CPAPtalk.com

Jason, you look a lot like a character in a book I read - Dirk Pitt.


and now for the nitty gritty . . .

I’ve been on CPAP since September 2005 – 3-1/2 years. Up until now Apria has been my sole provider of equipment. Here is my story . . .

First of all, I would like to relate my only previous experience with a DME. About twelve years ago I sprained my ACL, and as a result there was some lateral movement of the knee. It was severe enough to where I couldn’t bend my knee and I needed physical therapy for about six weeks. Since I played adult ice hockey at the time, my PCP wrote a prescription for a knee brace. I called a local DME supplier (one that had several locations in my metro area so it wasn’t a one store shop) and had to set up an appointment. The appointment went like this; it lasted about an hour, we tried on several types and brands of braces, the tech asked me about my lifestyle and recommended a certain brand due to me using it while playing hockey. The brace worked perfectly, it took a year for my knee to be strong enough to forego the brace and not have that “funny, loose, feeling”. My knee has been fine ever since. Now, keep in mind that device was only a few hundred dollars.

Now, let’s compare that to my CPAP experience with Apria.

I went to my PCP, he ordered the sleep studies, wrote a prescription for CPAP, setting @ 8 cm, humidification, there was no reference to a mask. I didn’t have any clue on where to get this equipment and someone, from somewhere, directed me to Apria. When I received my equipment I was given a Remstar Plus (the old non C-Flex, no data version), a passover humidifier, and a Comfort Gel nasal mask. I was given minimal instruction on attaching the hoses, cleaning, adjusting the mask, and turning on the machine. The whole process took about 15 minutes. For this, Apria received a total of $1,305, $230 paid by me and the balance by my insurance company. I was never asked about my conditions or lifestyle, or asked if I had sinus issues, I was never presented with options on the CPAP machine, C-flex, data storage, humidifiers, or mask options. I do remember noticing the heated humidifier option in the user’s manual and asked about it, I also expressed my concerns about a nasal mask because of my sinus issues and mouth breathing. These were downplayed by the tech, I cannot remember his comments on the mask, but he did tell me the heated humidifier was not covered by my insurance and would have to buy it myself but he didn’t recommend it. I now know that my insurance company will pay for a heated humidifier if required.

I’ve used this equipment for three and a half years now, the last year of which my symptoms have been returning, and frankly haven’t been getting good therapy from CPAP. Since day one I wake up with extreme sinus irritation, runny nose and often have small traces of blood when I clear my nose in the morning. From discovering this board two weeks ago I realize I started having symptoms since my twenties, I’m 53 now. I’ve fallen asleep during meetings and while driving (thankfully I never had an accident, but was close). I’ve always been a mouth breather as I have non-allergic rhinitis and my sinuses are often stuffy and cannot breathe through my nose. My compliance is less than 60%, which I find surprising since I always try using the machine. My non compliance results from a stuffy nose at bedtime, or waking up with a stuffy nose and removing the mask. Since I cannot wear my glasses with the mask on I often watch TV or read in bed before falling asleep without my CPAP, and if I do fall asleep I don’t bother to set up my CPAP equipment because it is so uncomfortable. Just this week I ordered a nasal pillow, I cannot use it because the back pressure when I exhale is just too strong and uncomfortable, and this is at the 8 cm setting which I know will be raised based on my recent sleep study two nights ago. I’ve lived with this condition for decades and I am not going to suffer from it any longer.

Your industry often responds that they provide what the doctor ordered, and it’s the doctor’s responsibility to prescribe the equipment. I don’t buy that excuse. When I had my knee brace, the doctor didn’t prescribe a model, or a certain manufacturer; a competent, qualified individual picked the correct equipment for my situation. Doctors and patients rely on the equipment “experts” at the DME’s to choose appropriate equipment. The same holds true for pharmacists, doctors frequently consult with pharmacists when prescribing medications. They are the drug experts, like you need to be the equipment experts.

