CPAP help with finding a provider

[shpanky]

I've been going through this process about three months now, trying to get my equipment (multiple sleep tests and multiple doc visits...I feel like this is all a big ripoff). Finally, today I was supposed to go into Apria's offices and get fitted for a mask and pick up my cpap machine.

Not only did they supply just one option for a machine, they also did not have a mask to pick up, as their warehouse didn't send one out...they were just going to deliver it. Also, there was no option to test different masks to see what might fit right. I was told repeatedly by customer service and sleep doctors they would have this option available to me. Lastly, it was a "class-style" instruction, meaning I was there with a group of people to pick up the equipment. They planned to train us all at once, but how do you train someone who doesn't even have all the equipment they need to learn?

I walked out and refused acceptance of the equipment, so now I'm trying to figure out my next step, whether I should give up as I don't want to get ripped off by some shady medical equipment provider, or keep searching. I'm with Blue Shield CA and live in San Francisco area. Does anyone have any advice? I'm kind of over the whole process at this point.

[chunkyfrog]

Contact your insurance, and request a hard copy list of local providers in their network.
Then start calling. You are probably not stuck with one provider unless you have an HMO.

[shpanky]

Thank you chunkyfrog, this forum has been very helpful for me and scared me off from Apria anyway. I'll find someone else.

[Janknitz]

Be sure to read my blog post "What you need to know BEFORE you meet your DME" before you start calling around.

Here is how I break down the steps:
1. Choose the machine you WANT.
2. Contact your insurance company to understand HOW they reimburse for machines (usually by billing code, so any APAP or CPAP will be covered).
3. Ask your insurer which providers are in network, and what your out of pocket expenses should be (including deductibles, co-pays, etc.), and what the compliance requirements are.
4. Make sure you understand if you are required to have a rental period, or if your insurer will buy the machine outright.

Do not call around to DME's UNTIL you know the answers above. NEVER ask the DME what the answers to these questions are as you cannot trust a DME to tell you the right information about YOUR insurance plan. (DME's are often misinformed and sometimes they just lie). Being armed with this knowledge will prevent you from being vulnerable to DME games outlined in my blog.

When you choose your DME, base your decision not only on the availability of the desired machine, but also on a good mask fitting and return policy. The mask is key to success with CPAP. If you can't try on and use different masks to make sure you're able to sleep comfortably with effective therapy, it's going to be very hard to have good treatment. Crapria's approach to simply handing you ONE mask is baloney.

[Julie]

But on the off chance you can afford it, think about going with an online company (like Cpap.com) who has a very wide variety of equipment at prices a lot less than the DME charges your insce. co., and ask your insce. if they have a problem with your buying that way and then submitting the invoice... you can scan a prescription through to the providers with no problem or they can call your doctor for one.

[gary1231]

I am chiming in with my experience with Apria - it was totally different.

Here, they have a warehouse and a separate storefront in a strip mall. I went to the strip mall location to pick up my machine. I had picked out my headgear beforehand, so I don't know if there were options available at the store. The back half of the store was cubicle like areas, and I was trained one on one on how to use the machine. The Apria person was very thorough and helpful.

I am about to try and order a different kind of mask, so my opinion of them may change if it doesn't go right. I do know that I called over two hours ago to their toll free call center and was instructed to leave a message for callback. Haven't heard anything. Just tried to call them back, was put in the holding queue. No estimate of wait time.

Will try their website and see how long it takes to respond. I hate sitting on the phone on hold.

I was actually referred to Apria by another DME provider after finding out that my insurance doesn't work with the first provider (another big name, can't remember who it was).