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What is Common Practice
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Mosquitobait Offline

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Posts: 746
Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #11
RE: What is Common Practice
(03-21-2016 05:21 PM)FrankNichols Wrote:  [quote='PoolQ' pid='154687' dateline='1458598452']
Since I am renting the CPAP machine, I assume I am renting from them, I also assume I will need to setup a payment method for that - sigh. I hate not being able to trust someone I have to deal with. I wonder if I could just pay the 13 monthly rental payments all at once up front also.

Don't do this. Apria customers are often not credited for it and you will be dunned for non-payment. Your option of course is to use a credit card that will go to bat for you. Keep EVERYTHING - including those notices you get from Medicare on what they paid. Also, if you can't get problems solved, be sure to report it to Medicare. The only way to get rid of Apria as a Medicare supplier is if people actually complain in writing.
03-21-2016 07:23 PM
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Charlie Sue Offline

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Posts: 23
Joined: Oct 2015

Machine: ResMed AirSense10 autoset
Mask Type: Nasal pillows
Mask Make & Model: Airfit p10
Humidifier: integrated with machine
CPAP Pressure: 8-12
CPAP Software: ResScan SleepyHead

Other Comments: struggling...but working on it

Sex: Female
Location: Ohio

Post: #12
RE: What is Common Practice
(03-21-2016 07:23 PM)Mosquitobait Wrote:  
(03-21-2016 05:21 PM)FrankNichols Wrote:  [quote='PoolQ' pid='154687' dateline='1458598452']
Since I am renting the CPAP machine, I assume I am renting from them, I also assume I will need to setup a payment method for that - sigh. I hate not being able to trust someone I have to deal with. I wonder if I could just pay the 13 monthly rental payments all at once up front also.

Don't do this. Apria customers are often not credited for it and you will be dunned for non-payment. Your option of course is to use a credit card that will go to bat for you. Keep EVERYTHING - including those notices you get from Medicare on what they paid. Also, if you can't get problems solved, be sure to report it to Medicare. The only way to get rid of Apria as a Medicare supplier is if people actually complain in writing.

I just reported my DME to the Better Business Bureau. Not a bad idea in my mind.

Charlie Sue
03-21-2016 07:54 PM
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ger365 Offline

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Posts: 37
Joined: Feb 2016

Machine: PR Dreamstation DSX500T11
Mask Type: Nasal pillows
Mask Make & Model: Dreamwear
Humidifier: Dreamstation
CPAP Pressure: 7-15
CPAP Software: ResScan SleepyHead Other Software

Other Comments: Contec CMS50i

Sex: Male
Location: between dazed and confused (NC)

Post: #13
Wink RE: What is Common Practice
(03-21-2016 05:37 PM)justMongo Wrote:  "I don't have a credit card; but, I can send you a US Postal Money Order."

+1 Lolabove
03-22-2016 05:08 PM
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Homerec130 Offline

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Posts: 444
Joined: Mar 2012

Machine: Philips/Resperonics BiPAP auto SV Advanced System One (950P)
Mask Type: Full face mask
Mask Make & Model: ResMed Quatro FX
Humidifier: Philips Respironics System 1
CPAP Pressure: 6-16
CPAP Software: SleepyHead

Other Comments: But it is a dry heat.

Sex: Male
Location: Tucson, AZ

Post: #14
RE: What is Common Practice
I use the don't have a credit card with Labcorp and they just bill me what my insurance doesn't pay. My DME (Symbius Med) has never asked for a credit card and just bills my primary who automatically sends the info to my secondary. If there is something I owe, I get the bill from them which I pay electronically. Usually my deductions are met before my refills are due.

Homer
03-23-2016 01:38 PM
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vsheline Online

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #15
RE: What is Common Practice
(03-21-2016 05:07 PM)FrankNichols Wrote:  I am very happy with my experience so far with Humana, nothing to complain about. So far. I just turned 66, so I have only been with them a year (via Medicare).

