CPAPtalk.com

Needsdecaf wrote:I have dealt with Apria here in NY and found them to be accomodating. No problem getting the machine or mask that I wanted. Do what others have said:

1) KNOW your insurance. This was the key for me. It took several calls to Aetna to find someone who knew what needed to hear, but finally I got the skinny.

2) Don't stop calling Apria until you get what you want. Be firm. This is when step 1 becomes important, because you can cut through their BS.

Good luck!

Needsdecaf,

Thanks for your comments.

Step one is kinda hard to do.... Since CIGNA has an exclusive National contract with Apria, any time I try to ask about coverage by calling Cigna directly, I always get the same comment.... that "Apria handles all of the DME supplies for them and they decide what the terms of the coverage are". They defer all questions about coverage and allowances to Apria.

Oh ya.... that one always gets my blood boiling. I cannot get coverage information from my Insurance company ! They tell me to call their contractor about it ?!

Sure.... I know I can write letters to my State Insurance Commissioner and write letters to my Insurance company, and complain to my employer that I can't get answers about coverage.

But... I admit... after hours on the phone, getting ulcers and headaches, that I have taken the easy way out by purchasing my own machine and supplies from another source and paying out of pocket for it, but I keep my sanity and blood pressure lower.

Fortunately, I can afford it ( no I'm not rich ). I feel very sorry for those Apnea sufferers who cannot afford to pay out of pocket for their machines and supplies and have to go through thru the wringer to get the treatment their Doctor's have prescribed.

Tim

Any item that a person is going to submit to insurance requires a perscription. Period. Online DME companies do not bill insurance which is how they get away with it. I know that it sucks, but it is the rules.

Tim,

Have you called your Human Resources Office? When I have trouble getting a straight answer out of my insurance company, we have 1 person in HR that handles these issues. The idea that CIGNA allows the DME to determine the coverage is rediculous - they most certainly have a contract for what CIGNA will cover.

May I suggest one other thing, perphaps the young man you talked to at APRIA is not up to speed on CPAPs. He looked up the replacement on a CPAP machine and doesn't know the mask is separate. (OK maybe I'm being to gracious) Call back and ask about the mask replacement again. If he comes back with 5 years again, simply state "No, I need a CPAP mask, not a CPAP Machine, you are looking at the wrong item"

I wouldn't pay out of pocket if I didn't have to. Your paying the insurance premiums, therefore you have already paid for the items covered.

[quote="pratzert"]
Needsdecaf,

Thanks for your comments.

Step one is kinda hard to do.... Since CIGNA has an exclusive National contract with Apria, any time I try to ask about coverage by calling Cigna directly, I always get the same comment.... that "Apria handles all of the DME supplies for them and they decide what the terms of the coverage are". They defer all questions about coverage and allowances to Apria.

Oh ya.... that one always gets my blood boiling. I cannot get coverage information from my Insurance company ! They tell me to call their contractor about it ?!

Sure.... I know I can write letters to my State Insurance Commissioner and write letters to my Insurance company, and complain to my employer that I can't get answers about coverage.

But... I admit... after hours on the phone, getting ulcers and headaches, that I have taken the easy way out by purchasing my own machine and supplies from another source and paying out of pocket for it, but I keep my sanity and blood pressure lower.

Fortunately, I can afford it ( no I'm not rich ). I feel very sorry for those Apnea sufferers who cannot afford to pay out of pocket for their machines and supplies and have to go through thru the wringer to get the treatment their Doctor's have prescribed.

Tim

[quote="Needsdecaf"][quote="pratzert"]

I would suspect that you could also get partially reimbursed for an "out of network" supplier doing what you have done.

Good luck.

> But it was better than nothing and W A Y better than the hassle of dealing with Apria.

This is a sad story. You end up paying _twice_, once for your insurance (for no service) and again when you buy something out of plan.

Everyone needs to understand what is going on. Apria resists every way they can so that patients will not come to them to get covered items. Every time a patient buys a covered item from somewhere else Apria employees probably high-five each other.

To add insult to injury.... Apria REFUSED to send out a Respiratory Therapist
to set up my machine and teach me how to maintain it because "I did not get it from them".

Pratzert: Good for Apria! Why in the world would you expect them to service you on something you didn't get from them?

xyz wrote:> But it was better than nothing and W A Y better than the hassle of dealing with Apria.

