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[Equipment] medicare compliance while in Japan ?
#1
I'm on Medicare. I got a ResMed CPAP last February. I had the compliance visit with the clinic in March, and met the compliance levels. Then I left for Japan. 

Now Apria is sending me threatening emails to pay up since  they claim I'm not in compliance. No data since March 15. Not surprising since I'm in Japan!

I thought that Medicare only required proof of 21 days 4+hour use during a 30 day period in the first 90 days of use.

Is Medicare not reimbursing Apria ? Or are they just being jerks ?
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#2
The usual agreement between Medicare, the DME, and yourself is that you meet the compliance requirement within the first 90 day period, which you state you did.....

But you more than likely have an agreement that Medicare pays rental to the DME for 13 months, after which you own the machine.  So as long as they are paying that rental fee, Medicare will require monthly proof of usage, and if the DME is unable to provide that, Medicare will stop paying and then the DME can take your equipment back or demand payment from you.

Did you sign a contract with Apria?  What did it say?
OpalRose
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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.




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#3
If you have to provide some form of monthly use (compliance) then what is the point of the first 90 day compliance period? Not that governmental regulation make sense all the time.

OP I would email back to Apria asking nature of the non-compliance. I would clearly point out that your March clinic visit demonstrated compliance with the 70% of 30 day w/i the first 90 days, and try to get them to put into writing what they expect compliance to be. They well could be looking at your use and auto generating warnings based on the 90 day compliance period, and not be aware that compliance requirements have been met.
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#4
seandarcy,
Forget Apria....call your insurance (Medicare) first.

They are the ones holding the cards. Find out if they are paying the rental for the 13 months. If they are, then the DME (no matter who it is) has to show Medicare that the machine is being used in order to be reimbursed. They are not going to let you keep a machine that Medicare stops paying rent on.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

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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.




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#5
Whatever you do, never give Apria any banking or credit card information.
If Apria's lips are moving, they are lying.
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#6
You should be able to access your Medicare Claim info on their website. This will tell you what Medicare has been paying and when. Add this info (claim number, date paid, etc...) to your letter to the DME. I would also send some type of proof that you are out of the country. I would also include any compliance info you may be able to pull from the machine via Sleepyhead or the machine's software. It is not their fault they aren't able to pull info because you are in Japan.

Homer
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#7
There are some things about Apria that I have just learned. I had my insurance company go after them. I happened to talk to a customer service who seemed aggressive and she went to Apria and would not let up on them until she got some answers that made some sense.

What she found out is that the standard agreement that I signed when I began bilevel CPAP treatment six years ago says that Apria never relinquishes ownership of the machine. They get paid a maintenance fee for 13 months and then no more after that, but technically they still own the machine. With that in mind, I will tell you that I still have the first machine that I got from Apria that was replaced about 3 years ago with a newer model.

Keep in mind what Mongo said about Apria. I would follow Homerec's advice and go at this through medicare while at the same time explaining to Apria the situation and ask them how they think the situation should be corrected. Then with information gleaned from Medicare you can  address their suggested corrective action.

Let us know how your interaction with Apria is going.

Best Regards,

PaytonA
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#8
Hi seandarcy,
WELCOME! to the forum.!
I sure hope you can get your insurance and DME problems straightened out and let us know how things go.
trish6hundred
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#9
(05-16-2017, 09:09 AM)seandarcy Wrote: I'm on Medicare. I got a ResMed CPAP last February. I had the compliance visit with the clinic in March, and met the compliance levels. Then I left for Japan. 

Now Apria is sending me threatening emails to pay up since  they claim I'm not in compliance. No data since March 15. Not surprising since I'm in Japan!

I thought that Medicare only required proof of 21 days 4+hour use during a 30 day period in the first 90 days of use.

Is Medicare not reimbursing Apria ? Or are they just being jerks ?

medicrap are all jerks

go to the usa embassy and have them fix the problem
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#10
I think that the jerks that he was talking about were the Apria jerks. What makes you think that the embassy will even get involved? I am just asking the question because I do not know.

PaytonA
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