And So The DME Saga Continues AGAIN

ajraih1 wrote:If you are putting any faith what-so-ever in Apria, then my prayers are with you.

Well yikes, I just finished reading some old posts about Apria and am now scared. Isn't there one honest, helpful, compliant DME on this planet? I mean, when i get a list of DME's from my doctor and the first three she recommends are all bad, that is scary! I'm just at a loss. Hopefully armed with copies of my prescription, letter of necessity, and my sleep studies, I can minimize any screw job Apria tries. You know, I was diagnosed with OSA almost two months ago and I still don't have a machine.

What is the machine at the bottom of your posting?

I went almost 4 months from my first sleep study until I got my equipment.

Linda3032 wrote:So it's getting late on a Friday afternoon.

What has happened with the problem today? Hopefully you are not waiting for them to get back to you.

Not too much has happened today. My medical information was transferred from the company that could only provide ResMed equipment (a problem because you can't get an APAP from ResMed that has C-Flex in auto mode) to the next one on the list from my doctor, Apria. I faxed a request to my doctor today that included my old prescription, what I needed it changed to, along with a request to get a copy of my letter of necessity. The latter I think I'll just ask the office for on Monday. As I have to work, I can't just sit at the doctor's office day and wait, though I'd like to. The earliest I could get an appointment to get my machine was August 1st, though they said one of their RT's may be able to fit me in for an in-home appointment. If I tried to get an M series APAP they said I might have to wait up to a month for it to come in, so I may just go with the Remstar Pro2 APAP because I'm sick of waiting. I'm hoping and praying that Apria can at the very least give me my machine, and maybe not totally over charge my insurance. I'm just getting really weary from the whole experience, Linda.

I'm assuming you meant Remstar Pro 2 cpap, not apap.

I know you are getting weary - that's part of the DME strategy. They already know you are tired and sleep deprived. They are just hoping they can wear you down so you will accept what they give you.

Before DME defenders start yelling at me, I will say I'm speaking in generalities. I know there are a few good ones out there (very few).

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME, APAP

[quote="Linda3032"]I'm assuming you meant Remstar Pro 2 cpap, not apap.

I know you are getting weary - that's part of the DME strategy. They already know you are tired and sleep deprived. They are just hoping they can wear you down so you will accept what they give you.

Before DME defenders start yelling at me, I will say I'm speaking in generalities. I know there are a few good ones out there (very few).

I really don't see where you would be sorry to get the same as I have. It's a great machine.

Go to Apria's site and look at all of the complaints in thier forums. Do a search for Apria on this site. This is the company that I deal with. I have only had them for a short while and I already can't stand the incompetence I see in this company. The left hand doesn't know what the right hand is doing.

I have the Remstar AUTO and I am quite happy with it. I have no experience with the M, but unless you need a super small machine to travel a lot the one I have is very nice. It sits in my bedroom and really doesn't take up much room and is very very quiet.

I also have Apria. While at first they didn't want to give me the auto (claimed insurance wouldn't pay) I sat them out. I did this because like you I am stubborn, I wanted what was on my prescription, and it will be $280 vs $709 cash with no insurance at CPAP.com. I won't go into all the gory details on that cost differential or my experiences with APRIA. I think if you want to see it you can easily search on my user name.

But the points I am making is APRIA does give APAP, maybe not without making you work, but it can be done. And I like the old Remstar Auto just fine.

Good luck with Apria and be firm.

Jay, who is your insurance co?

Sorry, I have been out all day which is why I didn't answer sooner.

I really don't want to name my insurance since it is really my work company which covers its own but gets someone else to administer it.

I hope that makes sense.

Means that it is not one of the big standard ones that you can compare to
but instead a contract for an insurance company to administer the plan but the employer actually funds it.

My company play denied my apap. But it is really is irrelivant due there only being one CPAP billing code (APAP is the same as CPAP) it is transparent to the insurance if the DME chooses to honor the prescription.

Lots of threads on this too.

Seems to me you are in better shape than I was since your insurance company actually said that they would pay for an APAP.

ajraih1 wrote:Jay, who is your insurance co?

My insurance company is Anthem. After reading everything about Apria, and MAINLY after discovering that HomeReach is affiliated with OhioHealth (a non-profit health care provider, and where I had my sleep study performed), I will be using HomeReach. One day I will ask my doctor why she didn't send me straight to them since they are affiliated with her clinic and are a non-profit provider.

You mentioned the possibility of having a unit home delivered and set up. I did this when I first started on cPAP. I was given the option to come in or have someone stop by and drop it off, since I did not know where their office was I opted to have them come to me. They brought the machine and a comfortgel mask which is what I used during my sleep study.

I recently went in to get a loaner machine while they shipped my malfunctioning cpap machine in for repair. While I was there I asked about getting an activa mask. While I was there the DME let me try on 3-5 other masks as well, a couple of different nasal pillow interfaces that I had been considering. This proved very benificial because I discovered the headgear for those units are not secure with the shape of my head.

