Apria rental / purchase / maintenance

[jqp]

So I got a Respironics M Series Pro about 18 months ago from Apria. (I have Aetna insurance)

I made monthly rental payments on it for about 12 months. After that, the bills stopped and I didn't get one for 6 months.

From what I thought I had heard, that meant it was now mine.

I've since bought a better APAP machine and sold the M series to someone else on CPAP.com.

I get a bill today from Apria for a bi-annual "maintenance fee." I called them up and asked them what this was about. They said they bill twice a year for this and it covers me if anything goes wrong with the machine.

My question is... do I own the machine, and if not... what will happen if I tell them I don't have the machine anymore and don't want to pay their stupid maintenance fee? Are they going to bill me $1,000 or something? I paid them well over that in rental fees for a $500 machine.

Anyone else run into this? I'm afraid to call Aetna up and ask them for fear they'll have a hissy fit.

Advice?

JQP

[Guest]

I would advise you too call Aetna and ask what their policy is on CPAP machines.

Example: Medicare used to have a policy for oxygen concentrators where the DME could bill a rental of the equipment for 13 months, after that time no "monthly" rentals could be billed. Starting on the 6th month after the last monthly rental billing the DME can start billing for a bi-anual maintenance fee. This fee covered any repairs or maintenance done to the machine, this was a set fee and not adjustable by the amount of maintenance done to the equipment during that time frame. The concentrator was still owned by the DME and needed to be returned if the patient moved out of that Medicare region or passed away.

If Aetna has the same policy as i stated above, you may be responsible for the cost of the CPAP.

I'm not saying your DME did everything correctly in notifiying you of the policies of your insurance regarding CPAP equipment, jsut letting you know 1 scenario where you could be held liable.

I do my best to make sure I give the correct insurance info to my patients, but the insurance company reps sometimes don't even know their own policies which makes it hard for me to explain anything to my patients.

If you have someone at you work who handles your insurance policy for you, ie. Human Resources. Ask them to research it for you, if you don't, you will have to make the call yourself.

[SnoozeButton]

Apria told me the same thing and I have Aetna, too. I didn't end up using Apria as my DME and I didn't ask my current DME to see if they told me the same. I was just satisfied to get a brand new APAP versus the bare bones, used CPAP that Apria was offering me. My plan with Aetna offers 100% on the rental, so same insurance, but different plan. I wonder if different DME's have different contracts with the Insurance company or if Aetna does it this way no matter the DME? It seems like a rip off to the insurance company to do it this way.

[roster]

............
the insurance company reps sometimes don't even know their own policies
.........

What's the difference between an insurance salesman and a used car salesman?

When a used car saleman lies to you, he knows what he is talking about.

[rickelia]

What did you find out from Aetna?

[carbonman]

Anyone else run into this?
Advice?
JQP

jqp, I had Aetna when I got my first machine and went to The Big A.

I paid rent for a year.
I changed insc. to UHC and The Big A billed them for 6mths., but I didn't have
to pay rent.......what a cluster........

A year ago, I put the Mseries on the shelf and switched to Resmed, on my dime.
Thanks Johnny and cpapauction.com

I occasionally get a computer call from The Big A,
telling me I am very important to them and
they want to know how I'm doing and
do I need any supplies.
What a crock.

I think the "maintenance fee" is a crock, too.
I would tell them it's all good and I'll see you on down the road.

[Kevin G.]

I would tell Apria that it was my understanding that I now owned the machine and that I had no need for a service contract. If they go away everytinig is resolved you can ask them to show you the agreement in which case you go back to your insurance to confirm.

These insurance contracts serve two purposes. First to increase their profit and second to create opportunities to sell you more.

The machines perform well and do not need any servicing other than changing of filters. In the rare event you machine breaks it is likely that the total cost of the repair contract is greater than the cost of the repairs. The insurance company may even pay for a new machine by that time.

[rickelia]

I learned of this maintenance plan today myself by calling Apria to make my first payment on my second machine. I asked when I called when my machine would convert to a sale since my last one converted after 6 months of rental. She explained that it would not convert to a sale but rather to a maintenance plan. The apria rep on the phone also explained this was an Aetna agreement as they could not do anything to change this contract with them. Of course there is nobody at Aetna to speak to about this until Monday. Seems to me its a way for them to keep you on the hook forever and get the machine back when you get its replacement. Anyone with information on this policy change please let us know.

I noticed this thread was started in January of 2010 so figured the author of this thread must have discovered an outcome by now.

JPQ can we please get an update?

Thanks!

[Calist]

Its a scam. I work in sleep and I've seen this kind of crap all the time from DME companies. Especially from Apria. This is what you do...

1: Call Apria, tell them you are switching DME companies. If they want the machine back, tell them you are switching to another Apria branch and they can transfer your account to them.

2: Call your insurance. Tell them you got really bad vibes about Apria and you would like to deal with another DME company entirely. Ask them who else you can go to in your area. This part is important because some DMEs are really good places and will treat you right. It is good to build a relationship with a DME company even if you don't need them right now. Tell your insurance that you want to get another mask as like... a back up... but you don't want to deal with Apria because they smell funny. Your insurance will have no problem directing you elsewhere.

3: If Apria calls or bills you again, immediately call your insurance company and ask them to inform Apria that you are using another DME from now on. Apria will get the message.

DME companies are REAL REAL careful around insurance companies. What people don't know a lot of times is that these DME companies are pre-paid by insurance companies. And they don't want to rock the boat. They play fast and loose with their clients but when it comes to their bread and butter, they are all business.

