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CobaltSky
Unread post  Post subject: Insurance / DME / Equipment questions  |  Posted: Fri Nov 17, 2017 2:32 pm

Joined: Thu Nov 16, 2017 1:32 pm
Posts: 13
Location: Peyton, CO
PAP Mask: Aitfit P10
PAP Machine: ResMed s8 Autoset II
Humidifier: H3i
Pressure Setting: 7

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So, long time OSA patient here, and I just had an updated titration and prescriptions written to replace my old S8 Autoset. In the past I have always had to rent equipment from Apria via Aetna, and then converted to a sale as soon as they would let me. Lately, depending on the status of my deductible, I have often stretched mask intervals and bought my own masks and supplies online.

The issue is, that while I wait for whatever DME Aetna is using here in my new state of Colorado to call me to fill my script, I know that as of January 1st, I will be on a new, high deductible, health care plan with a new provider (Kaiser). My employer is staying the same, we are just being switched from a "cadallac" POS plan to a HDHCP... I have no clue how to handle this on my end or how the insurance companies will handle this.

I have met my deductibles this year and so I am only paying 20% for the rest of the year. My ideal situation would be to talk them into a purchase vs rental because I have been compliant with my CPAP for decades. Second best would be to have it convert to a sale before of the year. If I get into a rent to own situation where I need to pay for that expense of an overpriced machine into 2018 (or beyond), I would rather pay a reasonable amount for a machine from an online DME in 2018 and have it count against my new high deductible and come out of my HSA, but that leaves me in a lurch until year end, unles I rent now with the intention of handing it back on Dec 31st and use my old S8 until the new one arrives from a 2018 online order. I don't know if they accept back an old machine or do they just let you keep it?

I thought I would check to see if anyone has gone through anything similar so I am armed with knowlege when Apria (or whoever) calls me to set me up, which could be any minute now, as my doc wrote the order yesterday.

Thanks in advance!


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LSAT
Unread post  Post subject: Re: Insurance / DME / Equipment questions  |  Posted: Fri Nov 17, 2017 8:04 pm

Joined: Tue Sep 05, 2017 9:40 am
Posts: 53
Location: WI
PAP Mask: Quattro
PAP Machine: S9 Autoset
Humidifier: H5i
Pressure Setting: 11-15

Offline
CobaltSky wrote:
So, long time OSA patient here, and I just had an updated titration and prescriptions written to replace my old S8 Autoset. In the past I have always had to rent equipment from Apria via Aetna, and then converted to a sale as soon as they would let me. Lately, depending on the status of my deductible, I have often stretched mask intervals and bought my own masks and supplies online.

The issue is, that while I wait for whatever DME Aetna is using here in my new state of Colorado to call me to fill my script, I know that as of January 1st, I will be on a new, high deductible, health care plan with a new provider (Kaiser). My employer is staying the same, we are just being switched from a "cadallac" POS plan to a HDHCP... I have no clue how to handle this on my end or how the insurance companies will handle this.

I have met my deductibles this year and so I am only paying 20% for the rest of the year. My ideal situation would be to talk them into a purchase vs rental because I have been compliant with my CPAP for decades. Second best would be to have it convert to a sale before of the year. If I get into a rent to own situation where I need to pay for that expense of an overpriced machine into 2018 (or beyond), I would rather pay a reasonable amount for a machine from an online DME in 2018 and have it count against my new high deductible and come out of my HSA, but that leaves me in a lurch until year end, unles I rent now with the intention of handing it back on Dec 31st and use my old S8 until the new one arrives from a 2018 online order. I don't know if they accept back an old machine or do they just let you keep it?

I thought I would check to see if anyone has gone through anything similar so I am armed with knowlege when Apria (or whoever) calls me to set me up, which could be any minute now, as my doc wrote the order yesterday.

Thanks in advance!


It's the insurance company you need to talk to...they will be the one to decide whether it can be a sale rather than a rental. DON'T trust Apria to give you a straight answer.


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CherylTheBarrell
Unread post  Post subject: Re: Insurance / DME / Equipment questions  |  Posted: Sat Dec 02, 2017 6:20 pm

Joined: Thu Nov 30, 2017 9:43 pm
Posts: 2
PAP Mask: ResMed AirFit P10
PAP Machine: ResMed AirSense 10 Autoset
Pressure Setting: CPAP 4-20

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From the time I initiated my order to the doctor, it took Apria 1 month plus a couple more days to call me to set up an appointment to go pick it up. I called three times but it did not speed up the process. I don’t think they are so fast to fill new orders.


