Apria is charging insurance 5K for non-compliance

[bryanschmiedeler]

A few months ago I got a new CPAP (DreamStation). Struggled with using it. Bought a new mask and struggled with that. Then some things happened in my personal life and I just almost totally stopped using the machine, intending to get back to using it when I sorted out these other things.

So now I am ready to use my CPAP again, lost my power cord, bought a new one.

Yesterday I got an explanation of benefits from insurance that Apria (my favorite company) is charging my insurance company 5K, I am sure for non-compliance.

First, mea culpa, I was wrong and I know it and admit it. My doctor, who is wonderful, warned me that sometimes insurance will do this. I feel very guilty about this. Really, just when I was going to get back on the wagon, this happened.

The amount I am being charged, however, is extremely out of whack I think. My last sleep study was 5 years ago or so. I bought my new mask out of pocket. The machine does not cost 5K.

Is there a way I can be on probation or something and get this amount waived/reduced or whatever?

Regardless I know I must use my CPAP and am going to do so, even if I have to pay this outrageous amount.

However, I have never liked Apria at all and after reading about them this morning I would rather just by things out of pocket. Looking at the cost of masks and supplies online the last few months I see that their prices are just ridiculous.

I am really really down about this. Any advice or suggestions would be appreciated.

Bryan

[LSAT]

If you got an "Explanation of Benefits"...it shows what was charged, and what was actually paid. Does is say that your insurance paid $5000? You can always call your insurance company and ask what it was for ? If you are non-compliant, the insurance company stops paying for the machine and your DME should take the machine back. I have never heard of a charge.

[Sheriff Buford]

5K???? Is that a typo? Crapria is the DME not the insurance. They sell the equipment... or in your case rents the equipment to you. I'd call the insurance company. But don't call them until you stop laughing!

Sheriff

[bryanschmiedeler]

Absolutely not a typo. A bit of an exaggeration...it is actually $4997 or something like that.

I am going to call insurance very very soon. When I was going to get the new CPAP I thought I wasn't due for a new machine, and was going to just guy it. It was I think about $800. So something is not right.

I do feel better that I have received two replies that make me think I am not losing my mind here. Again, I was wrong, I will correct this issue (non-compliance), but cannot imagine I really owe 5K somehow.

[bryanschmiedeler]

If you got an "Explanation of Benefits"...it shows what was charged, and what was actually paid. Does is say that your insurance paid $5000? You can always call your insurance company and ask what it was for ? If you are non-compliant, the insurance company stops paying for the machine and your DME should take the machine back. I have never heard of a charge.

I am trying to find the electronic EOB. The only parts I remember is that the provider was Apria, and it said of course this is not a bill, and that my responsibility is $4997.

Only thing I can think of is Apria said I am non-compliant, and so insurance toted up what they paid Apria (but there is no way it could be 5K) and charged it to me.

I am going to call insurance very soon. I wanted to calm down a bit and gather more information, which both of you have provided, before I called them.

[ChicagoGranny]

I am going to call insurance very soon.

Yes, and be nice to the girl you speak to. She doesn't make the policies and has no leeway or decision-making authority. They are just trained to go exactly by the policies.

I think she will be able to clear this up, and you don't owe thousands of dollars.

Please let us know how this works out.

[bryanschmiedeler]

I am going to call insurance very soon.

Yes, and be nice to the girl you speak to. She doesn't make the policies and has no leeway or decision-making authority. They are just trained to go exactly by the policies.

I think she will be able to clear this up, and you don't owe thousands of dollars.

Please let us know how this works out.

Absolutely. I used to program a CRM system and got to know the CSRs very well, and really really hated how a small minority treated some of them. Ever since I have always differentiated between the person (human being) on the other end of the phone and the corporation for whom they are working. It is the right thing to do *and* it is also the smarter thing to do.

When I have started to become particularly agitated I stop and say, I am sorry, I understand that none of this is your fault, but the situation is very frustrating to me....good way to let both people focus on the issue, not on blame for the issue.

Bryan

[Cardsfan]

I thought the only thing You are responsible for is what your Insurance Co. says you are responsible for. The DME has an agreement with your insurance co., not you. Apria can't bill you anything they want and expect you to pay it. They have to submit it to your insurance, your insurance pays their part of their negotiated prices, you pay your percentage according to what your insurance co tell you to pay. I'd just send the bill to my Insurance co.

Does the EOB state what they have paid Apria, and state what your owe Apria? That is the $ I wold be concerned with.

