Reject Medicare/Anthem and Apria Equipment?

A few weeks after I read my initial sleep study recommending a CPAP, I went out a purchased a used ResMEd S9 Elite, heated humidifier unit, a mask and heated hose. A month later, I called Apria Healthcare and asked them about the status of my doctor's Rx for me. They replied they could not contact me since the doc didn't include contact information. I gave them my contact information and they said, "we will be back to you within nine business days."

I have Medicare with Anthem supplemental insurance. I'm reading that Apria is going to want to bill me for rental of whatever equipment they will be supplying. They've already asked for my credit card number. Now, even before I see them, I'm considering NOT accepting the equipment recommended by my doc which I read will be supplied by Apria as a rental. The messy part is if I decline their equipment, I likely won't be getting any insurance coverage for replacement masks and hoses for my existing equipment, and I'm guessing those supplies will cost me several hundred dollars a year.

Without knowing the reimbursement rates, it's difficult for me to realistically assess which route to take. My problem is inquiries about rental and equipment charges through Apria and two insurance carriers may not give me reliable information about the coverage for rental costs. Thinking about working with three separate parties about charges gives pause. To peal this onion may cause more tears than I'm willing to accept.

Does anyone have an opinion about rejecting the rental provided?

A DME may tell you it's all or nothing, but you need to speak with your insurance to get the truth.
I'm not saying the dealer will lie, but it has happened.

I purchased my own equipment thru Craigslist and my DME still supplies my equpment through my insurance. As long as the DME has a copy of your sleep study and doctors prescription.

You don't have to buy a machine from a DME to get other supplies from them. I use a DME for masks mainly....hoses and filters are normally cheaper than my copay if I buy online. I have never used my DME for a machine purchase/rental and I get my masks and mask replacement supplies without issue

With Medicare plus your supplemental...once your part B deductible is met you wouldn't/shouldn't have any out of pocket expenses assuming your supplement picks up part B copay left from Medicare.
So the most you should have out of pocket would be the part B deductible which I think now is $147.

I had a link that showed actual allowed amounts from a couple of years ago but that link has now broken. If I can find another I will add it.

Your insurance may have a completely agreement with Apria than those you have read about here. The only way to find out is to call them. Also call your secondary as that may cover any co-pays so you may not have any out of pocket expense at all. If that turns out to be true I would tell Apria they have no need for your credit card.

But you did right by getting your equipment early.

Medicare would be your primary--no one pays until Medicare does. (unless other ins. is from a spouse's work)
Depending on your plan with Anthem, they should pay the remaining 20% of the items covered by Medicare,
after deductible. (my plan F covers deductibles, but it's expensive!)
If Apria refuses to sell you masks and supplies unless they sell you a machine,
ask them if Medicare would like it--they don't! --and pull out your phone!
If you want to look for another DME, use my link below.
Medicare's accepted prices are usually way less than the pie in the sky amounts the DME tells you.
Your out of pocket could be much less than you think.

I have BCBS Medicare. Their policy is rent to own over 13 months. The first month was $116, and then $15 per month for months 2-12. After that I own the machine. My copay on DME is 20% if a BCBS approved supplier (thank goodness not Apria) if medically necessary and pre approved. I called my insurance company directly and asked specifically what my costs would be. Then from their list of suppliers I called each supplier. I was concerned about wanting a Swift Bella with ear loops and one place told me "we don't need to have a lot of inventory on masks." LOL. Obviously did not use them.

Medicare only rents the blower; your humidifier, tubing, mask, etc. is purchased at Medicare specified prices.
Medicare pays 80%, you or your supplement pays 20%,
HMO's, ("advantage") plans are a different game entirely--in return for low premiums,
you give up things only specified when you need them.

I have Medicare with Anthem supplemental insurance. I'm reading that Apria is going to want to bill me for rental of whatever equipment they will be supplying. They've already asked for my credit card number. Now, even before I see them, I'm considering NOT accepting the equipment recommended by my doc which I read will be supplied by Apria as a rental. The messy part is if I decline their equipment, I likely won't be getting any insurance coverage for replacement masks and hoses for my existing equipment, and I'm guessing those supplies will cost me several hundred dollars a year.

There is no Medicare rule that says that the DME doesn't have to provide you with supplies if they don't supply your machine. It MIGHT be Apria's policy. The reason is that they make very little on the supplies, they make more on the machine. So it may not be worth it to them to provide your supplies--there's a good deal of paperwork involved. They are more open to the time it takes when they are making a profit on the machine.

I would suggest calling your secondary insurer to find out if there are any other DME's you can use. Then you can contact the other DME's to see how you might be able to work it out with them. If you are stuck with Apria, then you will need to file complaints with the state agency that regulates DMEs and with your insurer, and Medicare.

What I would do first is ask your doctor for a prescription for the supplies only (unless you wanted to get another machine for backup). Submit it to Apria with an order for supplies. If they won't fill the order, ask for them to state why in WRITING. You may not be able to get it, but if you get a writing that will bolster your complaints. If they won't provide a refusal in writing, be sure to record the date, the name of who you talked to, the time of day. Work your way up the corporate ladder--local manager, and regional manager. If they continue to claim they won't provide your supplies, you have a good basis for complaint because they are CONTRACTED to do so with your insurance company, and with Medicare.

Janknitz wrote: There is no Medicare rule that says that the DME doesn't have to provide you with supplies if they don't supply your machine. It MIGHT be Apria's policy

SirNoddinOff has Crapria and used them for supplies only as his machine was private purchase but after what he just wrote here in the thread below...maybe people should think twice about getting masks and misc supplies from them if there is anyone else they could use.
He used to be a happy camper but they changed to nationwide shipping I think and things went to hell.
viewtopic/t97660/Apria-this-cant-lead-t ... photo.html

Janknitz wrote:What I would do first is ask your doctor for a prescription for the supplies only (unless you wanted to get another machine for backup). Submit it to Apria with an order for supplies. If they won't fill the order, ask for them to state why in WRITING. You may not be able to get it, but if you get a writing that will bolster your complaints. If they won't provide a refusal in writing, be sure to record the date, the name of who you talked to, the time of day. Work your way up the corporate ladder--local manager, and regional manager. If they continue to claim they won't provide your supplies, you have a good basis for complaint because they are CONTRACTED to do so with your insurance company, and with Medicare.

Yausser - contacting your doctor is a good way to go. A few months back I wanted a particular mask and called my DME. I was told that they didn't carry it and couldn't get it. I told this to my doctor and either she emailed them or called because I received the mask I wanted in around a week. In the event that doesn't work I would call Medicare. Umm... I never said this but stay far away from Apria. You should be able to find more than one DME in your area.

Based on some recent posts I hope you didn't give Apria your credit card number. If you did, cancel that card & ask the cc company to reissue you one with a different number. Apria will use that number to send out stuff you didn't order & quite possibly don't need or want.

I've had past trouble in dealing with them for my BIL's oxygen. I had a major blowout with them this afternoon, so avoid Apria if at all possible.