Recently Diagnosed - Cigna+ Apria - Am I scrod?????

[Tired_in_NC]

Okay here is my saga - perhaps it will help my mental balance.

Had first sleep study in Dec. I am surprised that they got and data, how can a person sleep with all that gear on. I took a sleep aid, got 2 hours or so. Lab found that AHI was 17 with 56 during REM sleep, good or bad I do not know. Hand a followup visit to see what my pressure would be. With full face mask, I had issues, they finally put a nasal mask on me ( or the drugs kicked in) and I slept. Side fact - my nose was clear the next day,i could breath out of both sides.

Saw an ENT, said that there is no nasal issues with flow, no surgery needed. Said to use machine for a month and then come back I want to pursue a surgical option.

Doc signed off on Script for BiPAP before Xmas.

During 4 days before 2006 ended, tried to figure out what to. Learned that Cigna uses Apria and everything must go through the Cigna Intake Center. These clowns managed to loose the paperwork before 2007. ( i want to get unit before end oy year as we maxed out our Copay).

The intake center called me last week to say that they found stuff and had approved a unit and that Apria should be contacting me. I wait a week and nothing, I then call the local office and play phone shuffle for 10 minutes (at least it felt like that). I set up a time to go ito the office, next Sat. What a pain.

I just wonder is this "normal" procedure for these Drones....

One other issue, my Doc seems to not know very much in this area, Said to just use the machine and that the sleep Center will handle things, well this is not the case as Apria is the DME, not the sleep center. There was no mention of compliance or monitoring. I wonder if I need to see a sleep specialist to handle this - any thoughts?

One other question. Cigna says that all must go through Apria, but in the their list of approved DME, the sleep center is listed with a bunch of other vendors. Have I been sold a bill of goods or am I getting correct information?

Enough venting...

I am getting an M serier Bipap Auto with heated humidifier, the best???

The unit is not being rented, but purchased - ouch...

I plan on getting the Encore SW from somewhere and the card reader from another source. I am cheap. I may even look at the raw data on the card if possible.

Any suggestions - I look forward to not being brusied by my snore meter

Peace to all

[Julie]

Hi, I can't comment on the Apria business because I'm in Canada and don't know the ropes there, but as far as your machine goes, it's a very good one, but are you aware that you might be able (check with your insce. people, or Apria, or whoever) to buy the machine you want through Cpap.com at the best price around and then collect the insce privately? In other words, you may not have to get it through the DME (who will charge your insce. co. double from all I've heard).

[Bearded_One]

Some people have complained about Apria, I have have only had one gripe about them and one small issue.

The gripe was that it took so long to get a "class" scheduled to get one. The small issue was when I called to get a replacement filter the service rep didn't know which filter I needed and asked if the filter was the size of my thumb or the size of my index finger -- it turned out alright and I received the proper filters.

[snoregirl]

Depending on whether or not you think you will use any or some of your deductable for 2007, you may want to check and see how much you will actually gain by doing through a local DME vs buying cash online.

Check the price of your BiPap online at cpap.com

https://www.cpap.com/simple-find-cpap-p ... AP&sortBy=

$1409 for M series auto bipap with heated humidifier. No tax, no shipping.

Make sure that the hassles of dealing with Apria or whomever is not going to cost you this price or more when you add up the much higher price from the DME and take your copay and figure in the deductable. One can get masks at the DME even if you don't buy the machine there.

Call your insurance and double check if you can get reimbursed for buying cash online too. You never know.

[Craig-Tx]

I just wonder is this "normal" procedure for these Drones....

Sounds like you are doing good with Cigna / Apria. I too am setup with them. I personally went in for my PSG sleep study I believe Nov 2 (After about 2 - 3 weeks waiting for that appt.) My CPAP Titration study on the Tuesday before Thanksgiving. Finally get everything sorted out. The scrip was sent to APRIA a week before Christmas for a REMStar PRO 2 (One of the few CPAPs that supported the software.) The Friday before Christmas, it was sent to Apria's local office. Of course because I didn't take just any CPAP, mine is a "special order." As of today, I am hoping it will be on their delivery truck Monday.

So roughly 3 months here... and counting.

Good Luck
-craig

[Snore Blower]

I've done business with Apria, and I've done business with Cigna, but tomorrow will be the first time for me that I've used them together.

Wish me luck.

[gecko1977a]

I have been with Apria as my DME since april of 06.

They did not take long for me to get my initial setup (about a week)
they seem to be good about shipping what they have in stock. Key words being IN STOCK (took almost 2 months for my FP 432 mask)

I had united healthcare when i started, but when i lost my job and got on at my new employer; I got cigna

I got the runnaround from apria (gotta call the intake center, and they are clueless). they could not find the filters for my machine, even though i told them that most all of the respironics machines take two filters and most machines use the same two filters. they argued with me about the FP432 mask being available..... FORGET IT!!!


