Apria ADC may overrule your doctor.

dllfo wrote:I document it. For all you know, the person messing up your orders is doing the same for others and until you tell the boss, how is he to know?

YES! When dealing with any company, if things are getting ugly document EVERY little thing, no matter how inconsequential it may seem. Dates, times, what was said and agreed to, promises made, names and titles of everybody you talk to, etc.--everything. And keep every scrap of paper, including scribbled notes, not just official invoices and letters. I've done this a couple of times in my life--once an insurance company and the other an airline--and it was a godsend both times.

What it comes down to is thinking like the company thinks, not how you the individual thinks. Yeah, we shouldn't have to do it, but as long as any corporation in any industry exists, then the documentation makes sense. It's a matter of protecting yourself.

Management is often responsive when presented with detailed documentation from customers, because they don't usually run across customers that are that prepared.

Doug.

Snoredog, that's not MY checklist, that's Medicare's checklist. Straight from the provider manual.That's it, end of story, how it has to be documented for Medicare.
No other rational.
If a Medicare audit is done, that's the stuff that has to be present, or payment will be denied, anything that has been paid has to be reimbursed, and the company can be fined lots of money.
If you don't like the checklist, or the guidelines, by all means, contact your congressman. I have.

I am thankful every day that I dont have to deal with apria.

The part that gets me is the lying. Saying it wasnt in yet...then finding out it hadnt even been ordered.

Plus even if you dont meet the criteria that everyone is arguing about....they didnt tell you that. They came up with some crap regarding liability. If it is an insurance issue about what they will cover then they should have told you that in the first place and you could go battle the insurance company.

Documentation is key. IF it ever DOES get to the point where you are suing you will want to have that. Also whenever someone new tells you something stupid you can call them on it because you will have names, dates, and details at your fingertips.

It is really frustrating to see so many people not getting proper treatment because of a DME.

[quote="fidget"]Snoredog, that's not MY checklist, that's Medicare's checklist. Straight from the provider manual.That's it, end of story, how it has to be documented for Medicare.
No other rational.
If a Medicare audit is done, that's the stuff that has to be present, or payment will be denied, anything that has been paid has to be reimbursed, and the company can be fined lots of money.
If you don't like the checklist, or the guidelines, by all means, contact your congressman. I have.

I never said he had to have ALL the disorders, I said he needs to have the documentation required under his diagnosis, which, in his case, is the Central Apnea. A script alone won't do it. He doesn't know if he had blood gasses done, He'd probably remember if he did. There has to be proof that the rad with rate improved his condition, such as, low sats, or high CO2 while on his rad without rate, and then corrections documented on a rad WITH rate.

I'm not misinterpreting anything, prequalification is my job. And I know for a fact that even the smartest doctor doesn't know all the qualifications they need for things they prescribe. Forever doctors are ordering things based only on the latest rep they've seen, with no clue how these things are to be reimbursed. That's not their job. They order "flutter valves" for mucus, great, they work wonderfully. Medicare says they're not medically necessary. All the screaming and yelling by the doctor that he ORDERED it, isn't going to make Medicare pay for it, so the patient can pay out of pocket, or refuse. Brovana, nice drug, the drug reps are pushing it. A Formoterol inhaler is the same thing, and Medicare has a whole laundry list of criteria that have to be met before they'll reimburse, but the doctors are ordering it for every short of breath person in the office. If they're not documented as already using a bronchodilator 4 times a day routinely, Medicare won't pay for it. Period. And the doctors throw fits. And the patient winds up having to pay over $250 a month for a drug that the doctor WANTS him to have, even though a Formoterol inhaler is availabe for a quarter of the price, just because a rep sold him on how wonderful it is.

I hope he was tested on both the S/T and the Adapt, so there truly is a medical necessity shown for the Adapt. If an S/T will do the job, there's no reason that ANY DME should have to pay the price difference for an Adapt, that they'll only be reimbursed for at S/T rate. If the sleep study shows that an S/T won't do it, then by all means he should have the Adapt. But not if it's just the flavor of the day.

Sorry, just realized I was writing Adapt, when it's the Auto S/V ordered.

Medicare is not "bullet proof" either. Nor Tricare. Congressional mandates have turned a good thing into bureaucratic nightmares whose regulations lend new meaning to the term obtuse.

I spoke to a pulmonary doctor today, not my doctor, but he called me at home to discuss Apria and their handling of my case. He was not happy with Apria and tries to keep his patients away from them.

