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CPAP/MEDICARE/APRIA
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Ross Offline

Members

Posts: 14
Joined: Mar 2013

Machine: ResMed Airsense 10 Autoset
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX; AirFit N10
Humidifier: integrated
CPAP Pressure: 5-18
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Connecticut

Post: #1
CPAP/MEDICARE/APRIA
I have been using my CPAP daily (except during a recent 2 weeks vacation) for about 2 months, averaging 8 hrs a night, usually with an AHI at or below 1. A recent letter and follow up phone call with Apria informed me that I may be required to pay the CPAP charges myself due to a failure to satisfy a Medicare requirement of a qualifying sleep study. To make a long story short, although I have had 5 sleep studies (I had previous CPAP as well as dental appliance therapy), the most recent was in January, 2014, so it may well be that Medicare requirements were not met. (How should I know?)

My question, however, is didn’t Apria have an obligation, under Medicare or otherwise, to investigate and inform me of this Medicare deficiency before providing me with the CPAP equipment?

FWIW, after my 30-day follow-up with the doctor who prescribed the CPAP, he referred me to a new doctor (“the guy who wrote the text on sleep medicine”), and prior to seeing him I will have a new sleep study on 8/26.
07-29-2015 01:46 PM
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Mike1953 Offline

Preferred Members-2

Posts: 134
Joined: Aug 2014

Machine: Resmed S9 Escape Auto
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
Humidifier: Resmed Hi5
CPAP Pressure: 12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Kansas USA

Post: #2
RE: CPAP/MEDICARE/APRIA
https://www.medicare.gov/
Sleep study

How often is it covered?

Medicare Part B (Medical Insurance) covers Type I, II, III, and IV sleep tests and devices. Medicare only covers Type I tests if they're done in a sleep lab facility.

Who's eligible?

People with Part B who have clinical signs and symptoms of obstructive sleep apnea are covered when their doctor orders the test.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount after you’ve met your Part B deductible.

Note
To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.
Note
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.
also read this https://www.medicare.gov/coverage/sleep-...ories.html

For free Medicare assistance for your state check out this page. http://www.seniorsresourceguide.com/directories/National/SHIP/
or here http://www.medicareinteractive.org/
(This post was last modified: 07-29-2015 03:35 PM by Mike1953.)
07-29-2015 03:33 PM
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PaytonA Offline
Wiki Editor
Monitors

Posts: 3,005
Joined: Dec 2013

Machine: ResMed S9 VPAP Auto
Mask Type: Full face mask
Mask Make & Model: Resmed Mirage Quattro
Humidifier: H5i(distilled-top up)
CPAP Pressure: VAuto MinE14.0 MaxI 20.6 PS4.0
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Orange County,California

Post: #3
RE: CPAP/MEDICARE/APRIA
Medicare may just need a copy of that sleep study. That is assuming that it was done at a sleep lab facility. Medicare has not been involved in any of my CPAP use to this point. When I got my second machine (an S9 VPAP Auto) I was on a different medical insurance than when I was initially diagnosed and they wanted a copy of the original sleep study before they would pay for it. All of this happened through the DME before they delivered the machine. I supplied the study and everything went smoothly. That was through Apria.

Yes, in my opinion, your DME should have been aware of this and gotten it straightened out before they delivered the machine.

Best Regards,

PaytonA
(This post was last modified: 07-29-2015 03:59 PM by PaytonA.)
07-29-2015 03:55 PM
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justMongo Offline

Monitors

Posts: 3,845
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #4
RE: CPAP/MEDICARE/APRIA
Apria may be attempting to "upcharge" the patient.
Their reputation is so low that they are often referred to as Crapria.

Don't pay them a dime until they prove you owe it.
Also be careful what you sign with them.
They have been quoted as saying: "...you signed it; so, we can charge you whatever we want..."

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(This post was last modified: 07-30-2015 09:53 AM by justMongo.)
07-29-2015 04:44 PM
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