Does This Make Sense? No, It Does Not--An Insurance Rant

And I've had my machine for nineteen months.

Does This Make Sense?

No, nineteen months rental does not make sense. You probably own the machine. If you get another bill for rental call the insurance company and get it straightened out.

ChicagoGranny wrote:No, nineteen months rental does not make sense. You probably own the machine. If you get another bill for rental call the insurance company and get it straightened out.

Well, my contract regarding the machine is actually with Apria, not Aetna, so perhaps a call to the DME would be in order. I don't know that I want to go there. And I recall last year trying to get Aetna to tell me what the replacement schedule was for stuff like nasal pillows and they spent days researching it and then told me it was five years. Which I even I knew was wrong even when I was was still in a sleep-deprived fog.

To add to the merriment, although I have had the machine for nineteen months, they have actually not billed me for nineteen months of rental of the machine. They have billed me--let's see now--eleven times. They were relatively consistent in 2011, and hit-or-miss in 2012. And no, it's not a bimonthly cycle. The last time they actually seem to have billed one of these fantasy bills was in June.

If they haven't billed you since June, I would contact insurance, or better yet, your benefits manager at work.
You need to know exactly what the DME is allowed to do BEFORE you give the DME a chance to lie to you again.

chunkyfrog wrote: your benefits manager at work.

I think the benefits manager doesn't have a clue.

Ours believes it's his JOB to know.

ChicagoGranny wrote:

chunkyfrog wrote: your benefits manager at work.

I think the benefits manager doesn't have a clue.

Heh. My insurance is through my spouse. He works for an insurance broker.

Well, bite my sticky little tongue!
I never wish to promote marital dischord.

Actually, it looks like I do need to have a chat with Aetna--or the benefits manager thereof. The fine print on the back of the contract says that Apria continues to own the CPAP:

except as specifically provided to the contrary under applicable rent-to-purchase provisions in a contract between the Company [Apria] and the patient's Third Party Payor [Aetna]."

You really need to call Aetna. The contract apria gave you is boiler plate, but the important contract is the one between Apria and Aetna, the one you've never seen.

What you need to ask is:
1. Is this a capped rental (this means that they rent it for a period of time and then you own it)?
2. If not a capped rental is there a purchase option? If so, under what conditions?
3. If you choose to buy your own machine outright from another vendor will they reimburse you?

Those few dollars a month plus deductibles (if any) can add up over time much higher than what it would cost you to buy just the blower unit on your own (you can keep the same humidifier).

Ha! It's a capped rental, and I in fact own the machine now (with the qualification below). I have owned it since 11/17/2011. I will pay the $11.77 every six months now as a "maintenance-type agreement," as the Aetna person told me. And in fact, I see that they are now billing me only once every six months.

She also said, yes, it is rent-to-own but you never truly own it (because of the periodic maintenance charges. She made it sound like an extended warranty of sorts. If the machine malfunctions under normal wear Apria will repair or replace it.

After five years I can get a new machine.

I'd like to see any actual copy of the contract between Aetna and Apria.

She had no explanation why the monthly billing was $800 plus. She agreed it sounded like the cost of the machine new.

I also do not know what the manufacturer's warranty is like. If I own the machine and it has a real warranty associated with it, why am I paying the extra biannual charges?

My machine has a 2 year warranty, if this is typical, the extended warranty is a steal.
--at least compared to the rates you'd pay if Sears was a DME.