Comments needed - new to forum

[feeB eldooN]

I have just recently found this forum, and have read many of your posts and enjoyed the advice and comments. I would appreciate having your comments and any advice that you may have. I have used a Remstar pro CPAP for about 5 years, set at 14 ramp from 5 to 14 over 30 minutes. I don't know any of the other values that I see some others providing. I use a Mirage Swift nasal pillows, and have experienced problems with leaks. Before CPAP I would sleep for about 45 minutes, and then awaken, sometimes with palpitations. After CPAP, I sleep for 6 hours without awakening, and have no other symptoms.

The DME was Apria Healthcare, who charged my Insurance (Aetna) a large amount for the machine 5 years ago, and then $52 twice yearly as a service agreement(?). My company changed insurance intermediaries (BCBS) in January, and apparently Apria saw this as an income opportunity, and began billing at a rate of $186 monthly. BCBS asked them for further information on several occasions, and having received none, denied payment. This December I received the first statement from Apria, billing for the full amount, and at about the same time calls from a collection agency began.

BCBS has requested a statement of medical necessity from my physician, and suggested that it might be time for a repeat sleep-study anyway. This would be a great opportunity to get away from Apria, and to get an updated machine. My usage thus far has been pretty much successful at a setting of 14. Would a CPAP be correct, or would I be better with an APAP? Is the Swift LT any less prone to leakage and more comfortable to use than the older Swift, or the Swift II?

[Wulfman]

After all this time, why are they still trying to bill you or your insurance? Or, maybe more appropriately.....What are they billing you FOR? Have you ever looked at your contracts that you signed with them?

Your story makes no sense......to ME. But, then, I purchased all of my stuff outright in the beginning and have never dealt with a brick & mortar DME.

Do you have a copy of your prescription? (doesn't matter how old it is)
If you have your prescription, you can purchase a data-capable CPAP or an APAP from an online seller like CPAP.COM.
The APAPs are more "versatile"......not necessarily "better"......it all depends on the person and their therapy needs.

I have no experience with any of the Swift models.......or any nasal masks for that matter.

Welcome to the forum.

Den

[feeB eldooN]

[quote="Wulfman"]After all this time, why are they still trying to bill you or your insurance? Or, maybe more appropriately.....What are they billing you FOR? Have you ever looked at your contracts that you signed with them?

According to APRIA ("Crapria"), the contract with BCBS is different from the one that they had with Aetna, and although they did get a large initial payment from Aetna, the $56 twice yearly was a "rental fee", and Aetna never fully paid for the unit. Then when I switched, the BCBS contract started a "rent to own" at $186 monthly. I have no idea for how long, it hasn't ended yet.

It makes no sense to me either, and has aroused the ire of BCBS. They told me that they were turning it over to their investigations department to see if there's fraud. Unfortunately, I don't have Medicare to sic on 'em.

APRIA is obviously pretty slimey. I got ONE statement from them, accompanied almost immediately by calls from a collection agency. There wasn't even time for a check to have reached them in the mail before the calls started.

[Wulfman]

After all this time, why are they still trying to bill you or your insurance? Or, maybe more appropriately.....What are they billing you FOR? Have you ever looked at your contracts that you signed with them?

According to APRIA ("Crapria"), the contract with BCBS is different from the one that they had with Aetna, and although they did get a large initial payment from Aetna, the $56 twice yearly was a "rental fee", and Aetna never fully paid for the unit. Then when I switched, the BCBS contract started a "rent to own" at $186 monthly. I have no idea for how long, it hasn't ended yet.

It makes no sense to me either, and has aroused the ire of BCBS. They told me that they were turning it over to their investigations department to see if there's fraud. Unfortunately, I don't have Medicare to sic on 'em.

APRIA is obviously pretty slimey. I got ONE statement from them, accompanied almost immediately by calls from a collection agency. There wasn't even time for a check to have reached them in the mail before the calls started.

I think they're going to have to help you sort this one out. There have been some things that some of the forum members have been able to advise as to how to deal with some of these situations, but without the actual paperwork to look over, it's tough to do. The best thing would be to get the H*LL out of that situation and get your own equipment outright. Many of the forum members who have BCBS have reported that they had good success with BCBS reimbursing them for equipment purchased from Internet sellers like CPAP.COM.


Den