Got a call from my CIGNA and Carecentrix today!

Imagine my shock when the phone rang and it was an 800 number. I generally ignore them, but I decided to answer. It was Carcentrix which my insurance CIGNA uses. They wanted to know if I had gotten my supplies for the month yet and was I pleased with my DME company. Imagine my surprise!

I had spoken with the DME the day before as my supplies are running late. I usually have them within the first 3 days of each month. I called and was told things were running a little slow with getting insurance updated and approved. The DME sent me one nasal pillow the previous month to tie me over.

I told the carecentrix rep that I had been in touch with my DME and knew supplies were running later than normal due to getting new insurance loaded and approved. He asked me some other general questions about my DME and I told him all was fine. He also asked when was the last time I saw my sleep doctor or who ever is following. I was able to tell him a week ago.

Hmmmm...interesting..most insurance companies don't give a rats hind parts if you are getting decent follow up or if your DME is doing there job.

My past experiences with CIGNA was they created as many stumbling blocks and delays to keep from paying a claim. I guess a few class action law suites and show them the light recently.

What supplies do you get/need monthly?????????????

LSAT wrote:What supplies do you get/need monthly?????????????

Depends on the type of nasal pillow mask I'm using. When I was on the Swift LT, i'e get new mask each quarter and usually new nasal pillow once a month [along with one packet of ResMed filters] from my DME. Sometimes they'll skip monthly deliveries and send extra nasal pillows with the quarterly shipment.

With my Headrest, I now just got one new headset each quarter and no new nasal pillows monthly....

Or maybe, if you hadn't seen your doctor in a while, CIGNA would use it as an excuse to hold up your RX for supplies until the RX was updated with a physician visit. Sounds to me like they were checking to see if you're really using your CPAP so they really have to pay.

LSAT wrote:What supplies do you get/need monthly?????????????

I get two nasal pillows and two filters a month. Then every three months they send a new climateline hose. Every six months I get a new humidifier chamber and a complete replacement mask.

I go thru a nasal pillow about every three weeks with my Swift LT for her. When they start leaking I change them.

Janknitz wrote:Or maybe, if you hadn't seen your doctor in a while, CIGNA would use it as an excuse to hold up your RX for supplies until the RX was updated with a physician visit. Sounds to me like they were checking to see if you're really using your CPAP so they really have to pay.

That's exactly what I was thinking.

I too, have Cigna who recently switched to CareCentrix as the exclusive DME company.

They seem to be more of a central billing company rather than a physical DME.

So far, I have not had good luck with them at all.

I had to fax them all of my medical records concerning my Sleep Apnea before they would even talk to me.

It took them WEEKS to review the info and decide I was worthy of CPAP supplies even though I've been on therapy for 3 1/2 years. They lost the actual Rx and I had to send it again and wait longer for them to "allow" me to order a new mask.

But guess what ? They use CRAPRIA as their sub-contracted DME supplier.

So now, not only do I have the displeasure of dealing with CareCentrix, but I still can't get away from CRAPRIA.

It's the the worst of two worlds.

pratzert wrote: But guess what ? They use CRAPRIA as their sub-contracted DME supplier.

So now, not only do I have the displeasure of dealing with CareCentrix, but I still can't get away from CRAPRIA.

Why is everyone so down on APRIA ? I have them as my DME, as they have been fantastic in every way. The RT have been great to work with, and have helped me over the hump when I was having so many problems I was ready to give it up. They helped me choose the right mask for me. They've returned all my phone calls, and always been professional and courteous, and seemed genuinely interested in helping.

MOTOR815 wrote:

pratzert wrote: But guess what ? They use CRAPRIA as their sub-contracted DME supplier.

So now, not only do I have the displeasure of dealing with CareCentrix, but I still can't get away from CRAPRIA.

Why is everyone so down on APRIA ? I have them as my DME, as they have been fantastic in every way. The RT have been great to work with, and have helped me over the hump when I was having so many problems I was ready to give it up. They helped me choose the right mask for me. They've returned all my phone calls, and always been professional and courteous, and seemed genuinely interested in helping.