Coming from a licensed, practicing Medical Doctor, that is a warning across the bow to Apira. IF they knew. I told him I would tend to agree and didn't even bother to mention the episode of the Pulse Ox machine with an alarm. I needed an alarm for when my pulse ox dropped below the desired levels. Apria gave me the name of a unit that was pretty big. I asked them if they had a smaller unit. They said no to having any other unit, but they had those on the shelf now.

READ THAT SENTENCE AGAIN. They said "those" which to me, implies plural.
Had they said, "Sorry, but we only have one on the shelf right now and may not get another one in for awhile....." I would have taken THAT model. I thought they had more than one. All week before I was to leave on June 4th Apria tap-danced or more accurately stonewalled me. I was getting angry. THE FRIDAY BEFORE I WAS TO LEAVE ON MONDAY, AT ABOUT 6 OR 6:30 pm, THEY BRING ME A UNIT I NEVER HEARD OF. I looked at the box and the poor delivery guy handed to me like it held a snake. Bless his heart; he seemed to act like he wanted to be anywhere but in my home. I thanked him sincerely for delivering ANYTHING Friday night after 6pm
He asked that I sign for it and I started to, then the Good Lord intervened and I said let's open it. It had been brought up from Stockton by special courier. $$$$ being wasted. I opened it and looked it up on the internet, I immediately saw one of the three pieces was missing. The part you put your finger in. My temper is kept under lock and key, next to my Sig 220. I was not angry with the delivery man, but it was obvious they did not provide adult supervision in Stockton or Sacramento. More wasted assets. I wonder if Apria HQ is aware of this? Doubt it.

I quietly told the delivery man that they were missing the part that I put my finger in. I asked him who did the QC on it? He did not know. I called Apria and don't remember getting anyone. I refused to accept it. How would YOU like to be the manager of this mess? Based on my case there was No Quality Control in Stockton or Sacramento. Using a courier to transport a piece of equipment without even counting the pieces is dumb.
$$$$ wasted. They don’t even have a sticker to tell them a device has two pieces or three. I feel sorry for their managers at times, then other times I wonder why the local manager hasn't got more training for his people. Maybe Apria HQ does not allocate funding for this.

Regardless, I left without it Monday am, only able to drive short distances each day. I crossed passes over 9,000 feet and lived at 5,600 feet for about a month. I opened the old bottle and left it empty. Turned to "on".

The boss's assistant, I have her name, it begins with an L. I called her, telling her the doctors in Denver recommend I bring 4 of the M6 bottles, so Apria brought 2 more out. SILLY ME, I read the instruction manual. If you don't, you are asking for trouble. Bottles numbered 1-69,999 were to be used below 5280 feet. One statute mile. I had one in that category. I called the Respiratory people and this lady said "You have three, isn't that enough?" I told her no, the DOCTORS recommended four working bottles.
Not three. Her attitude was just that. I have my nerve asking her for four bottles. I again asked her what they can do. NOTHING. Apria doesn't use the HomeFill II unit very much and they don't have any of those bottles around here.

When I returned, I had read the tea leaves, I figured on what L would say about the pulse ox meter. I was ready.....with my notes. Her boss told me I had caused my problem by not accepting the original unit they offered. I told him that was partially true, but had anyone told me Apria only had one in Sacramento, to service thousands of people...I would have taken it. But your employee said they had "THOSE" on the shelf. Had your emplyee said that you had ONE unit I would have taken it.

So is Apria criminal? Or negligent? Or mostly a bunch of under trained, under paid people trying to survive? I vote for number 3 right now. If you were to ask the TRUE PROFESSIONALS, like the people who care enough to spend time here helping us for no pay, just because they care about the little people, you can learn a lot.

I think the battle may be with Respironics. If I have a prescription for Encore Pro 1.8, that will enhance my health and allow me to live better, I want to see how they justify giving it to a DME, but not giving it to me.

I have 37 pages of notes, they help me remember what we discuss. If I had to, I could turn these pages over to Medicare or Tricare. About five or six people at Apria try hard, of those, not all are management and therefore they are limited in what they can do.

