Apria and Aetna. Rip Off?

[parkerdt]

All,

I have Aetna through my work, and my CPAP machine and supplies are now through Apria.  I have a ResMed A10 Auto, and several masks.  My machine was replaces about a year ago with the new DME and new insurance.

I haver seen about 14 months, now, of bills at ~$870.  Higher months when I ordered supplies.  Normally, this would not matter as I have 100% coverage once my annual deductible is satisfied.

However, I'm at the start of a new year, and have not yet satisfied my annual deductible.  So, I am getting monthly bills from Apria for $50, on an $870ish charge to Aetna.

How long does Apria charge Aetna for "rent" of the CPAP machine?  Shouldn't I own it at some point?  Or will I go through this same BS next year?  Is this thing amortized over some time period? And if so, what is that period?  Apria has already billed Aetna over $9k....

thanks,
Dave

[Rich66]

You would do best to call Aetna and ask them about that. I googled Aetna and Obstructive Sleep Apnea in Adults and got a lot of information, including that they generally follow government guidelines. Speaking as a Medicare patient, once you rent the machine for 13 months and have compliance (4 hours a day minimum 70% of the time) then you own the machine.

[Sleeprider]

At the time you got your machine, the full retail price was about $870. It sounds like you are paying out of pocket more than the total for that machine and equipment. Definitely call your insurance and find out what the limits for billing from Apria should be. Apria has a reputation for endless billing, duplicate billing and many other problems.

[parkerdt]

Called Aetna. Zero help - thy said they reimburse by what Apria bills them, and to call Apria. Still waiting on a call back from Apria. However, Apria was quick to bill me for a SILICONE FRAME Wisp on my latest supply order! And it clearly states FABRIC. So, I guess a bit more telephone tag.

In this area, ADEPT has been buying DME groups like crazy. Apria was great the first year, but I fear they are regressing. Still, I'm not going back to ADEPT where I can't even order online from them.

thanks for the help all. If anyone knows a good DME, I'm all ears.

Dave

[hegel]

I had initial trouble with Apria, big time. I finally connected with a supply rep who is competent. since then, everything has become smooth as silk, with lightning swift fulfillment. However, when there were issues, trying to contact anyone who might help was nearly impossible. Frankly it was infuriating. Everyone I reached would direct me to yet another phone number that would take an hour to answer.

[parkerdt]

And an update:  

Completely out of the blue, I received a letter from Apria stating that Aetna had purchased my machine effective 3/23/2021.  So, I expect my billings from them to Aetna will now stop.

Of course, I'll watch them like a hawk, given their reputation.   It will be interesting to see how Aetna wants me to obtain supplies going forward.

[Sleeprider]

Supplies should be authorized through Apria or any in-network DME of your choice. Be sure to look at the list of in-network providers if you want an Apria divorce.

[parkerdt]

Thanks again,

Apria has apparently been bought by Owens & Minor, Inc. 

Perhaps this explains some of it!

Dave

[cathyf]

So when I got my machine back in 2014, my nice little small town DME managed to make a hash of it! So I got pretty good at reading and understanding the bills... AND I just got a machine from Apria delivered 10 days ago, and posted a thread about understanding the Apria paperwork that I received.

http://www.apneaboard.com/forums/Thread-...-agreement



https://www.dropbox.com/s/023ifh26u1iwhm...t.png?dl=0

What I believe this means is that the price of the machine is

• 13*$46.15=$599.95 <<< this is WITHOUT the humidifier
  
• $155.05 <<< this is the humdifier
  

total is a nice even round $755
PLUS $45.19 for the heated hose --
now we are at $800.19

Then the insurance allows for a "startup" of a mask -- billed separately for frame, cushion and headgear -- and a couple of filters, and a chin strap.

If I'm following correctly, the first bill will have 1/13th of the cpap machine (because technically it's a "rental") plus the outright purchase of humidifier, hose, mask, filters, chin strap, which might be $356.60, or maybe a slightly different amount because I got an F30 rather than N20 and the price might be different.

Then each month, Apria will bill for 1/13th of the machine -- $46.15 -- PLUS any MORE supplies that I got that month.

Ok, here is where Apria will screw up... MY insurance plan rents for 3 months, and then you have an appointment with your sleep doctor who certifies that you are using the machine, and then they want to pay the balance. So they want to see a bill for ~$350, then the next two bills for $46.15, then they want the next bill to be for $461.50, the balance of the remaining 10 months.

Instead, the computers at Apria will keep submitting claims for $46.15, and the computers at UMR will keep rejecting them with "send us a claim for the balance" and the computers at Apria will just keep sending the same claim, and then the next month they'll send a bill for another $46.15, and now the 4th month and 5th month rental will get rejected, etc., etc.,... I will watch this for awhile and then I'll start making phone calls, and we'll see how long it takes to get all of this straightened out!

The thing that really pisses ME off is that I passed my out-of-pocket maximum last July, and if it had been a normal year where my regular small-town DME just had A10's laying around, I would have gotten one in mid-September, with the initial bill which insurance would have paid all of, and then two rentals with dates-of-service mid-October and mid-November, and then the balance billed mid-December. And insurance would have paid 100% of all of it.

But since the machine showed up six months later, and I'm not even yet to my deductible, I'm going to be paying for it up front. Now I WILL make my deductible, and money is fungible, so I'm going to end up paying for 20% of the cost of the machine. (Unless I hit my out-of-pocket maximum THIS year, which I really do NOT want to do, LOL). So I'm going to end up paying about $190 for this machine that I wouldn't have had to pay if it weren't for the PR recall... So that's MY reason to hate Phillips Resperonics!

But, anyway, what I think might have happened is that you had a TOTAL bill for $870 for the whole machine, which was machine, humidifier, mask, filters, heated hose, etc. Apria sent Aetna a single claim with the entire $870 bill last year, which established a claim number. The first month Apria billed Aetna for the assorted startup charges and 1/13th of the base unit, using that claim number. Then each month Apria used the claim number to bill Aetna for another 1/13th of the cost (which you said was about $50/month). Since that was the claim number, and the amount associated with the claim was $870, that $870 kept appearing on the claims. Since they were paying 100% at that point, you didn't see the bills, which were for about $50. Then the end of 2021 came, and when Apria filed your monthly claims in January, February, March, Aetna told Apria "he hasn't met his deductible, so HE will pay you the $50." And then the 13 months were up, and they sent you notification that the machine was paid for in full...

Complicating things would have been if Apria was sending you every possible mask, mask part, hose, water tank, etc., which would have generated larger and smaller bills. As long as Aetna was paying 100%, that was great, but now if you don't expect to blow through your out-of-pocket maximum this year you need to make the supplies slow down to just what you need.

[parkerdt]

Thank you, Cathy. That makes perfect sense, now.  I'm not used to haveing an up-front annual deductible, or I never would have noticed the issue.

I have written Aetna to see how they would like to proceed with supplies.  My annual appointment with the Neurophysiologist is soon, so I want to know what is what.

thanks,
Dave