[bryanschmiedeler]

I thought the only thing You are responsible for is what your Insurance Co. says you are responsible for. The DME has an agreement with your insurance co., not you. Apria can't bill you anything they want and expect you to pay it. They have to submit it to your insurance, your insurance pays their part of their negotiated prices, you pay your percentage according to what your insurance co tell you to pay. I'd just send the bill to my Insurance co.

Does the EOB state what they have paid Apria, and state what your owe Apria? That is the $ I wold be concerned with.

I am trying to locate it on the web site. I tried calling them (insurance company) but they are closed. Now I am very concerned.

[LSAT]

I thought the only thing You are responsible for is what your Insurance Co. says you are responsible for. The DME has an agreement with your insurance co., not you. Apria can't bill you anything they want and expect you to pay it. They have to submit it to your insurance, your insurance pays their part of their negotiated prices, you pay your percentage according to what your insurance co tell you to pay. I'd just send the bill to my Insurance co.

Does the EOB state what they have paid Apria, and state what your owe Apria? That is the $ I wold be concerned with.

I am trying to locate it on the web site. I tried calling them (insurance company) but they are closed. Now I am very concerned.

Today's a holiday for most businesses

[chunkyfrog]

And, OF COURSE, they pulled this delightful surprise right before a long weekend.
Happy turkey day!
And now you understand why I think Apria is just another way to spell @#$%&/$.

[Goofproof]

Sounds like that would be a great incentive to Succeed. Maybe they need to put that in LARGE RED PRINT on every page of the Contract and above and below where you sign.

If so that would sure help to cure CAN'Ts. Jim

[Janknitz]

I'd be very surprised if that's the amount the insurance company will pay or that you will be responsible for. DME's regularly engage in what I call "fantasy billing". This is what they wish in their wildest dreams they could receive for their goods and services. They do this in part because when Medicare audits their books they want to look like they are losing money accepting Medicare reimbursements (if that was the case, why would they accept Medicare in the first place???).

In fact, most insurers have contracts with these DME's and will only pay what the INSURER deems to be a reasonable amount, usually a fraction of the fantasy amount Crapria wants. Your responsibility is generally only a percentage of what your INSURER allows, not what Crapria bills, although the insurer may refuse to pay its share if you didn't meet the compliance requirements. Even if you have to pay fully out of pocket because you didn't meet the compliance requirements, the most you should have to pay is your insurer's contracted price. Most state laws AND most insurance contracts prohibit a provider from charging you over and above the contracted price--it's called balanced billing and is usually illegal.

Often your insurance will only guarantee the contracted price if you use contracted or "preferred providers", and if Crapria wasn't a preferred provider for your insurance then they might charge you more than whatever your insurer considers a reasonable price. I suspect however, that Crapria is contracted with your insurer because they seem to be handling the billing directly with your insurer. You may need to confirm this, however.

[chunkyfrog]

As you get older, you will receive more and more mail that LOOKS like a bill.
It is a common scam; and works all too frequently.
Often they will go so far as making threats and masquerading as a collection agency.
It baffles me why this garbage is still legal. Or maybe it's NOT!

[Wulfman...]

A few months ago I got a new CPAP (DreamStation). Struggled with using it. Bought a new mask and struggled with that. Then some things happened in my personal life and I just almost totally stopped using the machine, intending to get back to using it when I sorted out these other things.

So now I am ready to use my CPAP again, lost my power cord, bought a new one.

Yesterday I got an explanation of benefits from insurance that Apria (my favorite company) is charging my insurance company 5K, I am sure for non-compliance.

First, mea culpa, I was wrong and I know it and admit it. My doctor, who is wonderful, warned me that sometimes insurance will do this. I feel very guilty about this. Really, just when I was going to get back on the wagon, this happened.

The amount I am being charged, however, is extremely out of whack I think. My last sleep study was 5 years ago or so. I bought my new mask out of pocket. The machine does not cost 5K.

Is there a way I can be on probation or something and get this amount waived/reduced or whatever?

Regardless I know I must use my CPAP and am going to do so, even if I have to pay this outrageous amount.

However, I have never liked Apria at all and after reading about them this morning I would rather just by things out of pocket. Looking at the cost of masks and supplies online the last few months I see that their prices are just ridiculous.

I am really really down about this. Any advice or suggestions would be appreciated.

Bryan

Don't you think you're being a little too premature in your interpretation?
Maybe they're just charging your insurance provider for the entire setup you received from them (Apria).
They may or may not be aware that you have not been compliant and just want to get their money as they usually do.

But, the best recourse for you is to just USE YOUR EQUIPMENT. If the subject of non-compliance comes up, try to convince them that you had problems and are diligently trying to use it. Your insurance provider wants to use the equipment. Apria wants you to use the equipment so they will receive their money.


Den

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