Just depends on regional representation and competition, I think. In some places they get fed so much automatic business that they feel they're "set" and have a chip on their shoulder... I'll save you the stories, as people have posted dozens of blogs and forum posts all over the internet with negative experiences. For example, I had a horrible experience and while I appreciate that they have the free "apnealink" devices to loan out to find potential future customers, I'll never touch them in business again if I can avoid it.

I keep wondering too--Why is everyone so down on APRIA ? I have them as my DME, as they have been fantastic in every way and seem to be on the ball with everything that i need from them. I call the 800 number and order what I want and they mail it out---no questions asked........They are very courteous and helpful each and every time.

Carrie.

I used them for apnea monitor many years ago why my youngest daughter was born. They really did care about the alarms and the data. All they care about was billing the claim to Champus and getting the compliance data.

Watch your copay go up. Cigna uses CareCentrix and pays them 100% of the MSRP for my supplies so my copay is now based on 100% rather than the lower amount the insurance company negotiated with my DME supplier. AND the DME supplier says they have an agreement with Cigna and CareCentrix not to disclose the amount they receive. So I'm paying more copay, Cigna has higher claims paid to justify more premiums from the employer, and I'm sure they get a reduced fee from CareCentrix....moving administrative costs up to claims paid. What a scam!

ms:
> Imagine my shock when the phone rang ... It was Carcentrix

pr:
> They use CRAPRIA as their sub-contracted DME supplier.

mo:
> Why is everyone so down on APRIA ? I have them as my DME, as they have been fantastic in every way.

sl:
> I keep wondering too--Why is everyone so down on APRIA?

I can explain these differences.

First, ignore the enthuiastic posts by Apria employees masquerading as OSA patients.
(Note: I didn't say all of them were.)

Second, there is a simple explanation why different people can legitimately have different experiences. The following is for regular insurance, not Medicare.

1. Capitated Plans
These are often (not always) HMOs.
With a capitated plan the DME gets paid a _fixed_ amount of money per patient per month. The way the DME makes a profit is by denying services. Or by making you work _very_ hard to get services. Road blocks, stone walls. Every service or product that is delivered decreases their profit.

Dirty tricks:
Not answering the telephone. Calls go to answering machine which are never followed up on or are answered much later.

Delaying delivery of products. Stretching out delivery ("Sorry. we're out right now") keeps their money in their pocket longer. Accountants love that. Because of rules about eligibility (e.g., one hose every three months, etc) it makes your _next_ eligibility even farther away.
"I want to order a mask cushion."
"It hasn't been 30 days."
"It's been 30 days since I requested it. It took you a week and a half to deliver."
"You have to wait to order until the 30th day after you got the last one."
'But then it will for certain be more than 30 days since I got the last one. You'll be out for a week and then half a week for delivery."
"Whatever."

The "We don't do that" answer which is used when they just don't want to do something that would cost them.
e.g., the eligibility rule for a FF mask is peculiar. Six months with headgear, but three months _without_ headgear.
"I want to order a FF mask."
"It hasn't been six months. You're not eligible."
"It's been 3 months. I'll take one without headgear."
"We don't do that."
"I'll file a grievance with my insurance company."
"oh ... um ... uh ... OK, we'll ship you a mask."

2. Fee for Service plans
These are often (not always) PPOs.
They have agreed to a "contract price" for each product and service. They may bill whatever they want, e.g., $750 for a mask, but the contract price that they get paid is $150 (or whatever).

The very important point here is that they only make money when they deliver a product or service. Which is exactly the opposite of capitated plans.

It is _absolutely essential_ that you know if you have a capitated or fee for service plan with your DME. That will help you understand what's going on.

Ask _both_ your insurance company and your DME to see if they agree. The person you speak with may not know. Ask them who knows, and to be transferred to that person.

cpaptalk members: post the dirty tricks that you have experienced so that others can be aware.

The scenarios above, which I have experienced, are probably illegal. Tell the DME that you will file a grievance. That usually works. Don't bluff, though. Actually write a letter to your insurance company's grievance department. Dirty DMEs just hate that. It exposes their illegal practices.

xyz... you took the words right out of my mouth.

I've been dealing with Apria for 4 year now and it's been 4 years of headache... misery... and PURE HELL !!!

They are the most inept bunch of liers I have ever dealt with.