PaytonA, how do I not give them my credit card info? I assume that means I go into their store to pick up supplies? That would be fine, I don't mind that as opposed to having them drop shipped to me. But, what do I say when they say (I assume they will) that they have to have my CC number on file for reason xyz. Since they are the ONLY DME I can use my insurance with, I don't have a lot of leverage to just leave...

Bring your checkbook or cash.

Obviously, they have no legal right to require you to have a credit card, much less provide them with credit card info, or force you to pay with one .
03-27-2016 03:54 AM
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PaytonA Offline
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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: #16
RE: What is Common Practice
(03-27-2016 03:54 AM)vsheline Wrote:  
(03-21-2016 05:07 PM)FrankNichols Wrote:  I am very happy with my experience so far with Humana, nothing to complain about. So far. I just turned 66, so I have only been with them a year (via Medicare).

PaytonA, how do I not give them my credit card info? I assume that means I go into their store to pick up supplies? That would be fine, I don't mind that as opposed to having them drop shipped to me. But, what do I say when they say (I assume they will) that they have to have my CC number on file for reason xyz. Since they are the ONLY DME I can use my insurance with, I don't have a lot of leverage to just leave...

Bring your checkbook or cash.

Obviously, they have no legal right to require you to have a credit card, much less provide them with credit card info, or force you to pay with one .

There is another method that I just found. I just had a nebulizer delivered from Apria. There was a $30 copay. They asked me during our phone conversation if I wanted to give them a credit card number. I simply said no. They told me that they would deliver the equipment and I could pay later.

I was going to take the payment in to the local office but decided to talk to their billing people to see if that was acceptable. They told me thatit was but it might take a while for the payment to get credited since the offices generally payments to collect until they get a fair number before they forward them on to accounts receivable. They gave me an address for accounts receivable in Atlanta and I sent them a check. We will see how well this works.

Best Regards,

PaytonA
03-27-2016 10:55 AM
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Mosquitobait Offline

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Posts: 746
Joined: Apr 2015

Machine: Resmed AirSense 10 For Her
Mask Type: Nasal pillows
Mask Make & Model: Airfit P10
Humidifier: integrated, Climate line tube
CPAP Pressure: 9-12
CPAP Software: ResScan SleepyHead

Other Comments: RLS and Bradycardia

Sex: Female
Location: Minneapolis

Post: #17
RE: What is Common Practice
(03-21-2016 02:00 PM)FrankNichols Wrote:  I have Humana Medicare and they require that I rent the CPAP machine for 13 months - it is a rent-to-own process.
I have this too - Medicare 13 month rental (not Humana). My 'rental' ends in July. Unfortunately, I am in a bid area which extremely limits who I can get Medicare paid-for stuff from.

My question is, during that 13 months is it "normal" practice to REQUIRE me to replace the various parts (hose, humidifier, F10-Cushion) etc on the ResMed recommended schedule? Or is it up to me when to replace them? No. You do not have to replace any of these items. I do recommend regular replacement of the filter, but how often depends on how dusty your home is. Other stuff, replace as needed. I have a couple of extra hoses, extra humidifier, and extra cushions. How long a hose lasts depends on your situation. My brother's ends up with cracks on the ends, so gets replaced every other year. I have yet to replace mine. With cushions, replace when torn or leaky. You can extend the life by boiling for 5 minutes.

Also, do most DMEs require you to purchase the parts through them? They will push for it, but there is no requirement.

And last (for now Smile ) does anyone know if medicare will reimburse me for those parts during the rental period if I purchase them online, or do I have to go through the DME I am renting the CPAP machine through?


Medicare will not reimburse you for anything you don't purchase from a pre-approved provider and online retailer's don't count. Getting them to reimburse for a covered item from an approved provider takes many, many hours of frustrating calls and paperwork and about 2 years. Ask me how I know this. Oh-jeez

If you want to go through a different DME, then find that DME FIRST and then make arrangements to get them all the Medicare info needed. Medicare doesn't CARE how many places you are dealing with so long as you don't get more than you are allotted. The biggest problem that I've experienced is that DMEs interpret the Medicare supply allotment differently. Find out ahead of time what they consider a mask vs. just headgear or just a mask. While some of Lincare's supply representatives get it, their orders are often changed by some other jerk in supply to their own interpretation. [edited to add] The other DME told me that most DMEs get ONLY the sealed combo pack from the manufacturer. As a result, they don't offer headgear and masks separately. This is why you can only get them every 6 months and can't get the head gear separately.

