Trying to get supplies from HMO nightmare

[chunkyfrog]

Crunch your own numbers--then you can make your own best choice.
The best deal for the right machine could easily be a used machine.
Every breath you take has been through someone (or something) else.

[dream321]

I recently spoke to some America based people who work for the DME. Much more helpful, and my order is getting processed. I was apparently dealing with a overseas call center, where the workers didn't know what they were doing (or care). Ill also be receiving my order from cpap.com, so it will be good to have backup supplies.

[dream321]

Be aware that since Oscar is an HMO, they don't have to do the 13 month capped rental. They can charge you a rental fee for the rest of your life (or theirs). Under that scheme, you may end up paying many times over the retail value of your machine. I never intend to give Crapria my money every month for the rest of my life.

My insurance contract just says it's 20% copay, but nothing about whether I'd own a new machine after a rental period. Right now, with the cpap machine shortage, the higher prices, and the Resmed machines without the cellular capability, I'll use my 5 year old machine until the supply gets back to normal.

[Pugsy]

My insurance contract just says it's 20% copay, but nothing about whether I'd own a new machine after a rental period. Right now, with the cpap machine shortage, the higher prices, and the Resmed machines without the cellular capability, I'll use my 5 year old machine until the supply gets back to normal.

At some point in the future you might want to clarify exactly what the coverage for the machine is and is there a time limit on your copays. Typically if they don't tell you a time limit...there isn't one.
Since you aren't trying to get a new machine right now....you have some time to clarify coverage and be aware that coverage can change every year. I have a Medicare Advantage plan and when I first got it they had the usual 13 month time limit for the 20% copay....and then the next year...it had no time limit and became a perpetual rental. They can change things each year as to how they cover goods and services. They do it every year.

[Janknitz]

My insurance contract just says it's 20% copay, but nothing about whether I'd own a new machine after a rental period. Right now, with the cpap machine shortage, the higher prices, and the Resmed machines without the cellular capability, I'll use my 5 year old machine until the supply gets back to normal.

At some point in the future you might want to clarify exactly what the coverage for the machine is and is there a time limit on your copays. Typically if they don't tell you a time limit...there isn't one.
Since you aren't trying to get a new machine right now....you have some time to clarify coverage and be aware that coverage can change every year. I have a Medicare Advantage plan and when I first got it they had the usual 13 month time limit for the 20% copay....and then the next year...it had no time limit and became a perpetual rental. They can change things each year as to how they cover goods and services. They do it every year.

You can easily find out by requesting the "Evidence of Coverage" (EOC). That's the actual contract between you and your insurer, and you've never seen it unless you knew to ask (Contracts require a "meeting of the minds" and I never understood how medical insurers get away with binding you to a contract you've never seen and you don't know what's in it).

The EOC will tell you exactly if it's a capped rental or a perpetual rental. And, as Pugsy points out, they can change the contract every year without giving you any input or explaining the changes. So you make payments and pay two deductibles thinking you're about to own the machine, and nope--now you rent it for life. The Kaiser EOC's specify if you die or stop using the machine, then it belongs to Kaiser. So people who stop using their machines and decide to sell them on Craigslist or whatever may be in for a nasty surprise if they haven't paid attention to that particular detail in the EOC.

[dream321]

I recently spoke to some America based people who work for the DME. Much more helpful, and my order is getting processed. I was apparently dealing with a overseas call center, where the workers didn't know what they were doing (or care). Ill also be receiving my order from cpap.com, so it will be good to have backup supplies.

Update: correction. My order was never filled. aerocare/Adapthealth is an incompetent, horrible, abysmal company. It's like not having insurance at all when they're the only DME you can use.

[clownbell]

I tend to think that the Kaiser/Apria experience depends upon where you live. Kaiser geographic divisions seem to operate as separate kingdoms.

Janknitz and other members have reported awful experiences with Kaiser and Apria. I wonder where they live.