Do a google search on Apria and you'll learn more.

xyz wrote:ms:
> Imagine my shock when the phone rang ... It was Carcentrix

pr:
> They use CRAPRIA as their sub-contracted DME supplier.

mo:
> Why is everyone so down on APRIA ? I have them as my DME, as they have been fantastic in every way.

sl:
> I keep wondering too--Why is everyone so down on APRIA?

I can explain these differences.

First, ignore the enthuiastic posts by Apria employees masquerading as OSA patients.
(Note: I didn't say all of them were.)

Second, there is a simple explanation why different people can legitimately have different experiences. The following is for regular insurance, not Medicare.

1. Capitated Plans
These are often (not always) HMOs.
With a capitated plan the DME gets paid a _fixed_ amount of money per patient per month. The way the DME makes a profit is by denying services. Or by making you work _very_ hard to get services. Road blocks, stone walls. Every service or product that is delivered decreases their profit.

Dirty tricks:
Not answering the telephone. Calls go to answering machine which are never followed up on or are answered much later.

Delaying delivery of products. Stretching out delivery ("Sorry. we're out right now") keeps their money in their pocket longer. Accountants love that. Because of rules about eligibility (e.g., one hose every three months, etc) it makes your _next_ eligibility even farther away.
"I want to order a mask cushion."
"It hasn't been 30 days."
"It's been 30 days since I requested it. It took you a week and a half to deliver."
"You have to wait to order until the 30th day after you got the last one."
'But then it will for certain be more than 30 days since I got the last one. You'll be out for a week and then half a week for delivery."
"Whatever."

The "We don't do that" answer which is used when they just don't want to do something that would cost them.
e.g., the eligibility rule for a FF mask is peculiar. Six months with headgear, but three months _without_ headgear.
"I want to order a FF mask."
"It hasn't been six months. You're not eligible."
"It's been 3 months. I'll take one without headgear."
"We don't do that."
"I'll file a grievance with my insurance company."
"oh ... um ... uh ... OK, we'll ship you a mask."

2. Fee for Service plans
These are often (not always) PPOs.
They have agreed to a "contract price" for each product and service. They may bill whatever they want, e.g., $750 for a mask, but the contract price that they get paid is $150 (or whatever).

The very important point here is that they only make money when they deliver a product or service. Which is exactly the opposite of capitated plans.

It is _absolutely essential_ that you know if you have a capitated or fee for service plan with your DME. That will help you understand what's going on.

Ask _both_ your insurance company and your DME to see if they agree. The person you speak with may not know. Ask them who knows, and to be transferred to that person.

cpaptalk members: post the dirty tricks that you have experienced so that others can be aware.

The scenarios above, which I have experienced, are probably illegal. Tell the DME that you will file a grievance. That usually works. Don't bluff, though. Actually write a letter to your insurance company's grievance department. Dirty DMEs just hate that. It exposes their illegal practices.

I found this older post searching info about Cigna because I'm trying to find out what I am getting into. I've been on CPAP for just over a week now and CIGNA sent me to get my machine and accessories through Apria. I ahve already met my deductible this year and from what I have been told CIGNA pays 80% of everything. I didn't have to pay anything at Apria but the RT seemed a little put off that CIGNA did not let them know how much they were assisting with. CIGNA approved all the purchases but the receipt just had zeros for everything. It listed the CPAP, mask, etc and then the services of teaching me how to use everything also. I just did checking online to figure out how much everything cost before insurance assisted to get an idea of the total.

I am a little worried now because of not knowing how much everything was, and also when January comes I start all over again with my deductible. I have a high deductible of $1,500 because I have an HSA account my employer adds too each year and a low premium. Once I meet the deductible everything is either 10% or 20% for medical, but until then I'm paying full price. I am wondering if apria is going to make me pay up front before I receive supplies.

The RT also told me that when it was time for replacements, customer service would call me to let me know. I had to ask her how to get replacements because with me being new I am mainly clueless. Without this forum I'd be completely ignorant. I'm going to call Cigna and see if I can get another DME besides Apria. I'm getting a little skittish based on what I am reading online about them. The staff was very friendly and RT was knowledge with explaining the mechanics of the device, but as to insurance questions and supply replacements she didn't know much at all. I just felt like she was being secretive because she can't be that clueless to what is involved with insurance.