I’m also of the opinion that a 275% mark up is not necessarily unjustified. There are so many other costs besides the direct cost of the machine. Especially anything related to the medical field. To name a couple, billing and DME training. We all know the requirements of insurance billing; people make careers consulting with providers on procedure codes, equipment codes, 1500 preparation, plus the costs of training necessary to competently choose the right equipment for the situation. Insurance companies know that the margins are high, but they expect you to educate, train, and choose equipment for the patient. All of that takes time and effort. So, if you’re going to have a high markup you MUST earn that high margin by taking care of the patient.

So for me, its three and a half years later and I am still struggling. I need equipment that will provide adequate therapy and I’m stressed I will be out of pocket on the required equipment because my insurance company won’t buy me new stuff since my current equipment is relatively new. “Relatively new” is even relative, since I now know that the Remstar Plus version I received was even obsolete back then. C-flex, heated humidifiers, software to evaluate the therapy, nasal pillows and full face masks were all available when I started, but I suppose you’ve got to dump that ‘ol stuff on someone.

You mentioned that you started CPAP three years ago, but I see that you didn’t include your equipment set-up in your profile. It would be interesting to find out what equipment you used 3 years ago when you started and compare it to the equipment your company decided I should have 3-1/2 years ago. Be honest now.

I’ve also had problems ordering supplies from Apria – order not showing up and calling a month later to find out no order exists for me and my prescription was expired – maybe to original order was deleted because no on wanted to take the time to get an updated Rx. On another occasion I’ve ordered supplies in early December to get them in before my annual deductable kicks-in in January, only to find out Apria didn’t bill my insurance until Jan 31, almost two months later. I would have had to pay that sooner or later, but still.

To wrap it up, I don’t feel my insurance company should have to buy new equipment for me, even if they agree. There is no excuse as to why I wasn’t provided with appropriate equipment to begin with. I have a new doctor now, and he cannot even see any stats on me unless I attend a sleep study, further costing my insurance company and indirectly costing everyone in higher premiums. I believe the responsibility of my discomfort, non-compliance, sleepiness, drowsiness, stress about getting new equipment that will give me adequate therapy falls 100% on your organizations shoulders. I’m not looking to get new equipment just because I want the latest and greatest, I NEED new equipment that will help me live a reasonably normal life, and everything I need was available when I started. Finally, let me finish with a question. If my insurance company won’t pay for new equipment since mine is so “new”, what can Apria do for me?

Welcome to the forum. Thank you for asking us how your company can improve its service. I appreciate that someone cares.

My husband and I are both CPAP users. Apria was our second DME because I got a good RT on the phone who helped me a lot. But we ended up firing them after a number of bad experiences.

A different staff member was very rude to my husband when he came to try on masks, telling him that he didn't have an appointment, etc. My husband took offense, and this staff member then told all the other staff members that we both are pains in the ass. And he's never even met me.

The next time we came in, we were treated poorly by a medical assistant. She made judgments based on the other staff member's comments. She told us to take our business elsewhere. The customer service and branch managers didn't like that, but I can't see that anything they did helped. I ended up getting her on the phone later and she was just as rude.

We expected we would be seeing an RT, but her name tag said "medical assistant." She was not able to answer our questions and tried to brush them off as unimportant.

These are branch specific issues, but I also have some company policy problems:

We are now getting our supplies from another provider, but are stuck with Apria when problems arise with our rented machines. We travel a lot and spend the winter in a different place than our home. We brought this up and asked questions about using other Apria branches before choosing to become Apria customers. At no time were we told that our "home" branch needed to provide us with "travel permission" in order for us to get service from another branch. This is a big oversight on their part. I was without a humidifier for one night because the mine quit working and the Tacoma branch couldn't get their act together to get the travel permission information to the Tucson branch. And I still don't have any travel permission paperwork in my possession, so we'll have to go through this again if I have problems in another place. My husband doesn't have any paperwork, either.

It is not possible for a customer to talk to a billing specialist. The best we can do is to talk to a patient pay operator who will send an email to a billing person when trying to resolve a problem. And no one ever follows up on these issues. I had to call back three weeks in a row and finally a patient pay supervisor gave me a direct number to a billing specialist, even though that is against company policy. The issue had actually been resolved two weeks prior, but no one bothered to inform the patient pay office or me of that.

