Recently diagnosed. Trying to navigate insurance/apria/carecentrix and determine best options

[imbaker]

I recently had a HST done, which said that I had sleep apnea. Doc said his office would give me a call to discuss treatment. A couple days ago, I got a call from Apria saying that my CPAP is ready.

Apria wanted to send the device right away, but I told them I would need to know what my out of pocket would be, as I have a HDHP and knew that I would be paying the full rate. I then spent 2 hours on the phone back and forth between apria and carecentrix, which was frustrating to say the least and I walked away feeling that both companies were incompetent at best or a total racket at worst. A quick internet search seemed to confirm this sentiment.

Eventually I got a final out-of-pocket cost. Insurance requires a 3 month rental to ensure compliance/efficacy. After that time it would be converted to a purchase. $570 for 3 months rental. Then $350 to purchase for a total of $920 for an airsense 10. This appears to be fairly consistent for the market rate for the machine and supplies. I would expect the ins co to be able to negotiate at least a somewhat lower rate (access to negotiated rates are one of the main reasons that I carry insurance.)

Apria and carecentrics have left such a bad taste in my mouth that I would prefer not to deal with either of them if possible. I could get it outside of the insurance, since I am basically paying the entire cost of it anyway, but it would be nice to pay down as much of deductible as possible just in case shit ever hits the fan.

How should I proceed from here.?

Can I go around carecentrix altogether and still get it approved through insurance?

If not, can I at least request carecentrix to use a different DME?

What does insurance consider to be compliance? I will be camping with no power for several days as well as taking a long trip out of country... I would hate to get stuck with the $570 rental fee and no cpap!

Has anyone here used a MAD and was it helpful?

[HoseCrusher]

If you have some money and don't want to play the game...

Purchase your machine from a trusted source and use it knowing that compliance requirements don't apply to you. Your interest is in productive therapy and improvements in overall health.

[chunkyfrog]

Some insurance is just not worth getting.
Try not to make the same mistake NEXT time.

[LSAT]

Top of the line machine can be purchased without insurance or DME for under $600...See if cpap.com will match the price
https://www.noinsurancemedicalsupplies. ... -humidair/

[imbaker]

Some insurance is just not worth getting.
Try not to make the same mistake NEXT time.

This is something I thought about when I initially signed up for it. I got it, because it was one of the few plans that offered an HSA, which I have used in the past, albeit one with a better plan, and liked for the savings advantages. Fortunately, I regularly put away a good amount of cash into my account to cover such things. It does offer me some tax savings, negotiated rates (usually...) and an out of pocket maximum in case things really go south. So, overall I'm happy that I have it over nothing at all. That said, sometimes the provider network sucks and irritating crap like this... I will definitely be shelling out a few more bucks next go round to avoid the bullshit.

[imbaker]

If you have some money and don't want to play the game...

Purchase your machine from a trusted source and use it knowing that compliance requirements don't apply to you. Your interest is in productive therapy and improvements in overall health.

I think this is what I will end up doing. I'm gonna try to see what I can do tomorrow and if its more bullshit than its worth I'm just buy it on my own and be done with it.

[imbaker]

Top of the line machine can be purchased without insurance or DME for under $600...See if cpap.com will match the price
https://www.noinsurancemedicalsupplies. ... -humidair/

Thanks for that. I'm going to try to see if I can get anywhere with these fools and if not just buy it outright and be done with it.

[Janknitz]

Some insurance is just not worth getting.
Try not to make the same mistake NEXT time.

AFAIK , most people don’t have crystal balls to tell them things like what medical emergencies or conditions are going to come up in the next year, what particular treatments, tests, medications or DME are going to be needed. It’s a crapshoot and you do the best you can. Some people don’t really have a choice, either.

So it’s not really a “mistake”. It’s life. You will be better informed next time you choose your insurance, but it’s not your fault that our system sucks so bad that without a crystal ball you have no way of knowing what the right choice will be.

[OkyDoky]

You mentioned they said you would get an Airsense 10, but there are several different models of Airsense 10. This site will help you see the different models. Don't get the one that is not fully data capable. https://sleep.tnet.com/cmd.class?class=as10 Also the Autoset can be used as a straight cpap or auto but the Elite can only be used as a straight cpap. So the Autoset is more flexible for changing needs.

[chunkyfrog]

Sadly, many lessons are learned the hard way--been there, more than once.
My crap list: UHC, BCBS, any HMO, Apria, and others I'd rather not recall.
I share when I can, hoping my mistakes can help others.
Cross me once . . .

[prodigyplace]

Sadly, many lessons are learned the hard way--been there, more than once.
My crap list: UHC, BCBS, any HMO, Apria, and others I'd rather not recall.
I share when I can, hoping my mistakes can help others.
Cross me once . . .

you forgot Lin(don't)care?

[chunkyfrog]

Never went to Lin(don't)Care myself--not likely to try them unless backed into a corner.

[imbaker]

My crap list: UHC, BCBS, any HMO, Apria, and others I'd rather not recall.
I share when I can, hoping my mistakes can help others.
Cross me once . . .

UHC also on my crap list from a while back. BCBS is who I am with now and unfortunately pretty much the main game in town and I avoid HMOs whenever possible. What I have is better than nothing, but sometimes...

[chunkyfrog]

Huge difference between private insurance and Medicare.
"Advantage" = HMO; same poor care, lack of options, etc.
We used SHIIP (state free insurance counseling) each year,
because insurance plans change every year.
The good ones almost always get rotten once you are hooked.
I went to SHIIP about 3 months before retirement--a great choice!
Go to a consultation with Social security 6 months in advance.

[dreamingofdreaming]

I'm in the same boat with a high deductible. I used an in network DME so that what I have to pay out of pocket, at least goes towards my deductible. I found that the price of the machine is about what I could find online, but there is a pretty significant price difference in masks. My full face was around $80 going through insurance. Online, its $150. My nasal mask also was much lower than any online that I found. It is unbelievably frustrating trying to get price from DME. I use Lincare and had such a hard time getting prices. I eventually called their 1-800 # and talked to someone and asked for a supervisor, who was able to tell me what I would have to pay for the machine and supplies, with my insurance rate. My insurance carrier requires a 12 month rental, then the machine is mine.