed or Philips Respironics BEFORE you take delivery. If you are not certain, don't take delivery. It's a bad mistake to get stuck with a brick.

[chunkyfrog]

Having the DME under the same roof as the doctor puts up a red flag for me.
Medicare does not allow it--EVER.
Conflict of interest, collusion, etc.
Get a list of providers in your insurance company's network.

[Guest]

Thank you everyone for your input. I called insurance company today and they said it depends on the codes they use as to wether I take it home that day or not. Unfortunately I don't have a copy of my script. I keep reading about the Resmed and phillips so I will make sure it is one of them. I have to make sure this works as I am not even sleeping in the same room as my husband . I make too many noises when I sleep lol

[ChicagoGranny]

depends on the codes they use

Yes, the people that answer phones at insurance companies have brains that don't work, so they cannot do anything without the dadgummed codes.

Here is the code for the machine - E0601 Continuous airway pressure (CPAP/APAP) device

The codes for the mask depend on whether it is a full face mask or a nasal-only mask:

A7030 Full Face Mask used with Positive Airway Pressure (CPAP/BiPAP/APAP) Device
A7034 Nasal interface (mask or cannula type) used with positive airway pressure (CPAP/BiPAP/APAP) device , with or without headstrap

Call your insurance and ask them about all three if you don't know which type mask. Of course, the machine is the bigger expense.

[Guest]

Thank you so much Chicagogranny ! That will help me tremendously, I have no idea what I'm doing lol I really like this site and will continue to use it for info . It will be awhile before I become a member. Thanks again

[ChicagoGranny]

I have no idea what I'm doing

This is to be expected when starting out. There are plenty of good people here who will help you through every step.

You might want to bookmark this thread and keep posting issues in it as you continue on this journey.

[ApneaQueen]

Hey it's me ! My account finally registered. About my username I went through hundreds of names lol and its just what stuck .

So I had to cancel my appointment today because it wasn't necessary. The DME has all it needs to hook me up.Its just a waiting game now. Have you heard of Aprea ? They just called with a recording saying i should get a call in 5 days.

[ChicagoGranny]

Yes, it is Apria. They are the largest national outfit selling CPAP. They have a bad name here. I discount that a good bit because the forum mostly gets complainers. People that are happy with Apria tend to go about their way and not post about their experience. Gramps used them for some time, and it worked out OK for him.

Do you know the exact model machine they are planning to provide?

[ApneaQueen]

I don't know the exact model . I am going to find there number so I can get more info. I will post it here when and if I get it.

[chunkyfrog]

I used Apria for awhile, but migrated to another DME when they started DEMANDING my cc #--
--even though my Medicare supplement covers 100% of my copay!

[ApneaQueen]

Yeah I keep hearing about the CC issue with Apria and they can't have mine. I am also Medicare and shouldn't have to pay anything.

I already spoke with 2 service reps and couldn't understand a word they said . Irritating to say the least, all I heard was 7 to 10 days! I will have to wait and see . I have already waited this long .