Accepted a Luna G3 CPAP; am I screwed?

[drdoombot]

I was recently diagnosed with moderate obstructive sleep apnea. After waiting literally months for one DME to get back to me, I had my doctor send my prescription to Apria. They called and told me I would be getting either the Resmed 11 or Luna G3. A box came in the mail a week later and it was the Luna G3. Not knowing any better, I opened the box and started using it nightly for about a week now.

What immediately jumped out at me was the terrible data. All it tells me is the Pressure, AHI, P95, CAI and Leak Time. My numbers improve nightly, with a pressure of 7-8, AHI <1 and CAI <1. However, the lack of data stinks.

I found these forums and realize I've been stuck with a lemon. Is there any way to return a used Luna G3 to Apria and request they send a Resmed? Any excuse I can use to either claim a defective machine or explain that it isn't working for me and I NEED a Resmed? My insurance is covering woefully little of the price for this device (less than 30%), so if I am paying the vast majority for a CPAP machine, I want a good one!

Any advice would be appreciated.

[ChicagoGranny]

Luna machines are not supported by OSCAR.

Did you even get the APAP model?

[Janknitz]

The DME will have little incentive to take it as a return, because now it's used, assuming you and your insurance company bought it outright. And there's nothing wrong with it as far as function. The DME isn't going to take it back because you don't have access to more data, that's not a malfunction (and it gives you more data than many of us had from our machines in the bad old days).

Do you know if you are renting it or do you own it outright?

If you own it, perhaps you could sell it online, and use the proceeds to buy a gently used, good condition ResMed 10 or 11 Autoset (our member LSAT can help you find a decent one). If you are renting it, you can return it and get your own with help from LSAT as well.

However, you need to be aware of your insurer's policies if they paid for an outright purchase. Do you have to prove compliance to get the DME reimbursed? If so, it's not really yours until that point. So be careful you don't end up with a bill for a machine you don't own anymore.

[drdoombot]

Luna machines are not supported by OSCAR.

Did you even get the APAP model?

It is the APAP (LG3600).

Do you know if you are renting it or do you own it outright?

It was complicated. Apria rep said an upfront payment of ~$200 was required, followed by a monthly rental fee of $40 for 10 months. After which, I would be given some option to pay remaining balance so I can own the machine outright? If my math checks out, I'm paying around $600 for an $850 machine and I might have to pay more to own it? What is my insurance actually paying?

However, you need to be aware of your insurer's policies if they paid for an outright purchase. Do you have to prove compliance to get the DME reimbursed? If so, it's not really yours until that point. So be careful you don't end up with a bill for a machine you don't own anymore.

Not sure on the compliance side of things. Will call Apria to find out.

[ChicagoGranny]

Not sure on the compliance side of things. Will call Apria to find out.

The insurance company sets the compliance requirements. I would ask the insurance company.

[loggerhead12]

Any excuse I can use to either claim a defective machine or explain that it isn't working for me and I NEED a Resmed?

You can drop paper clips into it until it sparks and smokes. That's what our customers used to do when I worked for a computer maker just north of Austin.

Vendors really hate the words "fire" and "smoke". Especially if there is an accompanying YouTube video. Makes them forget all about warranties and such.

[LSAT]

You could tell that that your doctor wants to review the data and that this machine's data is not adequate

[chunkyfrog]

Better yet, ask the doctor to notify the DME to that effect.

[Janknitz]

Janknitz wrote: ↑Sun Apr 02, 2023 3:13 pm
Do you know if you are renting it or do you own it outright?
It was complicated. Apria rep said an upfront payment of ~$200 was required, followed by a monthly rental fee of $40 for 10 months. After which, I would be given some option to pay remaining balance so I can own the machine outright? If my math checks out, I'm paying around $600 for an $850 machine and I might have to pay more to own it? What is my insurance actually paying?
However, you need to be aware of your insurer's policies if they paid for an outright purchase. Do you have to prove compliance to get the DME reimbursed? If so, it's not really yours until that point. So be careful you don't end up with a bill for a machine you don't own anymore.
Not sure on the compliance side of things. Will call Apria to find out.

You are doing something called a "capped rental". Do you have Medicare? Medicare typically requires you to pay a rental co-payment for 13 months, with deductibles each calendar year. At the end of that 13 month period you own the machine. Some private insurers also do capped rentals. BEWARE--you do not own this machine, so you can't sell it. Plus, you may have to pay the deductible this year and next in addition to the monthly co-pay for rental.

I have a saying. NEVER, NEVER, NEVER, EVER, EVER, EVER believe ANYTHING a DME tells you (especially Crapria!). Always check with your INSURANCE COMPANY. DME's lie and make stuff up when they don't know exactly. And you have to watch Crapria billing carefully. When I had to deal with them their billing was ALWAYS incorrect. Plus they try to pawn off cheaper versions of supplies even when the prescriptions specified exactly what they must provide.

The questions you should have for your insurance company are:
1, IS this a capped rental?
2. What should my out of pocket costs be including deductibles this year and next if the capped rental period extends past December?
3. Can the DME charge me anything additional after the rental period is over (this is called "balanced billing" and it is illegal in most states and most insurance contracts with DME's also prohibit it)?
4. What are the compliance requirements? If you are on Medicare, you must have a face to face visit with your doctor in the first 90 days who must document that you have used the machine at least 4 hours a day for at least a 30 day period--many insurers follow the Medicare guidelines.

You can ask what happens if you don't want that machine--since it's a rental, can you end the rental contract?

The problem with asking the doctor to go to bat for another machine for you is that they all have the same billing code. If the doctor had written the prescription in the first place specifying the make and model of the machine, and written "Dispense as Written" you'd have a good argument with Crapria. But now you got a machine with the correct billing code, and they don't want it back and to provide you with a brand new machine with the same billing code. There's nothing in it for them. Neither the doctor, nor the insurer, nor the DME is going to care that you can't access your own data via Oscar. They will even tell you that you are not allowed to, or that no such software exists, or it's "not important" (to them).

Honestly, your machine does have enough data to give you some which can be useful to tweak and adjust your therapy, but if you want a machine that works with Oscar, it's probably going to have to be your own sourcing and purchase. The aggravation you'll go through trying to do otherwise, without a huge chance of success, may not be worth it.

Sorry you are in this predicament, but if it's any consolation, it could be worse if they gave you what is known as a "brick"-- a fixed CPAP with no efficacy data.