If all else fails you can employ the nuclear option which is to go straight to the sleep doctor that diagnosed you. Call up his/her office and tell them that you are having serious problems with treatment and that you would like to schedule an appointment... this will take a while. Most sleep docs don't like meeting with patients and their secretaries will try to run cover. Don't be rude or pushy. Don't give them too much information either. Just get a meeting and tell him your story.

[jqp]

Still unresolved.

Earlier in the year, I tried to resolve it. I called into Apria, explained the situation and hoped they'd say OK, or maybe ... you owe us $100 and be done with it. I got transferred around to 4 or 5 different people, explaining the situation every time - nobody knew what to do. I even got a few "oh, boy - this is going to cost you" type comments and was then transferred. After an hour on the phone with no resolution, I hung up.

The closest I got to some good information was one lady that said, if it had been 3 years, Apria would write it off since that's when most insurance companies will pay for a new machine anyway. So- worst case, I'd pay $100 more in maintenance agreements over the next year and I'm done with this foolishness.

Fast forward....

I got another "maintenance" bill about 4 months ago. (~$50). They had tried to Bill Aetna yet again and the claim was denied since I had switched to United Healthcare at the first of the year.

I called up Apria and told them they billed the wrong insurance company, please bill the right one (thinking along the same lines as a previous poster... maybe this would trigger the cancellation of the "maintenance agreement")

30 days later, I got a "late letter" from Apria. Called again -same drill. They assured me they would re-file under the new insurance.

Repeat one more time. I finally just paid the $50 when I got a "you're going to collections" letter, and was once again assured they would re-file the claim.

They never have... it's never hit my new insurance.

What I'm hoping is that they'll never bill me again since all they have on file now is my new insurance.

I guess I'll find out in December.

[DreamDiver]

... These insurance contracts serve two purposes. First to increase their profit and second to create opportunities to sell you more. ...

I couldn't agree more - specifically in the case of Apria. If you paid for your machine, you owe them nothing. Sounds like a typical Apria scam to me.

[rickelia]

Great advice Calist. Are you saying my machine agreement will switch to the new DME even though the machine came from Apria?

jpq I believe how you could not have had resolution in almost a year. It literally took me from February when I ordered my new machine until August to get them to fill the order. The series of phone calls over the months were as comical as they were frustrating. I considered it free entertainment.

[GTOJim]

I've been having fits with Apria's billing for years. Seems they recently outsourced their billing department to India. Last month I was threatened by someone in India "If I didn't pay an outstanding bill today he was turning me over to a collection agency". I previously paid the 50% deductible prior to Apria shipping, returned the items due to receiving incorrect items, received a refund check from Apria. As I understand this billing error has been corrected. Took 4 to 5 hours on the phone. Per my insurance statement the co-pay amount billed by Apria was a few dollars higher than my insurance allowed.

Last week I spent an hour on the phone with Apria because they billed my insurance company for a face mask, instead of a mask cushion. Apria rep offered to send me a copy the payment Apria received from my insurance, stated it was $23 ( I now have a 50% co-pay). I told them no way would I accept that as proof, I've been down that road before. So Apria did a three way conference call between me and my insurance. Insurance company verified they were indeed billed for a face mask, the allowed amount was $125, insurance paid Apria $62+. I'm told it will take Apria 3 to 4 weeks to investigate this matter.

Apria's numerous billing errors, not one has ever been in my favor. Currently I have 3 different items pending due to Apria billing errors, such as the example above. One pending bill, per Apria billing I owe $49, insurance statement "my responsibility is $37". None of these billing errors are large amounts.

4 years ago Apria attempted to charge me a 20% co-pay, stating my insurance coverage changed at the first of the year. Checked with my insurance, coverage was still 100%. For the next 4 years, very order Apria demanded a 20% co-pay or they would not ship the items. A couple of years ago my wife joined me as a hose head and Apria also demanded she pay a 20% co-pay even though our insurance covered 100%. Our insurance changed this year and our current co-pay is 50%.

I could list many more examples.

The moral of this, check every bill from Apria very carefully. I save all my insurance statements for months and months as documentation because the printouts that Apria will provide are not always accurate.

So why do I still use Apria? It's the only DME my insurance allows. Why do I hassle with this? To keep Apria billing on the up and up. Is it worth the time I've spent? Probably not. Even though it's not large amounts of money Apria has thousands of customers, if these billing errors are common across the board so to speak it adds up to a great deal of money. Apria seems to be billing customers (at least my wife and I) in advance of billing the insurance company, the insurance company sets the amount allowed which determines the co-pay amount. Apria always bills exorbitant amounts, insurance authorizing a fraction of the billed amount. I think a lot of these billing errors are due to Apria billing customers prior billing the insurance company. The last 4 times Apria billed my insurance, Apria did not put the insurance authorization codes on the claims, my insurance rejected all four claims. This makes me responsible for the entire bill, the exorbitant amount Apria billed. Such as $1,100 for a face mask, tubing, and filters.

[chunkyfrog]

Does your state have a state insurance board? I might suspect collusion between Apria and the ins, co;
but that may not do you any good--corruption goes high.
Rat them out to BBB, and the local TV yellow journalists.
--Or you could do what I do--contact the guy in HR where you work--my guy is a pit bull!

[DreamDiver]

I've been having fits with Apria's billing for years. ... So why do I still use Apria? It's the only DME my insurance allows. Why do I hassle with this? To keep Apria billing on the up and up. Is it worth the time I've spent? Probably not.

It might be interesting if you kept records of exactly what you are going through and sent a year's worth of documentation about it to the state insurance commissioner's office. It could also make a very interesting expose on a local TV news slot. It might even start an investigatory news story. In Atlanta they have the 'Tough Question' team (local CBS affiliate, I think) that gets 'in the faces' of bad business. It's a little obnoxious, but it gets results.