Recently Diagnosed - Cigna+ Apria - Am I scrod?????

Emergencies are handled differently than DME goods by my insurance. They don't want you trying to tell the ambulance driver which hospital to go to or anything like that.

As for going to a non-covered pharmacy, unless it's an in-hospital pharmacy as part of my stay due to an emergency, no, I must go to an in-network pharmacy or no dice.

I said OUT-OF-POCKET........NOT out-of-network.
YOU as a policy holder/group member should be considered "IN-NETWORK".
If you purchase prescriptions out-of-POCKET......will they reimburse you?"

Yeah, I know what you said, but what you said is nonsense.

All of the following refers to buying or renting xPAP equipment and supplies. The poster indicated that their only in-network provider was Apria.

The policy holder/group member is not the entity that "In Network" refers to,

"In-Network" and "Out of Network" applies to the company selling or renting the equipment. In this case, Apria is "in network" and any other provider, including cpap.com, is "out of network"

Out of pocket is what the policy holder has to pay from their own pocket and it is frequently the "co-pay". Out of pocket does not include the money that is paid or negotiated by the insurance company. I believe that the poster said that their out-of-pocket expense, or co-pay was 20% of the billed cost of the equipment if it is obtained from an in-network provider.

Let's say you're out of town on a trip and you need some medicine or have some kind of medical emergency need and the pharmacy or hospital/emergency care clinic you go to isn't part of your provider's plan. Can you pay for the medications or services out-of-pocket and get reimbursed by your provider?

My insurance doesn't require emergency or urgent care providers to be in-network, and most hospitals are in-network. My pharmacy insurance is from Walgreens and is separate from my medical insurance. Just about any drugstore chain participates with Walgreens insurance. In my local area, I can go to any Walgreens, CVS, Rite-Aid, or Safeway pharmacy; and there are more.

I can even get 90 day supplies of meds from most of these pharmacies, with a co-pay of $30 for generics. 30 day co-pay for generics is $15.

Craig-Tx wrote:
The Friday before Christmas, it was sent to Apria's local office. Of course because I didn't take just any CPAP, mine is a "special order." As of today, I am hoping it will be on their delivery truck Monday.

Ok, so here I am, still waiting. Sorry to bother all of you, but I feel like venting.

My Rx was signed on 12/20/06, and sent to Apria sometime within a day or so, if not on the same day. I know Apria's main office forwarded the Rx to the local office on 12/22.

In that time I have learned that Apria only receives shipments on Mondays. And for some reason, they don't seem to be getting everything they need. (shouldn't be my problem, but I'm the one suffering.)

I am with Cigna and they cover DME at 100% otherwise cpap.com would be my DME provider. I spoke with a rep at Cigna and they confirmed that Apria is the only DME provider I can use. (to be covered...)

So now, best case, Apria will get my machine in on Next Monday's shipment. Which would make it Exactly 1 month from the time the local office gets the Rx. That's not counting how long they will delay getting me in for mask fitting etc.

Absolutely Frustrating.

-craig

Yes I know it is frustrating, but consider the fact that your DME is covered 100%, many of us are not.

Hang in there.

Keep calling them.

Craig,
This is just the beginning! Wait until you need new nasal pillows or a cushion for your mask, Took 3 1/2 months. New filters, took 3 weeks. New hoses that I don't need or want they send regularly, even after I requested for them to stop. I did report this to the insurance company, They now refuse to pay the $43 for each new hose unless I call them and request one.(That will take a long time because now I have 5 and I use the aussie hose!). I'm due for a new mask in another week and scared to death of how much "fun" that will be.

Brenda

Craig-Tx wrote:

Ok, so here I am, still waiting. Sorry to bother all of you, but I feel like venting.

Ok, so it appears persistence pays off. as you can see by my profile, I have a brand new machine to play with.

Very shortly after posting the above, I received a call from Apria. It seems that the RT I have been talking to decided to check on this a bit more. Well, they decided that they now had a unit in stock.

My Rx was for a REMStar PRO 2. They Gave me a M-Series PRO. I know there are slight advantages to both, but right now I'm happy to have a machine. And the M-Series Pro does everything I need especially the software part.

I was a little disappointed in APRIA's "mask fitting." Basically they had several to pick from, and the RT showed me how they each work. Unfortunately they don't have the equipment to sterilize the masks so you can pick them up, look at each on, push on the squishy parts with your finger, but don't put it to you face until you're sure that's the one you want.

I ended up deciding on the activa based on some of the good responses I've heard here. I wanted to stick to a nasal mask for my first interface. In 6 months I might start looking at a nasal pillow.

In any case I have toys to play with!

Thanks
-Craig

I also have Cigna. My copay (20%) ended up being more than the cost of my mask. So my last 2 masks I have bought from cpap.com. But since you are covered 100% you might consider waiting for another mask otherwise cpap.com is a very reasonable alternative when buying a back-up mask
Barb

This is just the beginning! Wait until you need new nasal pillows or a cushion for your mask, Took 3 1/2 months. New filters, took 3 weeks.

I have had good service from my local Apria warehouse for filters and hoses; they are always delivered within a few days of my calling them. One time the local warehouse didn't have a hose in stock and there was a handwritten note in the box with the filters saying that another warehouse will be sending me a hose. The hose arrived the next day. I haven't had to get a new mask yet.