I called the local branch and got my supplies. and that is how i have been doing it. I just told the RT that the intake center was not servicing me as well as they do at the branch (they like that cigna money since DME is covered 100%)

I called tuesday cause my hose was ripped (right at the connector) and yesterday i had a new hose (i think, i have not opened it - i am using my old hose - too much work to change my hose cover at the moment)

So, I can say that they are shaping up (wonder if it was that dang customer satisfaction poll i filled out with my name on it)

[Tired_in_NC]

[quote="snoregirl"]Depending on whether or not you think you will use any or some of your deductable for 2007, you may want to check and see how much you will actually gain by doing through a local DME vs buying cash online.

Check the price of your BiPap online at cpap.com

https://www.cpap.com/simple-find-cpap-p ... AP&sortBy=

$1409 for M series auto bipap with heated humidifier. No tax, no shipping.

Make sure that the hassles of dealing with Apria or whomever is not going to cost you this price or more when you add up the much higher price from the DME and take your copay and figure in the deductable. One can get masks at the DME even if you don't buy the machine there.

Call your insurance and double check if you can get reimbursed for buying cash online too. You never know.

[Wulfman]

Depending on whether or not you think you will use any or some of your deductable for 2007, you may want to check and see how much you will actually gain by doing through a local DME vs buying cash online.

Check the price of your BiPap online at cpap.com

https://www.cpap.com/simple-find-cpap-p ... AP&sortBy=

$1409 for M series auto bipap with heated humidifier. No tax, no shipping.

Make sure that the hassles of dealing with Apria or whomever is not going to cost you this price or more when you add up the much higher price from the DME and take your copay and figure in the deductable. One can get masks at the DME even if you don't buy the machine there.

Call your insurance and double check if you can get reimbursed for buying cash online too. You never know.

Cigna said that to use a outside souirce would be an out of network expense, 800$ ded. with 60% copay, otherwise it is in network at 20%. I know it makes no sense. I can get the combined unit for around $1325 (or somewhere in that area) As long as the price is not too outrageous, I am still better off, money wise, to use this DME. It would make better sense to get the equipment at lower cost, but this is our "GOOD" system of health care.

They (Cigna) will NOT reimburse YOU for out-of-pocket purchases and consider YOU "in-network"???

Ask them WHY? or WHY NOT? when you can save them a considerable sum of money and get the equipment you want.

If that doesn't work, here's my last question to you: How much is your health worth to get the equipment you need/want?

Best wishes,

Den

[KansasRT]

Becareful buying your machine online out of pocket and trying to get supplies at a DME through insurance. I know that if medicare did not buy a cpap machine for a patient they will not buy supplies for a cpap. (Exception- patient had a cpap before they became medicare eligible

[lvwildcat]

I also have Cigna. I don't have to change DME because I've been using mine since Nov'05. Yes starting Jan "07 Cigna is contracting with Apria. I found it cheaper to buy my supplies (masks and filters) on-line than the co-pay to my DME with their unbelievable mark up!!!

[Bearded_One]

"They (Cigna) will NOT reimburse YOU for out-of-pocket purchases and consider YOU "in-network"??? "

Why would they? "In Network" means that a product or service is provided by a specific group of participating providers. My insurance company (Aetna) will pay NOTHING if I use an out of network DME, and they pay 100% if I use an in-network DME. It doesn't matter whether the patient feels that they can save money. It doesn't matter why or why not; it is a hard and fast rule and it is just the way it is. There is a possibility that an exception could be made IF it can be shown that the patient cannot access any of the in-network DMEs.

[Wulfman]

"They (Cigna) will NOT reimburse YOU for out-of-pocket purchases and consider YOU "in-network"??? "

Why would they? "In Network" means that a product or service is provided by a specific group of participating providers. My insurance company (Aetna) will pay NOTHING if I use an out of network DME, and they pay 100% if I use an in-network DME. It doesn't matter whether the patient feels that they can save money. It doesn't matter why or why not; it is a hard and fast rule and it is just the way it is. There is a possibility that an exception could be made IF it can be shown that the patient cannot access any of the in-network DMEs.

Read it again.

I said OUT-OF-POCKET........NOT out-of-network.
YOU as a policy holder/group member should be considered "IN-NETWORK".
If you purchase prescriptions out-of-POCKET......will they reimburse you?

Den

[blarg]

YOU as a policy holder/group member should be considered "IN-NETWORK".

I believe he understood your comment. The difference is if individual patients are considered in-network. If every individual patient is in network for themselves, then they can buy stuff anywhere they want, and for many insurance/DME bedfellows, that doesn't work out so well. Also, if patients are in network, can you buy from some other patient on your insurance and have them reimburse the first guy?

I know I cannot bill my insurance for my equipment, with the stated reason being they believe my DME knows more about how to treat my OSA than I do, and if I buy something, i might mess up and buy a PVC pipe and try to use it with my CPAP to save them money, while billing them under a billing code for a hose (lol). So basically they assume we're liars and/or stupid and/or clueless, which for most patients isn't entirely untrue. I think the real reason though is so they can maintain a monopoly on my insurance money, which is fine, they just won't get much of it unless they provide me good service, which hasn't happened yet.

[Wulfman]

Let's say you're out of town on a trip and you need some medicine or have some kind of medical emergency need and the pharmacy or hospital/emergency care clinic you go to isn't part of your provider's plan. Can you pay for the medications or services out-of-pocket and get reimbursed by your provider?

Den