1 year fight with cpap supplier--Is this correct?!

Hello, all. I found this discussion board 8 years ago when I first began using a cpap and received lots of tips then. Unfortunately, can't remember that login, so had to create a new one.
Anyway, just wondering if what my cpap distributer (seller) is claiming is even remotely true. I'm calling BS, but they are refusing to budge. My insurance (Cigna) customer service reps keep telling me what Rotech's billing is telling me is nonsense, and even had me appeal to Cigna's official Appeals Unit, but even they threw up their hands and said "oh, well, not our problem" and insisted I have my provider resubmit the cpap prescription to Rotech (for the 4th time!) so that Rotech can correct their coding of it and rebill it and have Cigna pay it properly. And I've been on this Merry-go-round since Sep. 2021!!! Here's the history:

Bought first cpap in 2014 from Apria Healthcare. The dreaded Philips Respironics ONE that was part of the 2021 recall. But mine was already 7 years old and 2 years out of warranty, anyway, so once I found out about the "cancer foam" (that explained my constant coughing--I had taken to sucking on a cough drop all night!), I stopped using it and began looking for a replacement. By July I had met my deductible and out-of-pocket maximum, so I shouldn't have owed a cent for a new cpap. HOWEVER, my doctor noted on the prescription that the new cpap she wanted for me was a Resmed Airsense 11 and that it would be replacing the Respironics ONE, which also happened to be part of the recall. AHHHH. Huge mistake. This sent the Rotech team into a tizzy, apparently.

Rotech saw "recall" on the prescription, and refused to sell me the Resmed Airsense 11. Said I had to wait for Philips to start replacing recalled machines and there were hundreds of local patients in line in front of me. So I went back to the doctor and asked if she could rewrite the script and remove the word "recall." Now it was just a "purchase" to REPLACE an out-of-warranty machine. HOWEVER, Rotech claimed that since I had never bought a machine from them, I was a NEW CPAP PATIENT (to them), and therefore, I had to PROVE COMPLIANCE FOR 10 MONTHS, which is what their CONTRACT WITH CIGNA required. WHAT?! I had been using a cpap nightly for 7 years! My insurance company already knew that and had my initial "proof of compliance" info from 2014 already. But alas, I wanted out of the store with my machine and was tired of fighting with a salesman I knew would be on to selling jewelry or tires soon, anyway, so I paid the $47 first month rental fee, took my shiny new Resmed Airsense 11 home that day (Sep 7, 2021) and forgot all about it since I was at "0% patient liability," which meant that my insurance apparently was paying my rental fee for me, anyway, since I had already reached my max out of pocket.

Until I received a bill in Jan 2022 for $60 or $80+ or some odd amount, again claiming a "RENTAL FEE" since I was back to "100% patient liability"/0% insurance payment for rental. WHAT?! I called Rotech and asked what this fee could be for if mine was supposed to have been a PURCHASE (NOT a "rental"!) back in Sep 2021?! Got the run-around. "This is what your insurance company requires. Call your provider. Have your provider resubmit the prescription to us 'CORRECTLY' so that we can recode and BILL IT CORRECTLY to your insurance." Uh huh. Been there done that. But sure, I'll do it for a THIRD TIME. No problem.

So I did. And by May 2022, when I was starting to get nasty letters from Rotech telling me I was getting way behind on my rental fees and had better pay up, I had Cigna's customer service attempt a 3-way call to Rotech's billing dept. to sort this out. Same freaking story. "Have their provider send a corrected prescription and we'll rebill it." Blah, blah, blah. Now here it is Sep 2022, a full year later and they STILL HAVE NOT CORRECTED the coding for this purchase despite my provider having sent a CORRECTED PRESCRIPTION TWO ADDITIONAL TIMES with the EXACT WORDING they needed in order to change the billing to PURCHASE/OUT-of-WARRANTY REPLACEMENT rather than RENTAL/PROOF OF COMPLIANCE/NEW USER SETUP. I called yet again today and was hung up on by a frustrated Rotech billing agent who just couldn't understand what I was trying to tell her about how they needed to fix their billing of my machine. So I used the chat function on their web site and they supposedly brought in a supervisor. And even then I was told the same nonsense...

