Aetna Apria Stupidity

Krelvin · Post by **Krelvin** » Tue Nov 14, 2006 4:35 pm

Our company is changing Insurance companies starting Jan 2007. I noticed that Aetna was still being billed for my BiPap from Apria.

So I called Apria to find out what is going on.

They told me that it is a endless running rental. Never a purchase.

Huh?

I had been told otherwise... So I called Aetna...

They said the same thing.

So apparently, Aetna just keeps paying every month year after year for the same machine and never buys it. Stupid. Its 100% coverage, but still, very dumb.

As a result, at the end of the year, I am going to have to turn my machine back into Apria and deal with whomever/whatever Humana uses.

I've already been told it is 100% just like Aetna was, but I am not sure what is going to entail... or if I will be able to get the same machine.

I see my Doctor tomorrow so I will get an updated RX from him for the Machine (specific BiPap Auto), mask etc... so I am ready before the end of the year.

Wulfman · Post by **Wulfman** » Tue Nov 14, 2006 5:05 pm

Kevin,

You say it's 100% coverage......but do you have a deductible?

And, you will get no argument on the "stupidity" of this from me.
I'm sure Apria is smiling all the way to the bank.

Den

Snoredog · Post by **Snoredog** » Tue Nov 14, 2006 5:12 pm

yep that old 10 month rental plan then purchase seems long gone. They figure you will give up on therapy or your company will switch and they won't have to pay anymore, but it seems companies are switching insurance carriers every year and you are then left holding the short stick.

You should check out-of-network costs, even if they only cover 50% you may be better off, just get your masks from the carrier.

Today you have a job and coverage, tomorrow you could be outsourced and without and without a xpap machine. Reason I choose to buy an auto from the start.

Krelvin · Post by **Krelvin** » Tue Nov 14, 2006 5:15 pm

I'm not too worried about being outsourced. They would go out of business first... but I do see the Insurance adjusting every year.

100% coverage no deductible. That is if you call dealing with the hassle not some sort of cost.

snoregirl · Post by **snoregirl** » Tue Nov 14, 2006 7:05 pm

For me the stress of not knowing what will happen to my machine would be not worth dealing with. I guess in your situation I would buy my APAP and then get the rental 100% and use that and preserve my machine for back up purposes.

I am not one for uncertainty. I have one APAP, will be buying another in Jan. I also have a stock of swift pillows and hoses....

I like to be prepared

kteague · Post by **kteague** » Tue Nov 14, 2006 11:06 pm

It was unthinkable to me that I could be not just unemployed, but also unemployable, and uninsured at age 54. I had no plan for this eventuality. Wish I would have pushed sooner to possess everything I needed and was eligible for in equipment and supplies before the coverage ended, but was too sick to even work that thru. My insurance had purchased a cpap machine but after 8 months I still had the same mask and headgear (that wasn't working for me). I would encourage anyone to get every supply they are eligible for, and even present the rental vs purchase numbers to their insurance company and request a purchase. (Someone on here once wrote that they did that and were approved.) Never hurts to try. Several people have posted on here about being in a bind when insurances changed and they were stuck in a rental period. But an infinite rental is unbelievable. Places the insured at a higher risk or probability of experiencing that.

Krelvin · Post by **Krelvin** » Tue Nov 14, 2006 11:14 pm

With the exception of the machine, I am pretty prepared.

I've now have three of the masks that I use (two brand new), 4 extra bridges for them (I was breaking one about every 3 weeks *) and an extra set of hoses.

The results of being on the machine and not is so significant, I can't imagine going a day without it. Without AHI 92.1 With avg AHI 1.2.

I will be talking to the doctor tomorrow morning. I also found there is an Apria billing person that I can talk to about a purchase option. I can at least listen to what they say..

* with the new headgear, I haven't broken a single bridge. They were breaking because I had the mask on tight on the forehead. The new headgear has been wonderful.

Patrick A · Post by **Patrick A** » Wed Nov 15, 2006 1:05 am

And I thought I got screwed by APRIA and BC/BS FEHB.
Atleast they paid the rental on it and I owned it after 10 months.
Apria Strikes again.

sleepyinsunnyvale · Post by **sleepyinsunnyvale** » Wed Nov 15, 2006 7:57 am

Two years ago I was faced with a similar situation. CIGNA was switching from Apria to another DME. Apria said that they would not leave me without a machine and that I could keep their machine until the new DME was on board and I got their machine. You might ask Apria if they would do the same for you. They said there would be no charge but didn't say if they would extend 30, 60 or ?? days.

I only kept it for a week since i just decided to get out of the DME mire by purchasing the machine and submitting a claim to CIGNA.

yardbird · Post by **yardbird** » Wed Nov 15, 2006 11:24 am

Jumping in because I've been dealing with insurance again (I should know better) and getting more and more P***ed off!

