Is my Dr's office full of it?

I'm in the process of firing Apria ( ), having been with them for about five months of supplies and rental payments. I talked to my doc at the last appointment asking for DME recommendations. (Planning to take with a grain of salt and do my own homework, but more info never hurt.) He told me to talk to a specific person in his office, which I just did. I was told the following two things:

- I need to stay with Apria for a full year in case something goes wrong with the machine. The rental contract notwithstanding, I should continue to order my regular supplies through them for a year "just in case".

- After explaining why I wanted to fire Apria (completely screwing me over by placing orders for supplies my insurance wouldn't cover), she then told me that they definitely shouldn't be sending out supplies without a prescription. After clarifying that's actually what she meant (and picking my jaw up off the floor), I asked a couple more questions and was informed that actually, all of the supplies (pillows, cushions, masks, straps, etc) require a prescription and they shouldn't be sending out any supplies at all without one, and I should be going through the doc's office to get supplies.

She's completely 100% flat-out wrong about all of that, yes? The more I'm with this doc, the more I'm thinking I need to be looking for a new one of those as well...

JeffV wrote:She's completely 100% flat-out wrong about all of that, yes?

Well...let's put it this way...I think if she told me the sun rose in the East and set in the West I am pretty sure I would want to go look just to make sure. Poor woman doesn't have a frigging clue about how the DME business works and RX works or whatever.
100% totally wrong.

You've just discovered the main reason I ordered all of my initial equipment from https://www.cpap.com (my insurance provider reimbursed me for 80% of it) and went totally out-of-pocket after that.......most of it also from CPAP.COM.
Ten years ago, even before starting therapy and officially joining the forum, I had already read too many horror stories (here) about the brick & mortar DMEs to get suckered into doing business with them.


Den

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The doctor's office is not really going to impact you financially with the decision to fire Apria. You need to be talking with the insurance company about these concerns. They have limitations of coverage that Apria exceeded. You need to know the alternatives if you leave Apria, and discontinue the rental contract, and if the rental was mandatory to begin with. The insurance should be able to tell you if they will pay the machine out-right or if it becomes your responsibility, or what happens with an alternate provider.

Is your "doctor" a sleep clinic, or your PCP?

You can continue the machine rental contract with Crapria if you wish and simply not use them any more for future mask supplies, etc.
There's no real reason to return the machine and start a new machine contract with someone else unless you just want to.

The new supplier will needs some documentation but it should be minimal because your insurance company already has what they need.

Apria has automatic resupply but you can cancel that and have them send supplies only when YOU order them. I did that and haven't received any that I didn't order. As long as I don't need to talk to them with a problem, I will put up with them until I own the machine.

In some cases (mine) there are more complications. My doctor, who I like belongs to a medical group. Doc has his own private office and staff, but the medical group must pre approve any DME or specialist visit or anything outside of what they consider normal. One of the groups requirements is Crapria is the ONLY DME they will approve. If Crapria doesn't have an "M" number setup in their inventory system the item doesn't exist and you can't get it covered by your insurance.
So I am lucky enough to put up with Crapria, but only after I deal with my PCP and his staff and his medical group.

In my small community there are 3 or 4 medical groups that cover almost every doctor in town. The nice thing is the management company that actually manages my medical group manages at least one of the other groups in town. So even if I switched doctors and medical groups there is at least a 50/50 chance I would still be dealing with the same people.

When I fired Apria, I had them print out my records and documentation, so I could hand deliver them to the new DME.
I was very polite, complimenting the local office on their service, and blaming the main office's insistence on a credit card number;
so no one could gripe about me to my face. Behind my back, well, "what I can't hear was never said".

Your doctor's office is not full of it in that if you want insurance to pay for supplies you must have a prescription, and masks require a prescription by federal law (because they are so dangerous and likely to be abused, of course ). It may be that your initial prescription covers ongoing replenishment of supplies (most do or we'd have to constantly ask for new scripts and nobody wants that!). So you probably don't have a grounds to complain there.

You do not have to stick to Crapria for supplies as long as your insurer covers other DMEs. You can complain to your insurance company that Crapria was sending supplies you didn't ask for or need--Medicare, for example, prohibits that.

Sleeprider wrote:Is your "doctor" a sleep clinic, or your PCP?

He's my sleep doctor. He's a neurologist, and the guy I was sent to for sleep studies following a hospital stay last year.

Pugsy wrote:You can continue the machine rental contract with Crapria if you wish and simply not use them any more for future mask supplies, etc.
There's no real reason to return the machine and start a new machine contract with someone else unless you just want to.

The new supplier will needs some documentation but it should be minimal because your insurance company already has what they need.

Yep, that was pretty much what I was planning to do. Which is why it really threw me off when she told me that on the phone...

OkyDoky wrote:Apria has automatic resupply but you can cancel that and have them send supplies only when YOU order them. I did that and haven't received any that I didn't order. As long as I don't need to talk to them with a problem, I will put up with them until I own the machine.

Yeah, I've never had them on auto-resupply. The actual mistakes that were made were partly my fault but also very much theirs - they assumed they could give me a 3-month supply of pillows without checking with my insurance, and my insurance will only do it one month at a time. Also, I mistakenly ordered some of the supplies a bit early, which was my fault, but they had the reorder schedules and records just as much as I did. From my point of view, they took advantage of me (whether deliberately or through ignorant incompetence I don't really care) and I'm on the chain for a few hundred dollars now.

I started out with Apria three years ago and slowly but surely they headed down the crapper in terms of service, order accuracy and convenience. I'd get so frustrated with Apria that sometimes I'd sleep poorly the night after going round and round with them. I buy most of my stuff from CPAP.com but occasionally I'll look for super good mask and cushion deals on Ebay.

bwexler wrote:In some cases (mine) there are more complications. My doctor, who I like belongs to a medical group. Doc has his own private office and staff, but the medical group must pre approve any DME or specialist visit or anything outside of what they consider normal. One of the groups requirements is Crapria is the ONLY DME they will approve. If Crapria doesn't have an "M" number setup in their inventory system the item doesn't exist and you can't get it covered by your insurance.
So I am lucky enough to put up with Crapria, but only after I deal with my PCP and his staff and his medical group.

I believe it's illegal for a doctor or medical group to choose who fills a prescription.

Insurance can say they won't pay for providers or will pay less, but the doctor can't specify that.