Trying to get supplies from HMO nightmare

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
dream321
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Joined: Wed May 31, 2017 10:25 am

Trying to get supplies from HMO nightmare

Post by dream321 » Mon Jun 20, 2022 11:41 am

I have Oscar insurance, and they use Aerocare/Adapthealth, they are the same company now, for DME. My previous DME sent them the information, and they processed my order, and said I'd get it within 7 days. Then they called me saying that they didn't have my compliance info, even though they said they had everything they needed previously. They put in request from my last DME for the info, which went ignored (of course), and then I asked then to just get it off my machine. They said they can do it, so I followed up one week later, and they still didn't do it . So far It's been over a month, with nothing. Out of frustration I cancelled my order, and the only other company in my plan is Apria, who seems to be just as bad, according to reviews. Is there any way out of this Kafkaesque nightmare? Does anyone know if insurance commissions deal with this adequately? Any of you get so frustrated that you just purchase your equipment outside of insurance, even though it's technically covered by insurance anyway?

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chunkyfrog
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Location: in a nice, moist, Nebraska bog

Re: Trying to get supplies from HMO nightmare

Post by chunkyfrog » Mon Jun 20, 2022 11:56 am

Yes.
I used www/cpap.com to get the correct machine (Resmed S9 Autoset),
and a sequence of masks--until I found one that worked for me.
BCBSNE sent me a letter, wondering why I was not patronizing their pet DME.
I have fired a total of FOUR DMEs, before settling on the good local business
I use now--who take Medicare, and treat me like I matter.

_________________
Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: second identical machine --sticking with a good thing.
Laughter--the best medicine--up until your giggling wakes your spouse.
"Honey, how can you be having fun without me?"

Iamstumped
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Joined: Tue May 17, 2022 2:56 am
Location: Kansas City, Mo.

Re: Trying to get supplies from HMO nightmare

Post by Iamstumped » Mon Jun 20, 2022 12:11 pm

After being on a CPAP for more than 15 years, I still have never used insurance to get a CPAP machine. I get my machines and supplies (masks, ect.) from CPAP.COM

dream321
Posts: 50
Joined: Wed May 31, 2017 10:25 am

Re: Trying to get supplies from HMO nightmare

Post by dream321 » Mon Jun 20, 2022 2:39 pm

I just ordered from cpap.com. At least I'll have fresh supplies. Then if the insurance company's DME ever gets around to filling an order for me, at least I'll have new supplies saved.

KathyJL
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Joined: Tue Apr 16, 2013 8:58 pm
Location: California

Re: Trying to get supplies from HMO nightmare

Post by KathyJL » Mon Jun 20, 2022 4:27 pm

The whole situation with DME’s is horrific. Imagine if we had diabetes and the supplier took months to send needles or sent the wrong ones. We’d all be dead!
Daily user of CPAP since 2009.
Use very low humidity or pass through.
Slightly heated hose. Hose cozy.
Masks: Alternate between N30i, Aloha, Tap Pap, & occasional BleepSleep.

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babydinosnoreless
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Re: Trying to get supplies from HMO nightmare

Post by babydinosnoreless » Mon Jun 20, 2022 5:45 pm

KathyJL wrote:
Mon Jun 20, 2022 4:27 pm
The whole situation with DME’s is horrific. Imagine if we had diabetes and the supplier took months to send needles or sent the wrong ones. We’d all be dead!
I work in pharmacy and it does happen to diabetics, thyroid, pain patients, and even cancer patients. No one is safe. Medicine is screwed up beyond belief. Whoever figures out a way to un screw it up will be rich. In the meantime insurance has us just as screwed up as socialized medicine. Its all bs.

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SleepGeek
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Re: Trying to get supplies from HMO nightmare

Post by SleepGeek » Mon Jun 20, 2022 8:14 pm

dream321 wrote:
Mon Jun 20, 2022 11:41 am
I have Oscar insurance
I never heard of Oscar insurance but see if this helps.
Download this FREE app found right here - Oscar
viewtopic/p1414015/OSCAR-140-Released-- ... l#p1414015

Then you can either email or print them your compliance info - from OSCAR.
HTH

IF that doesn't help your doc should also have access to your compliance info - if so call Verus to see if they take your insurance. They are mail order but if you don't need or want a tech coming to the house it works.
https://verushealthcare.com/contact/
Why folks dont like it when you treat em the way they treat you?
If you can be anything why not choose to be kind?
we are here to help.
palerider aka GrumpyHere wrote: What exactly do you think you're adding to this thread?

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chunkyfrog
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Location: in a nice, moist, Nebraska bog

Re: Trying to get supplies from HMO nightmare

Post by chunkyfrog » Mon Jun 20, 2022 9:48 pm

Google will tell you more than that guy . . .

_________________
Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: second identical machine --sticking with a good thing.
Laughter--the best medicine--up until your giggling wakes your spouse.
"Honey, how can you be having fun without me?"

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zonker
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Re: Trying to get supplies from HMO nightmare

Post by zonker » Mon Jun 20, 2022 9:50 pm

kids?

oscar insurance is real. google it.
why folks don't like it when asked to clarify their statements?
We can't take this journey for you, but there is a forum full of people here who will gladly take it with you.-jnk

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Wulfman...
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Re: Trying to get supplies from HMO nightmare

Post by Wulfman... » Tue Jun 21, 2022 1:59 am

I have been on CPAP therapy for over seventeen years and I purchased my initial setup and supplies from CPAP.Com which my PPO insurance provider reimbursed me for 80% of the cost. Ever since then, I have purchased EVERY machine and ALL of my supplies "out-of-pocket". Some from private individuals and forum members, but mostly from online providers like CPAP.COM.

Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

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Pugsy
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Location: Missouri, USA

Re: Trying to get supplies from HMO nightmare

Post by Pugsy » Tue Jun 21, 2022 6:09 am

zonker wrote:
Mon Jun 20, 2022 9:50 pm
kids?

oscar insurance is real. google it.
It is indeed real.
A Medicare Advantage HMO plan.
Typically HMO anything plans have a limited supplier network. There are sometimes ways around the limitations but I often wonder if that is by design. Sometimes the "hassle factor" gets to be a pretty big annoyance and people opt to just go out of pocket.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

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SleepGeek
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Re: Trying to get supplies from HMO nightmare

Post by SleepGeek » Tue Jun 21, 2022 3:22 pm

Pugsy wrote:
Tue Jun 21, 2022 6:09 am
zonked wrote:
Mon Jun 20, 2022 9:50 pm
kids?

oscar insurance is real. google it.
It is indeed real.
Ok kids.
Indeed I did google it.

Maybe its my accent - this is what I said.
SleepGeek wrote:
Mon Jun 20, 2022 8:14 pm
dream321 wrote:
Mon Jun 20, 2022 11:41 am
I have Oscar insurance
I never heard of Oscar insurance but see if this helps.
Download this FREE app found right here - Oscar
viewtopic/p1414015/OSCAR-140-Released-- ... l#p1414015

Then you can either email or print them your compliance info - from OSCAR.
HTH

IF that doesn't help your doc should also have access to your compliance info - if so call Verus to see if they take your insurance. They are mail order but if you don't need or want a tech coming to the house it works.
https://verushealthcare.com/contact/
I am wondering if untreated or poorly treated OSA presents with uncontrolled anger and hatred?
Last edited by SleepGeek on Tue Jun 28, 2022 9:12 pm, edited 2 times in total.
Why folks dont like it when you treat em the way they treat you?
If you can be anything why not choose to be kind?
we are here to help.
palerider aka GrumpyHere wrote: What exactly do you think you're adding to this thread?

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Pugsy
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Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Trying to get supplies from HMO nightmare

Post by Pugsy » Tue Jun 21, 2022 3:38 pm

huh??? I wasn't really talking to you...and I don't think zonker was meaning anything about what you said since he didn't quote you. I really don't see a need for your explaining yourself here at all.
He was just commenting for anyone to see that there really was an OSCAR insurance out there.
Take a chill pill. Not everyone is out to get you...today anyway.

SleepGeek wrote:
Tue Jun 21, 2022 3:22 pm
Pugsy wrote:
Tue Jun 21, 2022 6:09 am
zonker wrote:
Mon Jun 20, 2022 9:50 pm
kids?

oscar insurance is real. google it.
It is indeed real.
Ok kids.
Indeed I did google it.

Maybe its my accent - this is what I said.
SleepGeek wrote:
Mon Jun 20, 2022 8:14 pm
dream321 wrote:
Mon Jun 20, 2022 11:41 am
I have Oscar insurance
I never heard of Oscar insurance but see if this helps.
Download this FREE app found right here - Oscar
viewtopic/p1414015/OSCAR-140-Released-- ... l#p1414015

Then you can either email or print them your compliance info - from OSCAR.
HTH

IF that doesn't help your doc should also have access to your compliance info - if so call Verus to see if they take your insurance. They are mail order but if you don't need or want a tech coming to the house it works.
https://verushealthcare.com/contact/
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

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chunkyfrog
Posts: 32439
Joined: Mon Jul 12, 2010 5:10 pm
Location: in a nice, moist, Nebraska bog

Re: Trying to get supplies from HMO nightmare

Post by chunkyfrog » Tue Jun 21, 2022 6:21 pm

If you depend on Medicare/insurance for payment, your doctor needs your data
in order for necessary paperwork to get filed.
--if your insurance is not paying, then the doc is only in the loop IF YOU CHOOSE SO.
Making "points" with your doctor can be a good idea--especially if the doc is good.
But remember--he works for YOU, not the other way around.

_________________
Machine: AirSense™ 10 AutoSet™ For Her CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: second identical machine --sticking with a good thing.
Laughter--the best medicine--up until your giggling wakes your spouse.
"Honey, how can you be having fun without me?"

Janknitz
Posts: 7973
Joined: Sat Mar 20, 2010 1:05 pm

Re: Trying to get supplies from HMO nightmare

Post by Janknitz » Tue Jun 21, 2022 7:28 pm

I'm stuck with Kaiser until Medicare (hope to jump ship then), and when the ACA plans came out I lost my DME coverage. And I celebrated, because all you get with Kaiser is Crapria. I spent more time trying to deal with them than the hours I sleep--what a nightmare! I will never deal with Crapria again if I can help it.

So now I buy my own supplies from cpap.com or Amazon. I know someday I'll have to replace my machine, and that will cost a good amount, but I know how to find one in good condition used for a reasonable price.

Be aware that since Oscar is an HMO, they don't have to do the 13 month capped rental. They can charge you a rental fee for the rest of your life (or theirs). Under that scheme, you may end up paying many times over the retail value of your machine. I never intend to give Crapria my money every month for the rest of my life.

I don't know anything about the other DME you're stuck with, but already it doesn't sound promising.

BTW, is it possible for you to just purchase the machine you've been using from the prior DME for the remaining rental term out of pocket?

If you want a good quality used machine, search for LSAT here. He often has good deals on used machines in good condition.
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