"Your insurance provider has a contract with Rotech that says EVERY TIME there is a cpap purchase you have to prove compliance for 10-13 months. And you also have to get a sleep study done EVERY TIME you purchase a cpap from us. So...you owe us money, all of those rental fees that you haven't paid yet, and that's why we are threatening to send you to Collections and to come take our cpap machine back!"

Just...wow. And for the record, the billing rep included a screen shot of what she/he was looking at on screen. It did NOT say "EVERY time" a cpap is purchased. It had "Purchase" marked, then underneath said: "Sleep Study Required?" and "Yes" was marked. Well, duh. Yes for the first time Cigna will cover a cpap to make sure it's really needed. And under "Purchase," it also had "Compliance Required?" and "Yes" was marked along with "10-13 months." But again, this was most likely for a FIRST cpap and Rotech just doesn't differentiate due to a software glitch. It takes an intelligent human to parse out what the contract ACTUALLY SAYS.

So: 1) Does anyone know if this is correct? Do insurance companies really require their customers to get a NEW SLEEP STUDY every 5 years when their cpap goes out of warranty and they get a new one?! It's not like my sleep apnea is suddenly going to go away! And the numbers are visible to my doctor on the Cloud from my cpap, so a sleep study is unnecessary, anyway. Would insurance companies really want to spend thousands of dollars on sleep studies every 5 years for every single cpap patient? This seems like a BS answer by a cpap distributor who doesn't want to admit fault for incorrect billing. 10 months of incorrect billing!!!

and 2) Has anyone been forced to "prove compliance" every single time your old cpap goes out of warranty and you buy a new one? So forced to "rent-to-own" every 5 years (or 7 in my case since as I didn't realize how long the warranty for it was) instead of just "PURCHASING" every 5 years after the initial "rent-to-own" to ensure that you will actually stick with it that first time. I mean, come on. I'm in my 8th year of use! Would my insurance company really think I'm going to suddenly not want to breath at night?! (The Cigna customer service reps all assured me that no, Cigna would NOT require this after the initial, first machine is purchased and compliance of use has been proven. But the Rotech billing folks insist "That's what our contract with Cigna says!")

I've just had it with incompetent billing reps today! Also, the "rental fees" are low enough to pay, but it's the principle of the matter. If I cave and pay it, they'll continue these abusive practices and continue to harm others who don't catch on to their tactics. In fact, if they do send me to Collections, I'm already researching how to sue Rotech for violating the Fair Debt Collections Practices Act (trying to collect $ that is not actually owed since I had met my max out of pocket by Sep 2021 and my insurance company had assured me they would purchase the cpap without me owing a penny).

PS I buy hoses, etc. on Amazon. Easier than dealing with suppliers & insurance. And paid for a basic refurbed travel cpap in cash, so it's not that I'm a whiner just looking for a freebie. I just want Rotech to be honest and fix their mistake.

Why can't you prove compliance? Do you not know how to print a report or, better yet, save the report to the file and email it to the supplier?

I'm sorry you are having to deal with this.

BTW, the tire companies and jewelry companies have already fired those people for incompetence.

Ami_ga wrote: ↑

Tue Sep 27, 2022 2:39 pm

So: 1) Does anyone know if this is correct? Do insurance companies really require their customers to get a NEW SLEEP STUDY every 5 years when their cpap goes out of warranty and they get a new one?! It's not like my sleep apnea is suddenly going to go away!

The short answer is, "It depends."

And for what it's worth: My husband has very mild apnea, but is symptomatic if he doesn't use his PAP. For reasons that neither of us understood, his PCP had him undergo a "home sleep study" a while back and he slept horribly that night---as in he didn't actually get much sleep at all due to a whole bunch of things going on in our lives and the fact that it was a very hot humid night. And unfortunately his AHI based on what little sleep he had came in under 5.0. So he officially no longer has OSA and we're concerned because he's still using a PR System One Series 60 APAP that is under recall, but probably won't be replaced anytime soon.

As for me? I'm dreading going on Medicare next year and having Medicare potentially demand a new sleep study before replacing my machine. Why? Well unless Medicare has changed their rules, I may not qualify. Why? On all of my sleep studies, my big problem has been with so-called "Hypopneas with arousal" and at least when I got my first PAP, Medicare didn't count them towards the Medicare AHI. You take out my Hyponeas with arousal and my AHI goes down from roughly 23 to something like 3.5. The basic fact is that I simply don't seem to have O2 desats with my hypopneas, probably because I arouse myself before the desat happens.