IF YOU ARE DEALING WITH APRIA, UNDERSTAND THEY HAVE LIMITED RESOURCES AND MAY ONLY HAVE ONE OF WHAT YOU WANT. Ask them if they have more than one E bottle or H bottle or Home Fill II unit. Very few people get up in the morning thinking they will rob the world or mistreat the poor, or sick. Apria is required to give the same level of care to all their patients. IF you deal with Apria, write that on your mirror because Apria has defacto become the lowest common denominator. If they provide me with the SV, they are required to provide everyone else. At...say. $3000 a pop and getting repaid over 13 months. 100 x $3,000 is around 300k going out, while congress gives Apria 1/13th of that monthly. Give or take some. Even if congress authorized repayment in half the time, Apria is required to provide the funds up front. Maybe the ADC is really an acronym for Accountants Don't Care? (My bachelors degree is in accounting...I am kidding here, no hate mail from accountants please, my green shade probably predates yours

So if they provide me with the newest Auto BiPap around, then all the Apria locations may incur the same liability. If you can deal with a smaller company, you may be better off. Unless you travel a lot.

LATE EMAIL FROM APRIA, MY SV UNIT WILL BE HERE TOMORROW. Now for the software.

Sorry fidget, I had ABG tests done several times. Even an IV in the artery.
That was when I told you about the ways to reduce the pain during ABGs.

As for the findings, I have a small book about the findings. But the morphine wins all the battles unless I look things up.

Yeah, ABGs are awful. There has to be a better way, that doesn't feel like your hand is being amputated huh?

I'm glad your getting your S/V.

You've had a long road.

Y'know, I do know of a couple of patients who actually sleep on a ventilator with a full face mask, not a trach. Try getting that through Medicare.

Perhaps, if claims departments actually hired people who knew medical things, instead of numbers, everyone's life would be easier.

And if Medicare made sense in the things they cut, and the things they overpaid for, it would be a miracle.

One example. It's standard practice for a trach patient to use saline in his trach to loosen secretions for suctioning. Medicare won't pay for that. They will however pay for saline to flush out the suction catheters. So the doctor has to order saline for flushing suction catheters, so people can get the saline they need for their trachs. You don't need to flush a catheter with saline, and I never heard of anyone actually doing that. You use sterile water, or throw the catheter away. Wierd.

fidget wrote:One example....

Yeah, there are plenty of examples of doctors who prescribe things that are medically necessary. But they know that either a) insurance won't cover it or b) it hasn't been FDA approved in the US for that specific medical condition, even though it will fix the problem. So the doc words the script "creatively." It's a great example of how screwed up the medical industry is.

Doug.

dllfo: you might want to download this:

http://global.respironics.com/UserGuide ... 043494.pdf

Sam of NY,

I had similar issues with Apria (Milford/Cromwell CT branch) and Cigna. My sleep doctor prescribed a ResMed machine and Apria would only supply the basic Remstar machine. They indicated they had shipped a machine and when the time passed, I asked for a proof of delivery and then they admitted that they had never shipped the machine and that I must pick it up at their facility which was 35 miles away. I tried several other DME's but none of them would deal with CIGNA.

Maureen Bryant (1-317-865-4238) an Apria supervisor of some type, did finally manage to get me a CPAP.

There has been no follow up by Apria although I did order a new mask and received it promptly although they seem unable to supply a new hose.

Barbara

I got my SV.

Our last Customer Service Supervisor/manager allowed me to give people her
direct phone line......if you had a problem with Apria, she would try to help you.
She sure helped me and the new lady in her job just did it too.

One thing I did do, and some of you will not agree with this, I wrote a letter,
printed and signed it in Blue Ink. I scanned it and emailed it to Apria, saying
I was setting my BiPap machine and they should not be assigned any liability for that.

They did not ask me to, but I sent it. DMEs have enough liability.

ABGs...I think I mentioned this, but use lidocaine on your right wrist, the inside area where they chase the artery. Do lidocaine about an hour prior, then again about 30 minutes prior, then tell the person doing the procedure, at NJC they understood and gave me a shot. Especially if they are putting an IV in the artery. Some times my wrist looked like a sewing machine had been used. Last thing was a warm wash cloth, with a plastic container on top of that. This plastic thing is very warm, the wash cloth is to protect your arm.

They called in the best person they had and I can tell you, after all that, I did not even feel the procedure. I looked the other way while she was doing it.

I downloaded the info Snoredog, thank you.

Doctors and prescriptions? My neighbor was an GP. He was frustrated by all of it. He worked his rear end off, borrowed thousands of dollars and feels like he is not being allowed to practice medicine. I see both sides.

No good answer.

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