Apria Healthcare / Philips Respironics recent recall notice discussion thread

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AfibApnea
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Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by AfibApnea » Wed Sep 15, 2021 5:43 pm

I’m hoping this can be as robust a discussion thread as the "Philips/Philips Respironics recent recall notice discussion thread".
It's unfortunate that the Philips recall has to have happened. However, Apria Healthcare, medical equipment distributor to a number of major hospitals and HMOs deserves scrutiny because it is responsible for PAP equipment distribution to many CPAP and BiPAP users and because it has been cited by my Hospital and HMO as the reason I cannot be issued another (Philips or Resmed) machine despite the fact the machine I’ve been using is over 6 years old (and thus satisfies Respironics requirement for a machine replacement) and the fact I need to use a humidifier.

So, to start this thread I have three questions:
1) When Apria ‘distributes’ (either for free or by having the user buy the machine) a machine, what are Apria’s (contractual?) responsibilities regarding that machine?
2) Is Apria responsible for replacing the machine (presumably with a more modern one) after the machine's manufacturer suggested replacement time?
3) Is it responsible for replacing the machine if the current machine cannot serve the needs of its patient (e.g., because the humidifier cannot/should not be used) even if that replacement comes from another manufacturer (ResMed—the company Apria/Kaiser has switched to in my case)?
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Janknitz
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by Janknitz » Wed Sep 15, 2021 6:28 pm

1) When Apria ‘distributes’ (either for free or by having the user buy the machine) a machine, what are Apria’s (contractual?) responsibilities regarding that machine?
There's no such thing as a "free" machine. Somebody is paying for it. When you have no out of pocket costs, your insurer is paying for it. If an insurer pays for it, there is a contract between the insurer and Apria which spells out what the obligations are regarding that machine. Medicare, for example imposes an obligation on the DME to provide compliance data and to service the machine for a period of 5 years for example. But it depends on the insurer.

2) Is Apria responsible for replacing the machine (presumably with a more modern one) after the machine's manufacturer suggested replacement time?
Not unless there is a contractual obligation with that individual's insurer. Unlikely, since insurers don't want to be on the hook for paying for a machine when the user may not even still be insured by them, or their contractual obligations with the user may have changed in the ensuing time period. If you are on Medicare or Senior Advantage, they will prescribe a new machine for you at that point, and then it depends on the insurers contract where you can get that machine.

3) Is it responsible for replacing the machine if the current machine cannot serve the needs of its patient (e.g., because the humidifier cannot/should not be used) even if that replacement comes from another manufacturer (ResMed—the company Apria/Kaiser has switched to in my case)? This is going to depend on your contract with Kaiser. If you are on Senior Advantage and you have a never ending monthly co-pay for CPAP, then you'd have a strong argument that Kaiser has to provide you with a machine you can use safely. But if you are a Kaiser member without Senior Advantage, you need to know what Kaiser's DME obligation is to you. You should call Member Services and Request the Explanation of Benefits, which is the contract between you and Kaiser, even if you've never seen it. That will tell you what Kaiser's obligations are to you with respect to DME. By way of example, I got my first CPAP machine while on a Kaiser plan that covered DME. They purchased the machine outright (and I paid the co-payment). While Kaiser's contract with Apria was that they had to maintain the machine for 5 years, I no longer had DME coverage with Kaiser so no way they would provide me with a new machine. It might have been an interesting question whether Crapria had to provide me with another machine because they had an obligation to service my machine for 5 years, if this had happened within that 5 year window.
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AfibApnea
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by AfibApnea » Fri Sep 17, 2021 11:54 pm

The current recall is one thing: "The FDA gave the recall a Class I designation, the most serious type. The classification means there’s a reasonable probability that use of a recalled product “will cause serious adverse health consequences or death.” https://www.theverge.com/2021/8/5/22609 ... cpap-bipap

But what about under normal circumstances?

Philips Respironics recommends their PAP unit be replaced after 5 years of use.

ResMed https://www.resmed.com/en-us/healthcare ... uidelines/ guidelines also recommend replacing the unit every 5 years.

https://www.verywellhealth.com/how-ofte ... es-3015041 also notes that “Typically, insurance will pay to replace the entire PAP device every five years.”

What are the reasons the two major manufacturers of PAP units recommend, even in normal circumstances, they be replaced after five years of use?
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chunkyfrog
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by chunkyfrog » Sat Sep 18, 2021 6:35 am

Apria is known on this board by another name---
CRAPRIA
It is a name well-earned.

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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by jimbud » Sat Sep 18, 2021 8:56 am

AfibApnea wrote:
Fri Sep 17, 2021 11:54 pm
What are the reasons the two major manufacturers of PAP units recommend, even in normal circumstances, they be replaced after five years of use?
1. They like to sell PAP units?

2. If they don't they don't make as much money?

3. It is an arbitrary period they just made up?

If you know, why don't you let us know?