I am trying to find a DME other than Apria in my area, and I am interested in what I can expect from a reputable company.
Medicare, with their bid process, has really limited the choices that patients have to move from a bad provider to a good provider. So, simply be prepared to pay for at least some of your supplies out of pocket.

A good supplier would give you a choice of masks (where you can return if it doesn't work out within a specified period). A good supplier will also let YOU choose to call to order supplies OR have them call monthly. I DO understand that Medicare doesn't let you order supplies 3 months in advance, although why some folks on this board are able to do that mystifies me (I'd like their supplier!). A good supplier understands that you have multiple masks and that this month you need a cushion for one mask, and next month, you might order a cushion for the other mask. They shouldn't give you crap about having to see a PT to make this change when you got your masks from them in the first place.

Now, the supplier I'm moving to does not have the wide selection (masks are limited to the Resmed and Respironics). But, at the same time, they are local, I can pop in and get a supply item or have it shipped and I can email them with my order every month instead of having them call me (usually interrupting me on something important). In addition, they are flexible for mask fittings - Lincare only did fittings on Monday and Friday during certain hours. Great if you don't have far to drive and can actually get there during those times.
(This post was last modified: 03-28-2016 04:55 PM by Mosquitobait.)
03-28-2016 12:48 PM
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FrankNichols Offline

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Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
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CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #18
RE: What is Common Practice
(03-28-2016 12:48 PM)Mosquitobait Wrote:  Medicare, with their bid process, has really limited the choices that patients have to move from a bad provider to a good provider. So, simply be prepared to pay for at least some of your supplies out of pocket.

A good supplier would give you a choice of masks (where you can return if it doesn't work out within a specified period). A good supplier will also let YOU choose to call to order supplies OR have them call monthly. I DO understand that Medicare doesn't let you order supplies 3 months in advance, although why some folks on this board are able to do that mystifies me (I'd like their supplier!). A good supplier understands that you have multiple masks and that this month you need a cushion for one mask, and next month, you might order a cushion for the other mask. They shouldn't give you crap about having to see a PT to make this change when you got your masks from them in the first place.

Now, the supplier I'm moving to does not have the same selection (masks are limited to the entire Resmed and Respironics collections). But, at the same time, they are local, I can pop in and get a supply or have it shipped and I can email them with my order every month instead of having them call me (usually interrupting me on something important).

Thank you for the informative reply, I understand better now after much research and web browsing and asking "stupid questions" here.

Unfortunately for me, I have Humana/Medicare. That this means is I have exactly one DME supplier I can go to, that is Aprea.

Well, that is not exactly true, after numerous exchanges with Humana Customer Service I found that I can buy online and get 70% coverage/reimbursement after a $975 deductible (the machine cost only $850 in my case) if I have the purchase preauthorized by Humana. After several more exchanges with them on how to go about that, I found that I have to arrange for my Doctor to get the preauthorization for the purchase, then I can buy it anywhere. Sadly my doctor does not deal with insurance on this at all - period, not discussion. He is happy to write the scripts the way I want/need them, but will not get into the business of trying to get supplies preauthorized for me - and I don't blame him at all from what I have seen.

So, I am going to see how things go with Aprea. If things go sideways I plan to just purchase the supplies online out of pocket and skip the insurance on them. My wife and I have discussed it and if Aprea turns out to be difficult with just getting the CPAP machine itself (this week I hope) then we are just going to purchase it online also and skip instance.

The difference between out of pocket and though insurance seems to be about $350 (that is a guess based on other's experience with renting at about 300% interest for the 10 months) - $850 for the ResMed 10 Airsense Elite online, compared to about $50/mth for 10 months paying my 20% of the rental.

Seems like a real racket to me...

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
03-28-2016 01:11 PM
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