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Apria/Medicare problem
#1
I'm a long time PAP user and have been on Medicare since 2008. In January, I switched from a Medicare Advantage Plan to Traditional Medicare. I have been trying to order supplies from Apria since March with no success.

Mu doctor has provided Apria a copy of the sleep study done when i went on Medicare, a script for supplies and a record of the required annual face to face doctor visit. Apria, who provide my current machine under my previous Medicare Advantage Plan, has the records that I have complied with the hours of usage.

Apria is insisting that there is a Medicare requirement that I provide documentation of my "initial encounter". My initial encounter was a sleep study done in 1992 that no one has been able to find a copy of. I have had two conference calls with Apria and Medicare attempting to resolve this delima to no avail. Both have promised call backs but haven't done so.

I cannot for the life of me figure out how a sleep study from 1992 could possibly be of any value to anybody.

I haven't given up yet, and I will continue to escalate this up the Medicare bureaucracy. But I was wondering if anyone else has run into this and if so how you got it resolved.

plannerman



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#2
You can approach another supplier. Medicare requires the use of a competitive bid winner to get supplies covered.
You can pop your zip code into https://www.medicare.gov/supplierdirectory/search.html
to find another provider. You do not have to use one in your area... they just have to be listed with MC.
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"Since this country was founded, each generation of Americans has been summoned to give testimony to its national loyalty. The graves of young Americans who answered the call to service surround the globe." JFK Jan 20, 1961
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#3
What state are you in? Can affect who else you can go to.
That aside, I just came back to original Medicare from an Advantage Plan and Apria is my supplier. Really very smooth transition. I actually called them in December and told them that I was coming back in January, and to reactivate my account. Did a visit to the sleep doctor who wrote a new scrip for supplies, substantiated my visit and compliance, and I was good to go - in fact they even wanted to give me a new machine (and I am on Bi-Pap auto SV, so that is a money loser for them), and I said thank you, don't need it yet.

They have a special desk for Medicare people. There was a white out and write over on the scrip, and they even called the Drs. secretary to ask to send in a clean copy so that there wouldn't be any confusion, and let me know what they were doing every step of the way. I think you may have just hit the wrong person, and they do not know what they are doing.

All of that aside, if you are in one of the competitive bid areas check the list and call someone else. But, it makes no sense that you are having a problem, especially if they were the supplier under the Advantage program (which they were not for me).
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#4
I just received a letter from Apria saying they were no longer a "contracted provider" under the CBA (competitive bidding area) program in my area (Westlake Village, California) as of 7/1/16, but they were grandfathered into the program so I could continue to rent the APAP from them and obtain supplies as long as I needed the equipment or until the ownership of the machine passed to me. They wanted an affirmative response by return mail or automated phone response.

So before reconsidering APRIA, you may want to research other vendors in the area.

As for the lack of a face-to-face visit, ask for a previous-user waiver and provide your doctor's name and contact information. I had a similar situation being diagnosed and getting a machine through my company's insurance carrier long before I became eligible for Medicare.

There appears to be a waiver provision for previous users who can document that they had a doctor, a sleep study, and had a prescribed machine. You may wish to contact the supplier of your old machine to see if they had your sleep study or prescription on file. Or the insurance carrier that paid for your sleep study to get the facility name. The files might be in storage and they can provide you with suitable documentation.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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