2) Has anyone been forced to "prove compliance" every single time your old cpap goes out of warranty and you buy a new one? So forced to "rent-to-own" every 5 years (or 7 in my case since as I didn't realize how long the warranty for it was) instead of just "PURCHASING" every 5 years after the initial "rent-to-own" to ensure that you will actually stick with it that first time.

I replaced my old PR System One BiPAP Auto with my current (recalled, but still in use) PR Dreamstation BiPAP Auto about 6 years ago, and as I recall it was again a "rent to own." This was OK with me because my insurance only pays 50% of the cost of the machine and the rent-to-own meant I didn't have a $1000 bill to pay the month I took delivery for the machine.

And yes, I did have to "prove" compliance again which surprised me. But I believe it was for the same initial 3 months that I had to for my first machine.

For what it's worth: I think your beef is probably with both your insurance company and the DME.

Your insurance company may very well have "rent-to-own" in its standard contract with DMEs. For newbies, it's to make sure that if the machine is not being used that the insurance company can insist that the newbie return the machine or pay for it out-of-pocket. For an old-hand like you, the insurance company is probably aware that another rent-to-own period minimizes the chances that they're going to have to pay for the whole machine due to the patient waiting until they've maxed out their annual deductible.

As for the DME, they are likely to not follow a script that says "purchase" if the standard contract with the patient's insurance is "rent-to-own".

So I think you need to find out what your insurance company's standard contract actually says about PAP equipment.

PS I buy hoses, etc. on Amazon. Easier than dealing with suppliers & insurance. And paid for a basic refurbed travel cpap in cash, so it's not that I'm a whiner just looking for a freebie. I just want Rotech to be honest and fix their mistake.

I sympathize with your position. I too buy most of my and my hubby's cpap supplies on line. Unfortunately this means that we no longer have an official DME that supplied our PR machines that are both under recall since the company that sold them to us went out of business several years ago and we didn't immediately set up an appointment with the company that "replaced" the first DME. So it's not at all clear we'll ever get our machines replaced under recall.

robysue1 wrote: ↑

Tue Sep 27, 2022 4:22 pm

I sympathize with your position. I too buy most of my and my hubby's cpap supplies on line. Unfortunately this means that we no longer have an official DME that supplied our PR machines that are both under recall since the company that sold them to us went out of business several years ago and we didn't immediately set up an appointment with the company that "replaced" the first DME. So it's not at all clear we'll ever get our machines replaced under recall.

You should still get your recalled machines replaced by Philips. They never asked me for my DME info and only need your Dr info if they cannot get the current settings off your machine with DreamMapper. I bought my Dreamstations at a yard sale and have done all the paperwork for replacement, currently waiting on the replacements to be shipped.

Is Rotech the only supplier Cigna has a contract with? Ask your Cigna rep if you can get a machine from another supplier and tell Rotech they can have their machine back due to their billing errors. I had my Phillips machine for around 7 years too and I stopped using it due to the recall. I had medical issues and had to return to my pulmonary doctor. I thought I would need a new sleep study but my insurance provider, Blue Cross federal employees plan did not require it. I called the DME where I got the Phillips machine but they couldn't get a ResMed machine. So I called a DME closer to me who happened to have contracts with ResMed and got a new AirSense 11 within a month or so. I had to provide my original sleep study to the DME, my doctor didn't have a copy so I'm glad I had it. I don't recall having to prove compliance for my original Phillips machine. I paid my copay of around $300 for each machine and I own them.

After over a year I received an email from Phillips a couple of days ago to upload my settings using the DreamMapper app. I did and it will probably be another year before I hear from them again. How they think it's OK for someone to go without cpap treatment for this long is crazy.

Jlfinkels wrote: ↑

Tue Sep 27, 2022 5:05 pm

robysue1 wrote: ↑

Tue Sep 27, 2022 4:22 pm

I sympathize with your position. I too buy most of my and my hubby's cpap supplies on line. Unfortunately this means that we no longer have an official DME that supplied our PR machines that are both under recall since the company that sold them to us went out of business several years ago and we didn't immediately set up an appointment with the company that "replaced" the first DME. So it's not at all clear we'll ever get our machines replaced under recall.