I tried to return the non-functioning humidifier unit, so that its problem could be verified and it could be returned to Respironics since it was still under warranty. They wouldn't take it and told me to throw it away. This concerns me because anyone could simply say their machine is no longer functioning just to get another one. If the humidifiers aren't worth taking back, are they really worth all the money that gets charged for them??????

Thanks again for asking us for our opinions.

Jason S. wrote:

elader wrote:I had two very different experiences at two Apria branches in Maryland. One was awful in every way, even in follow up calls (NO! you are not entitled to a different mask, go away). The other couldn't have been better. [\quote]

I think Apria is my BC-BS in-service provider. I have tried anything yet but I hope they don't give me a hard time. I have the Comfort-Gel and I really want to try out the Mirage Quattro. My 3 months will be up in mid March.

go there and try on a bunch of masks.

ApriaRT, You may feel you are swimming against the current for a while, but you will hear and feel what users like or dislike about DME service and that applies to all DME companies. Good service = happy customers. My first DME was not Apria and my experience ranks with the worst of the worst. My new DME is so wonderful, after my initial business with them I almost sent flowers, but sent a nice email instead.

Having been on Cpap for 3 1/2 years I have had to deal with Apria for everything due to my insurance. Every experience with them has been horrible. Fortunatly for me in the beginning of my treatment I found this forum and had a lot of help understanding equipment. When I asked Apria for a data capable machine because I was going to get software to monitor my therapy I was told no such software was available and if it was it would cost thousands of dollars. I got a card reader and the free version of Encore Pro on my own. I have been billed for more masks than I got. I have been sent numerious items I never ordered and was asked to bring them in or return them at my expense (huh?) My last experience was I dropped of a prescription that said "M series auto C-pap with a flex" When I went to pick up the machine it was a c flex. When I questioned why I didn't get an A flex I was told by the RT there is no difference. I left and said I'd get back to him. Emailed Den got the info I needed and when I called the RT back he changed his story and said that because the "a" was not capitalized on the presciption it was interpreted to be c flex. (huh?) I'm sure I have a frowny face on my records with them because I have always been outspoken with the knowledge I've gained here and have never been afraid to be sure that I get what I want and need. I'm always happy to hear others who've had good experiences with them. I've always shopped where I can get good customer service in case of errors, etc. Unfortunately with Apria I have no choice.

In the case of this particular Apria I would hope at some point they would understand the there are a lot of us users that understand as much, if not more, about good equipment and shouldn't have to jump through hoops to get it.

40 Winks wrote:Jason, you look a lot like a character in a book I read - Dirk Pitt..

Dirk is my brother.

My original sleep study said I needed a retest 90 days after starting CPAP APRIA RIPOFF Never did anything about it they stuck me with a &^$^#@@*&%%% Remstar Plus After 1 year I bought out of pocket a Remstar Pro2 w/cflex.

A year later I took my sleep study to a doctor he read it and asked who the IDIOT was that did not follow the prescription and he wrote me a new prescription for a BiPAP machine. I have been on it since and have not had any sleep apnea problems since.

I am sure glad I NO LONGER have to deal with APRIA RIPOFF any longer.

they should fire every one to the staff in the San Diego office. They never mind!!!

My first experience with Apria in Livermore, CA was awful. Lost my prescription! The technician was totally unprofessional: no discussion of different machines; no data capability on machine; didn't have a mask; didn't sanitize the one demo mask that they did have; no discussion of different masktypes etc. etc.

I filed a complaint. The supervisor called and apologized and got me a new machine with data capability... but did not tell the truth to the insurance company.

However since then, I have had very good experience, with quick response, follow-up etc.

As stated by others, the newbies have no idea as to what we are doing and need some practical guidance - with potentially some emotional support?1

Appreciate you asking the board for feedback.

Sam

I have had the worst service from Apria, and the representative in my area was horrible too. She could have cared less about my concerns, didn't return my calls (oh gosh 2 telephone calls). I fired her, returned the machine and am doing something different at this time. They won't get a good reference from me.

