insurance question

Earlier this year I was diagnosed with sleep apnea and prescribed a CPAP machine. Unfortuanetly the insurance I had, at the time, used Apria as their DME. I realize that the CPAP machine was rent to own, contract ending date to be decided by my insurance company. After much wrangling and issues, Apria sent the correct bills to my insurance and my insurance just recently paid out, as well as my monthly payments. After about my 3rd month on the rent-to-own contract, my husband changed jobs and now we have Aetna HMO (before I had a POS plan).

Not sure how to deal with Aetna now with the change of insurance. I saw my PCP today and told her that I was on a CPAP machine (prescribed to me from before). She said that was fine but that I would have to see the Aetna pulmonary specialist to be able to get authorization for my CPAP supplies. I won't be able to see the pulmonary specialist till end of Dec.

Not sure how this break in insurance coverage will affect my Apria coverage for the CPAP. I know that without insurance, my CPAP monthly charges would be about $331/mo. Once I see the pulmonary specialist, will he be able to backdate the prescription coverage of the CPAP, since I never had a break in insurance coverage (just changed new insurance), but wasn't able to get an appointment to see the specialist till end of Dec?

Having DME and changing insurances can be a real pain. Thanks for taking the time to answer my questions.

Most of the rent-to-own contracts are pretty bad deals. Pretend that you had no break in coverage. Go find out how much a CPAP machine like yours costs without insurance, and check how many months that would take you to buy it outright at $331. I bet it's not more than 3.

I personally do what is the best deal for me. That is often paying out of pocket rather than going through insurance. Don't be wedded to using insurance just because you have it.


Call Apria and find out what happens if you wish to stop renting now. You might inquire what the pay-off amount is to buy it outright, but it's most likely a waste of time. If I were in your shoes, I'd seriously consider taking their machine back to them, if your contract allows that, write off whatever you have spent on it, then go get a good data-capable machine and pay for it out of pocket. It's likely to be less expensive for you overall. Your PCP can write you a prescription for that, or you can use your previous Rx. If you don't have a copy, call the first doctor and request a copy of it.

If Apria won't let you bring the machine back, then scour the contract. They might just be lying about it, but I would have no idea, because I wouldn't use Apria if there were any other option.

thanks. I will take a look into that.

I didn't realize how bad Apria was until I started dealing with them and then doing research about it.

Wondering if anybody else had to deal with a situation like mines.

I was in a similar situation. I have BCBS of LA with a high deductible. I have met my deductible. I started a new job and then got BCBS Anthem with my new job.

I was lucky enough that my BCBS of LA I could choose to rent or to outright buy. Since I plan to drop this coverage at the end of the year, I chose to buy and just pay the $303 co-pay. They were suppose to secondary bill my BCBS Anthem.

Now next year I am not sure what I am going to do about supplies..as my new BCBS only has a $2,000 allowance for DME equipment.

I did get a copy of my script from the sleep doc...so I can order what I need if need be. My DME has been good so far...other than the therapist never returns my calls.

Don't know about your plan specifically... but my Aetna POS II plan... says that I'm supposed to use Apria (but I don't!). They actually sent me a letter on that awhile back, but I chose to ignore it.

CPAP machine and insurance changes wrote: I know that without insurance, my CPAP monthly charges would be about $331/mo.

Well that tells you how much your DME is overcharging you. Even the best CPAP (except bi-level, etc.) would only cost 2-3 times that to buy and own outright. You must pay a lot of money in co-pays for all this - is it even worth it? It would help to know what your equipment is, etc. Register and put your equipment in your profile and there are lots of people here that will tell you how you are being handled.

MsRadar, if you've bought your CPAP outright already, then your supplies and accessories should not take up $2000 next year. Your current accessories were all paid for outright.

cflame1 wrote:Don't know about your plan specifically... but my Aetna POS II plan... says that I'm supposed to use Apria (but I don't!). They actually sent me a letter on that awhile back, but I chose to ignore it.

While I realize that there may be differences in the actual plans, that is the name of the insurance through my work. One of my co-workers (who has the same insurance) uses a Walgreens home health service - apparently an in-network provider. Just something to think about.

Slinky wrote:MsRadar, if you've bought your CPAP outright already, then your supplies and accessories should not take up $2000 next year. Your current accessories were all paid for outright.

Yes, I bought my machine outright using my insurance and paid my portion. I have also been checking out Ebay for nasal pillows, filters and such. I think I can do better just buying the stuff...that letting the DME ship it to me. I will probably get climateline hose from them if I can't find it elsewhere cheaper.

Not sure how to deal with Aetna now with the change of insurance. I saw my PCP today and told her that I was on a CPAP machine (prescribed to me from before). She said that was fine but that I would have to see the Aetna pulmonary specialist to be able to get authorization for my CPAP supplies. I won't be able to see the pulmonary specialist till end of Dec.

I think you need to call Aetna directly. First, are you on an Aetna HMO plan???

Regardless, imagine if your medical condition was diabetes instead of sleep apnea and you needed insulin, injection supplies, a meter, etc. Your insurance might require you to have a current RX from their specialist, but they would not cut off your equipment and supplies in the meanime. I think either you pcp needs to write an rx at least to tide you over or there needs to be some sort of coverage in the gap.

What I am most concerned about is that you are going to be hit with a whopping and inflated bill for your machine in this gap between your old insurance and your new rx with an Aetna covered specialist. You should get on this right away to see what you need to do to get your machine rental covered in the interim.

I was shopping for a new DME because our Mom & Pop doesn't do Medicare; and when I was on the phone with the local Apria manager,
I had the strongest urge to go out and kick a few tires. She also let it slip that a $400 mask was not unusual!
Guess who is NOT going to be hearing from me.

Good Grief... I could've written the same note and asked the same question. I had Welmark BCBS and one month after beginning a 10-month rent to own, my employer switched to United Healthcare. There was supposed to be a 'carry over' from BCBS to United. It's not happening! Imagine that!

I talked to the Insurance rep that handles my employer's account and set him on fire to chase down the correct answer... three weeks ago. Contact your HR person too and tell them what's going on. Those are the only suggestions I have...other than to get on the phone every business day with those two Ins. Co. Start out by saying, "I have a problem I hope you can help me with."
If you do this, write down the following if you have not done so already: Date and time called, name of person you spoke to, and what was said. Record everything in as much detail as possible. Climb up the chain of command. If the first person doesn't have answers for you really press them by saying you want to speak to their supervisor.

You and I are possibly in for a long session to get this mess taken care of. I wish you much more success than I've had to date!
Cindy