You should still get your recalled machines replaced by Philips. They never asked me for my DME info and only need your Dr info if they cannot get the current settings off your machine with DreamMapper. I bought my Dreamstations at a yard sale and have done all the paperwork for replacement, currently waiting on the replacements to be shipped.

See, that's part of the problem: The sleep doc who prescribed both machines retired at least 3-4 years ago. And I haven't seen a sleep doc since, nor has my husband.

I filled in the info (for all three machines) at the web page way back when the recall was first announced and didn't seem to have any problems. But if I try to "check" on the any of them, I get into a neverending loop of "provide the name of your DME" or some such thing.

*sigh*

I need to try yet again.

And as for replacing that retired sleep doc with a new one: He was hands down the best sleep doc I had and he was the 4th sleep doc I dealt with back when I was in my multi-year adjustment to PAP therapy. I was fired by sleep doc #1 and sleep doc #2 for not responding as expected to PAP therapy. I fired sleep doc #3 for a whole bunch of reasons. But sleep doc #4? He was fantastic. He was also the only one of the sleep docs who used a PAP himself. And he quickly figured out that I actually knew something and was keenly interested in learning more, so he never treated me like a mushroom. At my last appointment with him, when he told me he was retiring, he re-iterated that I basically knew as much as he did about interpreting machine data and he'd already given me his blessing for doing whatever pressure adjustments I saw fit at least a year before he retired. Since by the time sleep doc #4 retired I was doing well on PAP therapy, I never bothered to start the painful process of finding another sleep doc who would respect my knowledge instead of treating me like a mushroom.

As long as your machines can power on and connect with DreamMapper, you can get the settings (prescription) uploaded to the Philips website. No idea how or if your machine can use DreamMapper as my only experience with Philips is a Dreamstation, which connects via Bluetooth.

Try giving the recall hotline a call and see if they can help. I think their hours are 9-6 ET.

DreamMapper 1-844-240-1649
Recall support line 877-907-7508

Jlfinkels wrote: ↑

Tue Sep 27, 2022 5:50 pm

As long as your machines can power on and connect with DreamMapper, you can get the settings (prescription) uploaded to the Philips website. No idea how or if your machine can use DreamMapper as my only experience with Philips is a Dreamstation, which connects via Bluetooth.
Try giving the recall hotline a call and see if they can help. I think their hours are 9-6 ET.

DreamMapper 1-844-240-1649
Recall support line 877-907-7508

Thanks for these numbers. I'll give them a call tomorrow.

As far as DreamMapper is concerned: Neither hubby nor I ever used DreamMapper and I don't think either of our machines was set to connect to it. Is there any way to tell? And just how do you connect a PR machine to DreamMapper?

robysue1 wrote: ↑

Tue Sep 27, 2022 6:23 pm

I don't think either of our machines was set to connect to it. Is there any way to tell? And just how do you connect a PR machine to DreamMapper?

It's been some years so my memory may fail me but I am not so sure the System One models could connect to DreamMapper unless they had a special modem to send the data to the web.

Go through your menu options and look to see if you have "airplane mode" available....if you do then it should at least have the modem to phone home. If you can't find it then I have my doubts as to whether the machine is compatible with DreamMapper or not.

But again....it's been years and years and years since I owned a System One....and it wouldn't work with DreamMapper but I never really bothered to sort it out because I didn't really care.

An interesting update:

I just did a search of my email. Two messages were sent from PR to my personal account while my husband and I were traveling in Europe this summer. They have an actual confirmation number that lets me by-pass the DME questions when I log into the patient portal for the recall. After logging in, there is a place that says they have matched my (presumably DreamStation?) to a DME, but there's no indication as to how to find out what DME it got matched to. Nor can I tell if this is the old Station One (which I also registered because I have used that for camping in the past) or the DreamStation.

I'm going to do a search for hubby's email later tonight.

Pugsy wrote: ↑

Tue Sep 27, 2022 6:32 pm

robysue1 wrote: ↑

Tue Sep 27, 2022 6:23 pm

I don't think either of our machines was set to connect to it. Is there any way to tell? And just how do you connect a PR machine to DreamMapper?