My current Community Blue plan (HMO 202) has NO out of plan coverage for durable medical equpment. None. Anything not from a "participating DME supplier" is out of my pocket and there is NO reimbursement. At participating DME I have a 50% copay.

So I went to a local DME to look into getting replacement pillows for my Swift. They have no relationship with Resmed and "could get them through another DME, but they'd have to be marked up"....

huh?

You mean you're not only going to hold a gun to my head, but you're going to put the squeeze on my **wallet** even more as well?

OK so... no Resmed parts. Let's look at getting that ComforLite2. This is a single manufacturer's part number that has TWO billable insurance codes. The DME can bill for the mask and the headgear. This place was going to bill for mask, headgear, tubing, pillows, and on and on... I said, "Hey! Hold on a second. This is like buying a car by ordering all the parts. I'm not ordering parts now. I'm ordering the mask!"

OK so now they adjust this down to just the 2 billable codes. They HAD this up so that my 50% copay (in-plan...participating DME) was going to be $117 and change. Basically they were going to get a total of $235 for an item I can buy at cpap.com for about $90.

As it stands right now they are getting me the ComfortLite2 and my copay is about $76. So they're getting a total of $152 for something I can buy from cpap.com for $90. That's STILL being charged at 80% more than the price from cpap.com. I'm going to let them order me the comfortlite2 and see how it works out as THIS TIME it means $76 out of pocket.

Wonder why health insurance costs so much? It's because they're p***ing your money away! I am really angry over this (again.... happened when I needed a new machine as well). I am writing my congressional representative. Happens to be Hillary Clinton who is pushing for health care reform. I am also going to try to get a campaign started to enable us to buy equpment at the lowest cost. It's absolutely ridiculous as it stands right now.

I haven't had a new machine (from the insurance company) in over 5 years. Maybe I should get them to buy me one. I'll buy it from cpap.com and when I ask for reimbursement I'll send each allowable billable code to the insurance company. If I can bill them enough... it might cover my copay.

snoregirl · Post by **snoregirl** » Wed Nov 15, 2006 11:57 am

Good luck with Hillary. I have tried on a number of things no success.

The latest was for them to look into why my doctor's office was told that they couldn't have more than about 20% of their flu shots before Nov 1 because they are "giving them too early".

So it is not Ok for the doc to decide when to give flu shots but the vaccine supplier can?

And hey how about the fact that Wallmart and Rite aid and half the other grocery stores and drug stores in town had clinics and were overflowing with flu vaccine starting at the very beginning of October? Who is telling a pharmacy that they are giving it out too soon?

Of course if I go to my doc I am covered by insurance for the shot. If I walk into the grocery store I have to pay out of pocket.

Gee wonder why the stores get theirs? They are probably giving the drug distributer more money for each shot where as I believe the docs are bound by some limit due to insurance .....

All comes down to the almighty dollar.

Now I digressed, but really it all ties in. Hillary did nothing other than an auto email response in terms of answering my questions. And all the email response said was thank you for your input.

I encourage you to write her but be realistic.

While we are on Hillary. A number of years ago she was quoted in the newspapers as "going to find out why we aren't using Stewart Airport (Newburgh). We all have known this for years. TOO EXPENSIVE. Drive one more hour or so to Hartford or Newark and pay half. Not too swift if she makes a statement like this that the common folk have known for years.

yardbird · Post by **yardbird** » Wed Nov 15, 2006 1:16 pm

I understand what you're saying. And I have no delusions (ok... well THAT's debateable.... hehehe) but I do have political contacts that I have not let die. Though some of them will be going sooner than others.

I'm just getting so fired up over this. I want to buy my stuff from cpap.com. Why? Well quite frankly it's because they took really good care of me. Better than my sleep doc, my local DME AND my insurance company. I bought my machine out of pocket.

Know what the allowable billing is on a E0601 (CPAP purchase) under my plan?
$1385.15

If I get a 50% reimbursement of THAT, I can have almost any machine I want. And on the phone just now...and after confirming with a supervisor, I was told that I submit for reimbursement and reimbursement is PAID based on the code and allowable.

The ComfortLite2 has actually 2 billing codes associated. A7034 (mask) and A7035 (headgear) even though they all come under one manufacturer's part number. OK...
$117.64 allowable for E7034
$ 35.42 allowable for A7035
That's $153.06
At 50% reimbursment of THOSE prices... I could buy the mask I want from cpap.com for $89.99, submit for reimbursement on those 2 codes, and (theoretically... I KNOW they'll find a way to screw me out of this) the insurance company would reimburse me $76.53. So out of pocket for the new mask I would be $13.46.

Anyone done the reimbursement thing? I mean... is that how it works?

Aetna Apria Stupidity

Aetna Apria Stupidity

Machine Rental