JPB

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AfibApnea
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by AfibApnea » Sat Sep 18, 2021 12:21 pm

I didn’t know I’d stir up a hornet’s nest. I could tell, from perusing “Philips/Philips Respironics recent recall…” there were a few out there, (and, yes, I did notice “cr”apria) but I didn’t know the nest was so alive and kicking.

A fellow Vespidae

p.s. Jimbud, thanks for the Clinician manual links.

p.p.s. I’m going to repost this subject, not directed to crapria, who, when all is said and done is only a middleman, but to Philips Respironics and ResMed. It is they who recommend the 5-year replacement plan, and they who would, if they could be approached, have to come up with viable reasons for so doing.
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Janknitz
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by Janknitz » Mon Sep 20, 2021 5:59 pm

What are the reasons the two major manufacturers of PAP units recommend, even in normal circumstances, they be replaced after five years of use?
Because that is/was Medicare's replacement schedule and Medicare provides the bulk of their customer base.

Prior to a few years ago, after 5 years, Medicare would replace a CPAP machine as a matter of course after 5 years. This required a new prescription, and started a whole new 13 month capped rental. I think part of this had to do with the fact that ultimately, Medicare pays MORE than standard retail for a CPAP machine since the DME is contractually obligated to service the machine under Medicare for 5 years. Since the service requirement expires in 5 years, Medicare thought it was prudent to allow a new machine to be issued at that point.

But a few years ago, Medicare adopted a rule that there must be a reason for the replacement--i.e. the machine is older than 5 years and needs repair. If the machine is less than 5 years old, the DME must repair it, unless it's not repairable. That's the only time you can get a new machine under Medicare within the 5 years.

Machines wear out eventually, but not necessarily exactly after 5 years use. Medicare finally figured out that it is wasteful to replace a machine that's still working perfectly. The same goes for consumables like masks, hoses, humidifier chambers and filters. There is a replacement schedule, but now you have to state there is a problem before Medicare will pay for the replacement. And it is no longer legal for DME's to automatically replace these items on a schedule when they are not requested.
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AfibApnea
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by AfibApnea » Mon Sep 20, 2021 10:15 pm

Thanks for your very knowledgeable reply. Thanks especially for all the information included in your "Signature"!

My particular problem with the current recall situation is that for my BiPAP ASV experience to work for me I need to use the humidifier (has to do with my nasal passages).

1) In your signature articles, at some points I believe you only refer to CPAP units. Does everything you say relate equally to a BiPAP ASV machine?

2) I know I will not, on my own, be able to convince Apria to release a ResMed machine for me (the hospital, vis-a-vis Apria, is now ONLY offering ResMeds). However, my Cardiologist would like to advocate for me to get a machine w. working humidifier. Do you have any advice I can give my Cardiologist as to how to do this and be effective?

Thanks again.
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GrumpyHere
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by GrumpyHere » Mon Sep 20, 2021 10:33 pm

AfibApnea wrote:
Mon Sep 20, 2021 10:15 pm
My particular problem with the current recall situation is that for my BiPAP ASV experience to work for me I need to use the humidifier (has to do with my nasal passages).

2) I know I will not, on my own, be able to convince Apria to release a ResMed machine for me (the hospital, vis-a-vis Apria, is now ONLY offering ResMeds). However, my Cardiologist would like to advocate for me to get a machine w. working humidifier. Do you have any advice I can give my Cardiologist as to how to do this and be effective?
ResMed ASVs have humidifiers with bigger water chambers than Philips Respironics machines.
ResMed Lumis Tx - VAuto mode

Janknitz
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by Janknitz » Tue Sep 21, 2021 7:42 pm

You are correct that Crapria is only the middleman. When you have Kaiser, Kaiser is your DME and your Medicare intermediary if you have Sr. Advantage. Crapria is essentially only the supplier in this love triangle (or hate triangle, to be truthful). This doesn't mean that Crapria ever gets billing and supplies correct, even if you are a Kaiser member. But Kaiser is wholly in control of the Durable Medical Equipment if they pay for it.

So your cardiologist should have some sway, but your cardiologist probably has to be communicating with the sleep clinic at Kaiser because that's the department that calls the shots on what gets ordered and when. Ask your cardiologist to contact the sleep clinic at Kaiser and see what strings he/she can pull for you to get a replacement machine.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm

Janknitz
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Re: Apria Healthcare / Philips Respironics recent recall notice discussion thread

Post by Janknitz » Tue May 03, 2022 2:59 pm

Good insurance companies can help you with any problem.
Insurance companies, even so-called "non-profit" insurance companies, are concerned with the bottom line. If it's good for the insurer, they will help you with a problem. If it's costly for the insurer, they will try not to have to pay.

A so-called "good insurance company" is a unicorn.
What you need to know before you meet your DME http://tinyurl.com/2arffqx
Taming the Mirage Quattro http://tinyurl.com/2ft3lh8
Swift FX Fitting Guide http://tinyurl.com/22ur9ts
Don't Pay that Upcharge! http://tinyurl.com/2ck48rm