I've just recently switched over to Apria from OxygenPlus due to an insurance change. I had good service with OxygenPlus--they gave me a good machine 2 years ago when I had no idea what I needed, and regularly called to follow up and see if I needed any new equipment. When I first called Apria, I was told that I would just need a current prescription from my doctor. I got that, called them back, and was THEN told that I needed a copy of my original sleep study, info about my machine and who paid for it, etc. I called my previous DME, and was told that they needed something in writing requesting my records. When I told Apria that OxygenPlus needed something in writing to transfer my files, they said that they didn't have any forms like that, and that it wasn't standard procedure. I tried to explain that they just needed a fax sheet saying "Please send records," but it still took a few days for that to happen (told them on Tuesday, finally happened on Friday). The lady at OxygenPlus even called to talk to Apria, and after 4 days and at least as many phone calls, she was told that Apria had no record of me or my calls. I finally got everything transferred, but was told I could not set up an appointment for a fitting because the appointment lady wasn't there. I will be calling Apria in the morning to see when I can get in for a fitting. I've told them exactly which mask I want (and will do so again), so I'm hoping that I can get it relatively quickly. I'll follow up with my experience.

Went in for my second sleep study to sleep with CPAP and determine what my settings should be. Called my neurologist the next day and was told it may take some time to get things sorted out because my insurance company insists on my going through Apria. From the postings I have read it does not appear as though this is going to be an easy journey.

I felt claustrophobic and it took some time for me to adjust and fall asleep during the sleep study. I asked the doctor for a sleeping pill in advance and was sure glad I did. The first study did not go very well as I had shoulder issues and woke up when I rolled over on my shoulder.

I went online to check my insurance coverage and it appears as though my machine, mask, and supplies will be covered but who knows what Apria will try to stick me with. I have allergies and am a mouth/nose breather. The Mirage Liberty face mask with nasal pillows was suggested in an earlier post to help with the claustrophobia and the nose/mouth breathing. I hope to be able to get a unit with allergy filter.

Any suggestions on the CPAP machine I should try and get? I travel by plane approx once a month.

julieanne, For your own good please check with your insurance company to see if other DME's are available. If you are starting out this way as a new customer, do you think things will improve? If you must go to them, how about PM ApriaRT who started this thread and maybe he can talk with them. As part of the Apria network this hurts him also.

Apria was the preferred DME for my insurance, but others are in-network. I googled Apria and after 10 minutes decided on another (which turned out to be not so good). My current DME is stellar and I hope they are around a long time.

Also, where I live, Apria is run by a lady out of her house and she visits you to set things up, etc. I can't imagine her dropping her kids off and coming to my house because my mask leaks to much?

The Muse wrote:I have had the worst service from Apria, and the representative in my area was horrible too. She could have cared less about my concerns, didn't return my calls (oh gosh 2 telephone calls). I fired her, returned the machine and am doing something different at this time. They won't get a good reference from me.

Try calling them in San Diego...To get to talk with an RT you are on hold for anywhere from 15 min to 95 min. It being a toll call from my house to their office I have old phone records showing just how long I was on hold.APRIA RIPOFF SUCKS

I can't speak for all Apria DMEs, but the 3 that I have dealt with are no longer choices at 2 of the 3 labs I work at. My experience with them, along with patient horror stories goes something like this. Cheap CPAP machines, cheap masks. They tell their patients that their insurance only reimburses them $80 for a mask, and many of the masks cost well over $200. I have seen people come in with duct tape and all sorts of interesting home remedies on their machines and masks, because Apria does not follow up in my area. They send over truck drivers, have them dump off a machine and tell the patient good luck. Its a DME's responsibility to make sure a patient is compliant, and in my opinion Apria doesn't not follow through. The whole reason why DME's claim to be better for CPAP setup is because of the support you should get from them. Otherwise you would be better off ordering them online. This is why many DME's will give away masks until they are blue in the face. They want that CPAP sale. I hope that your company is much stronger in patient relations. Having said that, I will say that if you are an Apria patient, you can go anywhere in the USA practically, and get a replacement mask if you were in an emergency situation. (So they claim anyways.)