It seems like finding a DME that lets you try on masks to find a comfortable one is a rarity. Still, I only had the option when I went into the DME's office and specifically asked, over a year after starting my cpap therapy. Many insurance companies only pay for masks ever 6 months and new cushions/mask parts every 3 months or so. Getting a good mask seems like a lifelong endevour, there is always a new mask out that looks like it might work a little better. Having the option to try on a few options can save you tons of money and time wondering if a particular mask would work well for you. I would definately recomend asking if you can try on a few mask types if you came into the DME office. It doesn't hurt to ask. Good luck!

Will

Just a couple of comments.

1. In response to the issue of wanting a RemStar M (as opposed to a more traditional RemStar model: First, it's like BMWs. Everybody knows that the M models are better, and that's why they're more expensive and come in cooler colors too. But seriously, there are some good reasons for perferring an M (ceteris paribus). When I decided to get an APAP, I looked seriously at the M and very likely would have gotten one if it had been available. But I got the 420E instead. Why? Two reasons. The primary one is size and the fact that I sometimes need to travel. The smaller machines are a LOT more convenient when travelling by plane or hauling around in luggage. (That's why a lot of airline pilots use them!) Second, the better integrated heated humidifier. I don't know how this works in the case of the M, but with the 320e, it is quite good and again takes up a lot less space than alternatives. So if you travel at all, an M (or 420e) is something to consider.

2. Doctors and prescriptions. I don't know what kind of insurance plan JayPSU has and consequently how much choice he has in selecting a doctor. But there a couple of things to consider. First, writing a prescription (or multiple prescriptions) is not a burden to a doc. If your doc won't do it, there are a couple of alternatives. One is to switch docs. Who wants a doc that won't do something completely reasonable? Second, virtually any doc can write a prescription for a CPAP/APAP. If you're regular doc (internist, family doc, etc.) won't do it, get a referral to another doc and try that one. If you are working with a "sleep doctor", try going through your family doc. But don't IMAGINE that this is beginning to annoy your doctor. Just ask him/her to write a prescription for exactly what you want and fax or mail it to you. Or go pick it up. As an example, when about a month ago I decided I really wanted to switch to an APAP (and knew that my insurance -- Aetna -- wouldn't go for it and I'd have to do it out of pocket), I called my doctor, talked to her nurse and said "Look, I'm tired of this CPAP stuff. I want a prescription for an APAP." She said "What should it say?" I told her and she said "I'll check with Dr. R... and get back to you." About an hour later, she called back and said "Come and pick it up this afternoon." Now it's true that my doc knows that she can depend on me for objective reports and decisions. But in general, a doctor who knows you should be willing to do this. If not, they haven't been paying enought attention to your care.

By the way, my DME is Apria. No further comment. Enough has been said about that.

ghmerrill wrote:But seriously, there are some good reasons for perferring an M (ceteris paribus).

I had to Google....

Ceteris paribus is a latin phrase for "all else being equal."

Ceteris paribus is a Latin phrase, literally translated as "with other things [being] the same," and usually rendered in English as "all other things being equal."

I do love languages. Cool phrase, that one.

ghmerrill wrote:Just a couple of comments.
(snip)

2. Doctors and prescriptions. (snip) First, writing a prescription (or multiple prescriptions) is not a burden to a doc. (snip) If you are working with a "sleep doctor", try going through your family doc. But don't IMAGINE that this is beginning to annoy your doctor. Just ask him/her to write a prescription for exactly what you want and fax or mail it to you. Or go pick it up. (snip) I called my doctor, talked to her nurse and said "Look, I'm tired of this CPAP stuff. I want a prescription for an APAP." She said "What should it say?" I told her and she said "I'll check with Dr. R... and get back to you." About an hour later, she called back and said "Come and pick it up this afternoon." Now it's true that my doc knows that she can depend on me for objective reports and decisions. But in general, a doctor who knows you should be willing to do this. If not, they haven't been paying enought attention to your care.

By the way, my DME is Apria. No further comment. Enough has been said about that.

First of all, there actually have been a (very) few GOOD experiences with Apria.

Secondly, the doctor should be very concerned about her prescriptions being filled correctly. This is not ANYTHING out of the ordinary to expect to have a correct prescription written--and if you are willing to go pick it up, all the better.

Doctors need to know the feedback on various providers. They may not need this information to help you, but it does help them to know how to prescribe for others. That said, now that doctor and her office need to give you the correct support.

While my sleep doctor is nice, he has still not given me as much information as my internist, or my psychiatrist--and my internist had almost nothing to do with the sleep study. In fact, I'm thinking of having one of them write MY next scrip.

This is just one demonstration of needing to be an advocate for oneself. This always seems to be required for medical treatment when one is least able to do so.