This is a sad story. You end up paying _twice_, once for your insurance (for no service) and again when you buy something out of plan.

Everyone needs to understand what is going on. Apria resists every way they can so that patients will not come to them to get covered items. Every time a patient buys a covered item from somewhere else Apria employees probably high-five each other.

Except Apria doesn't make out.
They can't bill the insurance company in this case. Why do you think the MAP things are going on. It's because Apria is putting pressure on the hardware vendors to set MAP.

Some people have high copay percentages and deductibles to the point that there is not a whole lot of benefit from their DME.


For many people who have high

Anonymous wrote:

To add insult to injury.... Apria REFUSED to send out a Respiratory Therapist
to set up my machine and teach me how to maintain it because "I did not get it from them".

Pratzert: Good for Apria! Why in the world would you expect them to service you on something you didn't get from them?

How about you post something intelligent and useful. And why not register rather than to hide behind a anonymous screen name.......

Anonymous wrote:

To add insult to injury.... Apria REFUSED to send out a Respiratory Therapist
to set up my machine and teach me how to maintain it because "I did not get it from them".

Pratzert: Good for Apria! Why in the world would you expect them to service you on something you didn't get from them?

Apria ( The most EVIL DME in the World. ) gets PAID by my Insurance company for a RT. It has ABOSLUTELY NOTHING to do with the machine or where I bought it, or even if I bought one.

RT services are COMPLETELY separate from any CPAP related charges.

Even if I did not have a CPAP and required some sort of RT services, such as for Bronchitis Therapy, then Apria is the one who is supposed to supply such services.

There is no relationship between the two.

I am now convinced you must be some sort of planted spy from Apria with all of your comments about how great Apria is....

You post as a guest and obviously have NO idea what you are talking about..... Oh Ya.... just like Apria !

A few issues to address:

1.) You guys are right, Apria is terrible.
2.) You can get a new mask, headgear, and tubing every six months and depending on your insurance, a CMN signed for lifetime will be just fine.
3.) The only way that you can get a new flow generator every five years is if yours is broken beyond repair or no longer repaired by the manufacturer.

nmh:
> Except Apria doesn't make out.

Sure they do. Big time!

OK, I need to be a little clearer here. In many case, obviously not all cases, when Apria is contracted by a large insurance company they have a _capitated_ contract. This means that for each patient that Apria serves, Apria gets a FIXED amount of money. *Whether the patient uses them a little or uses them a lot!*

Every single item or service (labor) that Apria delivers to a patient REDUCES their profit.

That is, the evil accountant back at corporate headquarters may view all the money they get from the insurance companies as profit. Every single penny that they expend in products or services reduces their "profit".

It is to Apria's great advantage for patients with capitated contracts to buy things from other sources.

guest:
> They'll wish they had once the FDA audit comes

Can you give us a written source for the requirement for a prescription for supplies like, say, disposable filters. I'm not saying you're wrong, but I really want to know the right answer. And if it is really a firm policy as you say, then it must be in writing somewhere.

the other cpap guy wrote: 3.) The only way that you can get a new flow generator every five years is if yours is broken beyond repair or no longer repaired by the manufacturer.

At five years and one day it got ACCIDENTALLY pulled off the self while I slept and it broke into 5 pieces. Do you think it can be put back together with Duck Tape? At five years technology will hopefully changed enough that you deserve another one.

Jerry

[quote="xyz"]nmh:
> Except Apria doesn't make out.

Sure they do. Big time!

OK, I need to be a little clearer here. In many case, obviously not all cases, when Apria is contracted by a large insurance company they have a _capitated_ contract. This means that for each patient that Apria serves, Apria gets a FIXED amount of money. *Whether the patient uses them a little or uses them a lot!*

Every single item or service (labor) that Apria delivers to a patient REDUCES their profit.

That is, the evil accountant back at corporate headquarters may view all the money they get from the insurance companies as profit. Every single penny that they expend in products or services reduces their "profit".

It is to Apria's great advantage for patients with capitated contracts to buy things from other sources.

guest:
> They'll wish they had once the FDA audit comes

Can you give us a written source for the requirement for a prescription for supplies like, say, disposable filters. I'm not saying you're wrong, but I really want to know the right answer. And if it is really a firm policy as you say, then it must be in writing somewhere.

I have had a lot of patients replace thier CPAP after 5 years even it was working.