It's been some years so my memory may fail me but I am not so sure the System One models could connect to DreamMapper unless they had a special modem to send the data to the web.

Go through your menu options and look to see if you have "airplane mode" available....if you do then it should at least have the modem to phone home. If you can't find it then I have my doubts as to whether the machine is compatible with DreamMapper or not.

But again....it's been years and years and years since I owned a System One....and it wouldn't work with DreamMapper but I never really bothered to sort it out because I didn't really care.

That's me as well. I never really cared about whether hubby's System One Series 60 or my DreamStation could call home (i.e. contact DreamMapper) because by the time we got those machines I was fully fluent in SleepyHead and Sleep Doc #4 had already told me I could pretty much do whatever I wanted with the BiPAP's pressure settings since I knew as much as he did about using the machine data to fine-tune my therapy. And he'd already turned hubby over to his PCP since hubby's apnea was so mild that according to Sleep Doc #4 its was hubby's decision about whether to start PAP or not.

Full stop.

Have you seen your insurance company's policy in writing? Unless you have requested and read the EVIDENCE OF COVERAGE for the year you got your replacement CPAP, you have NOT.

The EVIDENCE OF COVERAGE (I will abbreviate this as EOC) is the actual contract between YOU and your insurance company, but most people NEVER see this document unless they know to ask for it. Anything they send you (e.g. marketing material, welcome letters, etc.) or tell you on the phone that is not the Evidence of Coverage is not the contract.

The EOC spells out exactly the policy for CPAP coverage--whether it's a purchase or a rental with a monthly co-payment, how long do you have to rent it before it is considered yours if a rental is required, what the compliance requirements are, and whether the co-payment resets each year. That is the BIBLE. If it says it in the EOC, the insurer AND the DME must follow it. If it says something different than what you thought was the policy you are SOL. Don't take anyone's word for it, you need to see it in black and white. If you appeal or anything else you will need that EOC to show exactly what the policy is.

So if you are correct, the EOC will state that Cigna purchased the machine outright for you, and then your issue is with the DME. If you were given wrong information and it's a rental for 10 months as the DME claims, you owe the money because more than likely your deductible did reset in January.

One problem you are going to have is getting hold of the EOC for the year you got the replacement machine. This year's EOC may have changed the policy. Make the request IN WRITING for the year you received the replacement machine. Most states require them to provide the copy to you within 7 to 10 days of a written request. Getting the correct one for the correct year might be a challenge. You can also look at the current EOC and see if it agrees with what you think is the policy. That may be good enough for an appeal if necessary.

If you are correct about the policy and the DME continues to try to collect, you can report them to the state agency that regulates medical supply companies for fraud, and also to your insurance company for violation of their contract with your insurer.

robysue1 wrote: ↑

Tue Sep 27, 2022 6:40 pm

An interesting update:

I just did a search of my email. Two messages were sent from PR to my personal account while my husband and I were traveling in Europe this summer. They have an actual confirmation number that lets me by-pass the DME questions when I log into the patient portal for the recall. After logging in, there is a place that says they have matched my (presumably DreamStation?) to a DME, but there's no indication as to how to find out what DME it got matched to. Nor can I tell if this is the old Station One (which I also registered because I have used that for camping in the past) or the DreamStation.

I'm going to do a search for hubby's email later tonight.

You should also have received or will shortly receive an email about creating an account on a private Philips email server they use for communicating with recall patients. It may come from a third party they have contracted with to handle the communications, so check closely for something like zixmail or such.

Janknitz wrote: ↑

Tue Sep 27, 2022 7:11 pm

Full stop.

Have you seen your insurance company's policy in writing? Unless you have requested and read the EVIDENCE OF COVERAGE for the year you got your replacement CPAP, you have NOT.

...

Thanks for attempting to get this thread back on topic. It's very important to Ami_ga.

Jlfinkels wrote: ↑

Tue Sep 27, 2022 8:16 pm

You should also have received or will shortly receive an email about creating an account on a private Philips email server they use for communicating with recall patients. It may come from a third party they have contracted with to handle the communications, so check closely for something like zixmail or such.

Quick follow-up…

After running the DreamMapper app for my two Dreamstations I called the Philips DreamMapper support line and they verified they received the settings/prescriptions from the machines. It does work as they say, just doesn’t hurt to check that they did in fact receive the settings.