My experience with Kaiser and Apria have been first rate. I live in the SF-Bay Area, part of Kaiser's Northern California division. My original acquisition of the machine was a straight-up purchase, NOT a rental. I pay no recurring machine charges, just expendable supplies. The machine was given to me at a Kaiser sleep clinic, and it was explained to me that the transaction was a purchase. I'm on Kaiser Senior Advantage (a Medicare contract), and so I paid 20% charged to me by Apria (not Kaiser), just as one would expect with a Medicare transaction. When I need supplies, I call the special 800# which is staffed by an Apria special group dedicated to Kaiser patients. The order process is straightforward. I tell them what I want and the supplies arrive in 2-3 days. The bottom line has been excellent service. Maybe it's just where I live.

I speculated that Kaiser demanded that Apria clean up its act or lose Kaiser's business. Maybe that speculation was wrong. On the other hand, one can't argue with good results.

[Janknitz]

My experience with Kaiser and Apria have been first rate. I live in the SF-Bay Area, part of Kaiser's Northern California division. My original acquisition of the machine was a straight-up purchase, NOT a rental. I pay no recurring machine charges, just expendable supplies. The machine was given to me at a Kaiser sleep clinic, and it was explained to me that the transaction was a purchase. I'm on Kaiser Senior Advantage (a Medicare contract), and so I paid 20% charged to me by Apria (not Kaiser), just as one would expect with a Medicare transaction

First, I live in Northern California too, NorthBay specifically and I'm not on Medicare yet. And what you describe is how I got the machine I have now--I was in the last days of really good insurance, the Kaiser sleep clinic handed me a brand new machine and I got billed only 20% of an outright purchase. But I was NOT on Senior Advantage.

I don't know how you got the machine for an outright purchase on Medicare with a single purchase co-pay.

Here's the Evidence of Coverage statement for Kaiser Senior Advantage Northern California DME coverage: https://healthy.kaiserpermanente.org/co ... e-ncal.pdf See page 52:

You can see that the EOC is somewhat deliberately confusing. It starts out "Durable Medical Equipment includes such items as oxygen equipment and supplies, wheelchairs, walkers . . . and hospital beds ordered by a provider for use in the home. [Janknitz note: NONE of the listed items are owned by the member EXCEPT supplies]. The member always owns certain items, such as prosthetics.


It goes on to say "In this section, we will discuss other types of DME that you must rent."

And here's what it says about other types of DME that you MUST rent:

In Original Medicare, people who rent certain types of DME, own the equipment after 13 months. As a member of our plan, however, you will not acquire ownership of rented DME items no matter how many copayments you make for the item while a member of our plan.

While it says nothing specifically about CPAP, CPAP is ALWAYS a rented item under Medicare, and HMO's have the option of renting it for the 13 months capped rental of Original Medicare or a perpetual rental, but CPAP is not purchased outright ever by Medicare plans. So either, you weren't on a Senior Advantage Plan at the time you acquired your machine (because before Kaiser Sr. Advantage did perpetual rental, they still had to do 13 month capped rentals) OR someone at Kaiser F'd up to your advantage. Your experience is very much the exception, not the rule. Color yourself lucky--you won the lottery so to speak.

As for Crapria, watch your billing closely. Make sure that they provide what you ordered and the billing is correct. I haven't used Crapria in several years now--thank goodness--but when I did, their billing was incorrect 100% of the time.

[clownbell]

@ Janknitz. Interesting feedback. We live Alameda County in the East Bay, and thus are on the on the Alameda County plan. I do watch the billings for consumables, and they have always been completely accurate. I am one of those people who scrutinize every bill.

This is really puzzling. Not arguing, just sayin'

[Janknitz]

@ Janknitz. Interesting feedback. We live Alameda County in the East Bay, and thus are on the on the Alameda County plan. I do watch the billings for consumables, and they have always been completely accurate. I am one of those people who scrutinize every bill.

This is really puzzling. Not arguing, just sayin'

Alameda County is the same Kaiser region. You can (try to!) contact patient services in your local hospital and ask for a printed copy of your EOC. (I wouldn’t explain that you got yours as an outright purchase lest they try to fix the error now). I’m certain it won’t be any different UNLESS you are on some Employer Health Group plan as a retiree rather than the standard Kaiser Senior Advantage plan. Is that possibly why?

I haven’t used Crapria since we lost coverage for DME when my husband lost his job around 2015. ACA plans do not have DME coverage (except walkers and crutches). Perhaps Crapria improved. ‍♀️