Medicare Co-Pay

Hi All.

I am on Medicare with CIGNA as my supplemental coverage.

I tried to order some simple supplies from Apria and they said I would have to pay a $47 co-pay.

My initial deductible is already paid with Medicare, and Cigna pays 80% of whatever Medicare doesn't cover, so I am perplexed why my co-pay is so large.

I admit I have no idea how CPAP supplies work with Medicare.

Can you all give me an idea what type of coverage Medicare provides as far as CPAP machines and supplies?

Thank you.

What is it you are wanting to purchase?

Medicare pays 80% of the "allowed" amount and you (or your supplemental policy) is responsible for the remaining 20%.
This is all based on the approved or allowed amount...and not the pie in the sky amount that DMEs want to charge.

They should file Medicare for you and then file your Cigna supplement and you shouldn't have to pay anything if you have met all of your Part B deductible. All the CPAP stuff...machine, mask, etc comes under the Part B coverage of your Medicare.

Question everything Apria tells you. Based on what you said, you should owe nothing. Hold off paying until you see exactly what Medicare and Cigna pays.

LSAT wrote: ↑

Tue Nov 01, 2022 5:20 pm

Question everything Apria tells you. Based on what you said, you should owe nothing. Hold off paying until you see exactly what Medicare and Cigna pays.

Yes, speak directly with your insurance about anything that Apria tells you. They are only interested in making profit from you.

obtw - Never give Apria a credit or debit card. If you have no other choice get a pre-paid card cuz they will charge it and it becomes impossible to refund.

I flat out told them if they do the billing codes correctly there will be no balance - its part of their scam, I mean charm.

Thanks all for the info.

I think I'll be investigating in the morning..... and I will NOT be giving them my credit card.

I'll report back with my findings.

LSAT wrote: ↑

Tue Nov 01, 2022 5:20 pm

Based on what you said, you should owe nothing.

Whoa, based on what the OP said, his Cigna supplement only covers 80% of the remaining balance after Medicare pays.

Consequently, there will always be a patient liability.

For example, if the Medicare allowable for a product/service is 100 dollars, Medicare will pay approx 80 dollars, leaving a patient balance of 20. Cigna should pay 80% of that 20, or 16 dollars, Leaving a remaining patient responsibility of 4 dollars.

My own practice is to not pay anything until AFTER I get an explanation of benefits from BOTH Medicare and my supplement.

Not every part B supplement to original Medicare is the same.
You need to know what supplement you have.
Some plans pay deductibles and copays--as long as the provider is in network.
Some may not.
You pay for what you get.
Read the documentation for your plan--yeah, I know, a huge PITA.

chunkyfrog wrote: ↑

Tue Nov 01, 2022 9:10 pm

Some plans pay deductibles and copays--as long as the provider is in network.

I had never heard of a supplement to traditional Medicare that was networked, but I suppose it’s possible.

pratzert wrote: ↑

Tue Nov 01, 2022 6:14 pm

Thanks all for the info.

I think I'll be investigating in the morning..... and I will NOT be giving them my credit card.

I'll report back with my findings.

You might want to look for another supplier. Apria is infamously bad. I try to stay away from the big girls. Fortunately, we have a three-county supplier who is very good. The owners are actively managing the business and working full-time in it.

Hi All.

Here is the scoop....

After calling 3 times and asking why the Co-Pay was so high, I finally was able to get pushed thru to a "supervisor".

After going around and around, I asked them for the breakdown of the secondary Cigna payment/coverage.

After several minutes the person said there was not secondary insurance listed.

Somewhere along the line, someone at Crapria must have deleted my secondary insurance. (This wasn't my first order with Medicare/Cigna.)

After putting in my secondary coverage, I owed ZERO co-pay.

Thank goodness I never gave them a credit card number.

They are idiots !

Thank goodness I never gave them a credit card number.

They are idiots !

They certainly are.

There's a reason we call them "Crapria". My experience was their bills were wrong 100% of the time, and they often substituted less expensive items than my very specific prescription from Kaiser called for. I disputed a bill with them with Kaiser, spent hours of time on this, and Kaiser sided with them. Then I got a refund for the disputed amount 6 months later because a Kaiser audit found the billing was wrong as I said. (Kaiser is no great prize, either).

I don't have DME coverage any more and I wanted to have a party that I would not have to deal with Crapria any more! I prefer to pay out of pocket (but I buy from our hosts at cpap.com or Amazon). No more hassle is priceless.

Do NOT pay them anything until you receive the EOB from your supplement.
Apria may be trying to get balance billing--illegal with Medicare.
It would help if you shared a list of the items you purchased.

Hi Chunkyfrom.

Here is what I ordered from Apria:

1.) Respironics Dreamwear Nasal Mask "Medium" .
2.) Filter(s) for Resmed Airsense 10 Autoset.
3.) Slimline Hose (Non-Heated) for Resmed Airsense 10 Autoset.
4.) Humidifier Chamber for the Resmed Airsense 10 Autoset.

That's it. Originally they tried to get a $47 co-pay. But it ended up being zero.

But it meant wasting time on the phone to get it straight.

pratzert wrote: ↑

Sat Nov 05, 2022 12:37 pm

Here's what I do: Each and every time I order I ask the DME to confirm my insurance coverage in their files, both primary and secondary.

(also, and I'm not sure that this works with universally, but Medicare tells me that they send their (Medicare's) EOB to my secondary automatically, consequently the provider does not have to send an additional claim to my secondary --- this seems to work well with Part B medical claims, but I don't know about DME claims)

I order my CPAP supplies online from my DME. Once I sign in to their ordering portal there are menu selections pertaining to supplies that I can order, as well my contact information and insurances. The insurances shown on file include both my Medicare and my Medicare supplemental. If my insurance should change I can change the information in this portal.
Does Apria or other DME's have patient portals for ordering supplies where one can check to ensure their insurances are on file?