Insurance coverage and part questions

I need to ask you good folks this before talking to my DME and insurance companies. (That would be Apria and Aetna, if it matters.)

Not wanting to wait for insurance to cover a new mask, I purchased a Hybrid as my latest Mask Experiment(tm). Given the time it will take for them to get stuff to me, I will need soon to get hold of Apria for replacement nasal pillows and cushion. Does anybody else have experience with insurance companies covering parts for a mask that they originally purchased out-of-pocket?

For obvious reasons, I don't want to sheepishly ask them, "Will you cover this?" because if I put it that way I know the answer already. Does anybody else have experience with this issue? I realize that it would be easier from a stress-level point-of-view to just get them online, but we pay insurance that covers 100% of this for a reason, dammit, so it's a principle thing!

I suppose the next question would be: what's the shelf-life of full face cushions and nasal pillows? If Apria says they want me to just get a six month supply, would they keep that long? What about filters? Frankly, it would save me having to deal with them every month. (Problem there is if it isn't a mask I want to deal with for six months, I'm sorta, well hosed and stuck with six months of supplies I can't use--of course, I can always throw the mask and/or supplies into the mask exchange or offer them up if I REALLY don't need it.

That's purely hypothetical situation, though, since I'm happy with the Hybrid for now. So no solicitations, please.

Doug.

As inconsistent as service appears to be from one Apria office to another (altho overall most offices seem to be pretty lousy) I can't speak for them. I can tell you that my local CPAP DME supplier doesn't even carry parts of the ComfortLite 2 mask that they say they sell a lot of.

Matter of fact, my local CPAP DME supplier's RT wasn't even bright enough to know that Medicare would pay for 2 simple nasal cushions for my CL2 every 30 days if need be. (Cat "got" my original).I actually had to look up the HCPCS code for them and give it to her. (Either that or she enjoys playing dumb - six of one, half dozen of the other w/this gal).

I don't have Apria, my local (and lousy) CPAP DME supplier is relatively "local", they cover about a 3 state area as opposed to Apria and Lincare being pretty much national chain DME suppliers.

Slinky wrote:Matter of fact, my local CPAP DME supplier's RT wasn't even bright enough to know that Medicare would pay for 2 simple nasal cushions for my CL2 every 30 days if need be.

Heh. That sounds familiar. I sent a letter to my RT "educating" him about reimbursement allowances, since he told me a blanket "every six months" for all supplies since he couldn't be bothered to check my insurance. (My reply: "So you're telling me that we just have to file claims and hope we waited long enough so they aren't denied?" No answer from him. I don't know if that's a sign of incompetence or laziness. Either one seems just as likely.

Regardless of whether I can get it from Apria, I'd love to know whether insurance will cover these things when you didn't submit a claim to them for the original mask. I can just see Apria saying that I have to get the mask from them also in order for insurance to cover it.

Doug.

It sure wouldn't surprise me either. I know when my Resmed S8 AutoSet Vantage was subject to Recall my local CPAP DME supplier would NOT handle the Recall. They told me to contact Resmed. (I got my S8 Elite from my CPAP DME but not my Vantage). The schmucks get paid $115 for each Resmed they replace! Resmed was surprised my local CPAP DME wouldn't handle the replacement, they said that ANY DME who handles Resmed products "should" have been willing to handle the Recalls since people "do" move not just across town but across state lines and across the country. Resmed saw to it that I got my replacement thru SteriCycle.

It depends on your insurance and which Apria branch. My insurance, HIP, allows Apria to give supplies that are Rxed only. So if I buy a mask to get replacement parts I need a new Rx and it has to be approved. I ordered a new comfortlite July 27, I had to get a new Rx for it, then they sent the wrong mask. So I'm still trying to get the correct mask. I also have to order my filters monthly(this is as per my insurance). 2 fine filters per month, 2 foam filters every year. If I don't call I lose the filters for that month. Apria rarely has the correct filters, so when they finally come in and get shipped to me, another month has passed that I get no filters for. I got extras from cpap.com to use(clicked a few buttons on the computer and had them in 3 days). My insurance will not reimburse me for them.

Brenda

I have Aetna... but I refuse to deal with Apria... I originally had Lincare, now I deal with a small shop.

I bought my Hybrid out of pocket from cpap.com. When it came time for a new mouth cushion for my Hybrid... I went to Lincare and they got me one. Aetna paid for it.

cflame1 wrote:I have Aetna... but I refuse to deal with Apria... I originally had Lincare, now I deal with a small shop.

I bought my Hybrid out of pocket from cpap.com. When it came time for a new mouth cushion for my Hybrid... I went to Lincare and they got me one. Aetna paid for it.

I know insurance companies and plans within those companies vary, but that's what I wanted to know. I just wanted to hear whether somebody else had had an experience with this situation. Thanks.

Doug.