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cindyY
Unread post  Post subject: Re: Insurance / DME / Equipment questions  |  Posted: Sat Dec 02, 2017 9:04 pm

Joined: Sun Apr 23, 2017 8:34 pm
Posts: 370
Location: Southern California
PAP Mask: AirFit P10, Swift FX, Swift FX Nano, Eson2
PAP Machine: Resmed AirCurve 10 VAuto in S mode
Humidifier: Integrated set to 5 @ 81F; ClimateLineAir heated hose
Pressure Setting: IPAP 19 EPAP 15

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CherylTheBarrell wrote:
From the time I initiated my order to the doctor, it took Apria 1 month plus a couple more days to call me to set up an appointment to go pick it up. I called three times but it did not speed up the process. I don’t think they are so fast to fill new orders.


Same.


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OldSarge
Unread post  Post subject: Re: Insurance / DME / Equipment questions  |  Posted: Sun Dec 03, 2017 9:15 pm

Joined: Wed Oct 25, 2017 12:21 pm
Posts: 5
PAP Mask: Quattro FX
PAP Machine: PR 550
Humidifier: yes
Pressure Setting: 9- 14

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dme's would rather have a one time payment. some insurance companies leave it up to the dme whether they want full or time payments. so ask crapria because if there is a decision to make, they will be making it.


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Lisalisacats
Unread post  Post subject: Re: Insurance / DME / Equipment questions  |  Posted: Mon Dec 04, 2017 10:20 am

Joined: Tue Nov 07, 2017 5:45 pm
Posts: 7
Location: Bay Area, California
PAP Mask: Respironics DreamWear Gel Pillow - FitPack-1124984
PAP Machine: DreamStation 500 Auto

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I just know that several years ago when I was first diagnosed I only paid 20
% of my supplies including machine. Last year I contacted the same company and found out that my insurance through Kaiser had changed and I was no longer covered. Needless to say I now purchase everything through Amazon.


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CobaltSky
Unread post  Post subject: Re: Insurance / DME / Equipment questions  |  Posted: Mon Dec 04, 2017 2:09 pm

Joined: Thu Nov 16, 2017 1:32 pm
Posts: 13
Location: Peyton, CO
PAP Mask: Aitfit P10
PAP Machine: ResMed s8 Autoset II
Humidifier: H3i
Pressure Setting: 7

Offline
CherylTheBarrell wrote:
From the time I initiated my order to the doctor, it took Apria 1 month plus a couple more days to call me to set up an appointment to go pick it up. I called three times but it did not speed up the process. I don’t think they are so fast to fill new orders.

Oh no! That is horrible. I have called them and they are unable to speed things up or even give a status other than "processing". They just say wait for a call. I may not get my stuff this year before my insurance changes and deductible resets , let alone before I travel to 10000ft in 6 days. :(


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CobaltSky
Unread post  Post subject: Re: Insurance / DME / Equipment questions  |  Posted: Wed Dec 06, 2017 4:06 pm

Joined: Thu Nov 16, 2017 1:32 pm
Posts: 13
Location: Peyton, CO
PAP Mask: Aitfit P10
PAP Machine: ResMed s8 Autoset II
Humidifier: H3i
Pressure Setting: 7

Offline
Apria says my o2 concentrator will be delivered by end of day (they have 2 just hours left before I leave at 6pm!). And they gave me a tracking number on my APAP that left KC and is on the way to their branch near here. I'm not counting chickens yet but I *may* get my stuff before I head up into the mountains on Sunday...


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hoserdude
Unread post  Post subject: Re: Insurance / DME / Equipment questions  |  Posted: Wed Dec 13, 2017 8:32 am

Joined: Wed Sep 07, 2016 8:57 am
Posts: 12
Location: Orlando Fl.
PAP Mask: Philips Dreamwear under nose Nasal mask
PAP Machine: Resmed aircurve 10 ST bipap
Humidifier: resmed heated
Pressure Setting: Ipap16 /Epap 13

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CrApria is not your friend! They will never give you the same answer twice. AND if your rental started too late during the course of the year they will try to roll back the payments you have made on the machine to $0 and start all over the next year what a scam. Insurance companies (not your friend either) are different too as to how many monthly payments you must make before you own your machine which confuses matters more. It's when you start getting credited for the payments and how many payments before you own it that makes all the difference plus actually getting them to credit you with the correct starting date. If it's a cheaper machine and depending on your deductible sometimes you could be way further ahead to get a screaming online deal and buy outright as opposed to dealing with a DME. Of course if you have met your out of pocket in other ways then the 10%-20% charge for supplies is definitely a better deal


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