Is Medicare Crazy !?

I ordered a new Mask from APRIA. I have been using them for years. ya... they suck).

I have been on Medicare for 3 1/2 years, but have ordered supplies thru Apria while on Medicare.

This time, Medicare denied the claim saying that they could not determine I actually owned the equipment that the mask was for.

Apria has appealed and I got a copy of the letter Apria received from Medicare.

Medicare wants the below info in order to allow the claim:

QUOTE: "Beneficiary Authorization, Continued Need, Continued Use, Detailed Written Order (DWO), Dispensing Order (if applicable), Face-to-Face Examination (F2F) (if applicable), Medical records from treating practitioner, Proof of Delivery (POD), Refill Requirements, Standard Written Order (SWO), Written Order Prior to Delivery (WOPD), and Advanced Beneficiary Notice (ABN)." :UNQUOTE

WOW.... they want my Medical Records? I have a letter stating the Medical Necessity and a copy of the RX for the mask from my current Doc.

They are not asking for a "few" of these items, they want them ALL in order to process/allow the claim.

Why in the world are they asking for all of this other info if I have that letter and the Rx?

I'm not a fan of Apria, but in this case I have to say I think Medicare is asking for excessive information.

How are you all coping with this kind of problem with Medicare.

I'm worried Apria is going to come after me for the bill.

Thanks

pratzert wrote: ↑

Sat Feb 15, 2025 6:43 pm

"Beneficiary Authorization, Continued Need, Continued Use, Detailed Written Order (DWO), Dispensing Order (if applicable), Face-to-Face Examination (F2F) (if applicable), Medical records from treating practitioner, Proof of Delivery (POD), Refill Requirements, Standard Written Order (SWO), Written Order Prior to Delivery (WOPD), and Advanced Beneficiary Notice (ABN)."

Not unusual. Just have your doctor send the info to Apria.

I have had Medicare cover my CPAP gear for 18 years without question. I have used 5 DMEs but not Apria. I have never found one of them to be to my satisfaction but at least the Medicare has gone well as it is currently. Your doctor's Rx and Apria's filing for coverage should be enough or are we all about to experience some audit situation due to the political climate?

Note: When I first get a new machine I do not own it, rent is paid on it to my supplier (DME) by Medicare for a time then I own it. I do not recall how long the time is but it is substantial.

Thanks for the info ejbpesca.

It must be something that Apria is doing wrong.

And I think since I used my primary care Doc for the Rx, he isn't familiar with the Medicare requirement.

But Apria certainly SHOULD be aware.

ejbpesca wrote: ↑

Thu Feb 20, 2025 10:07 am

Your doctor's Rx and Apria's filing for coverage should be enough

-------------------->

Medicare may continue to cover CPAP devices and accessories if you meet with your doctor in person, and your doctor documents in your medical record that you meet certain conditions and the CPAP is helping you.

https://www.medicare.gov/coverage/conti ... re-devices

pratzert wrote: ↑

Fri Apr 04, 2025 10:51 pm

pratzert