FSA a way to get around DME?

[Starpilot]

Hi folks,

My DME is killing me -- possibly literally. My doctor's office ordered me a new mask months ago. I never got it. I asked them to request a new nose pillow and filters. They sent me a new hose instead. My doctor perscribed me a bipap machine. I got a call two weeks ago from Apria saying they needed more information from the doctor and that they would let me know after talking to the doctor again. I never heard back from them. (Just left a message with my doctor asking what was up).

My sleep doctor calls Apria the worst company he has ever dealt with for anything -- either as a consumer or a professional. He would love to set me up with another DME but unfortunately Apria is the only one my insurance will take.

I remember someone on the board once made a mention of using their Flexible Spending Account to purchase CPAP supplies online. I was wondering if and how this works? Is this a way to get around the @#$*^@)#(@& DME? How do you prove to a website that you have a prescription?

All help appreciated. I am so tired and busy and its hard to call all the damn time to check up on this awful company.

[sc0ttt]

Of course you can use your FSA.

You can use it for your deductible if you do go through a DME and insurance, or you can use it for the full amount if you buy on-line. I think you could even use it to buy a used machine if you get it from a legitimate retailer... not from Craigslist though.

CPAP.com has a way to upload a copy of your prescription, or they'll call your doctor's office to get it.

[chunkyfrog]

Since cpap.com requires a prescription, my PayFlex at work never required more than a receipt.
Depending on your FSA, you may or may not need additional documentation.
Check with them. I wish PEHP worked the same way--I really liked the debit card.

[Starpilot]

I'm inquiring about the FSA from my employer, although I worry I'll have to wait for the enrollment period before I can get set up, which might be next year.

I hope I can get this resolved though so I can fire Apria. I can't believe how awful working with them has been.

[library lady]

You can fax or scan your prescription to cpap.com.

[ChicagoGranny]

I'm inquiring about the FSA from my employer, although I worry I'll have to wait for the enrollment period before I can get set up, which might be next year.

I hope I can get this resolved though so I can fire Apria. I can't believe how awful working with them has been.

Just know that you are spending your own money, not the insurance company's, when you use a FSA.

Try calling the customer service supervisor at Apria. Apria can be bad, but if you "work" them you can get what you need.

[Nozzelnut]

Dealing with companies that don't care about your treatment can be difficult.

You must be your own advocate. You have to stay on top of them and keep calling until they get it right. Keep moving up the supervisory chain until it's right. Take notes of who and when you spoke with people and don't be afraid to throw them under the bus. Remember they failed you and it's unacceptable.

I have an FSA; I do purchase masks other than what my DME has in stock; usually online. Downside is I can't try them on. I usually purchase out of pocket then submit my claim for reimbursement. I don't have a debit/credit type of card that some other folks have.

[Redonthehead]

Not defending Apria at all - but perhaps your doctor's office has some blame here.

For your mask and supplies, I would suggest calling Apria at 1-800-310-3363 - talk to Sam if possible. I requested a new P10 and it was delivered to the door in 5 days. He also went out of his way to confirm the date my "rental" period is over, and said I could get up to 6 new cushions if I wanted them.

And as Granny said - I'm sure you could use your FSA to buy supplies (pre-tax money), but that's your money without any contribution from insurance.

[Starpilot]

Thanks everyone. I have never had an FSA before so I didn't know how they work.

I did get in touch with my HR department and I can't even enroll in our FSA till October. I did call the doctor yesterday and left a message for the equipment specialist they have there and then left a message on the general line just now.

Thanks for the number for Apria Red and the tips. I will try calling them in a bit as well. I'm so frustrated with this pervasive exhaustion.

[Redonthehead]

The way it has worked for me, which I believe is typical, the doctor writes the prescription and sends it to the DME of your choice (typically one "in-network"). My prescription read something like "APAP set to 5-20, and mask of choice". You then work directly with the DME. Similar to going to the Pharmacy.

And of course you can ask for a copy of the prescription so you can buy supplies yourself through any supplier, but the hassle level to be reimbursed by insurance rises.

[sc0ttt]

Thanks everyone. I have never had an FSA before so I didn't know how they work.

I did get in touch with my HR department and I can't even enroll in our FSA till October.

FSAs are generally on a calendar year basis - January to December (because they're linked to your income taxes), and usually allow a few weeks into the following year for expenses as well for a bonus. So even though you might not be eligible to start contributing until October, you could probably still claim June expenses in October.

The way mine works is I just send copies of receipts and then they deposit the money in my bank account. My company contracts with an outside FSA firm and the folks there are really helpful, so if you're not confident your HR person is giving you all the facts, try calling the FSA firm directly.

[Redonthehead]

She may enroll in October but it probably won't become effective until Jan 1 2015. I only do FSA if I know of a big expense coming the next year, which my OSA diagnosis came too late in 2013 to enroll

For example, in October of 2012 I signed up for $2500 in FSA (the max) for 2013 (we also have health insurance signup at that time) , then had lasik done on Jan 4 2013.

[sc0ttt]

She may enroll in October but it probably won't become effective until Jan 1 2015. I only do FSA if I know of a big expense coming, which my OSA diagnosis came too late in 2013 to enroll

That doesn't make any sense. If she's enrolled, that means she's contributing untaxed 2014 dollars that have to be used on 2014 expenses. There's no way she could contribute 2014 untaxed dollars and be allowed or required to use them in 2015 (outside of the grace period).

Her ineligible period before October is probably just an employer thing to make sure she's going to last long enough on the job to make it worth while administratively.

[Redonthehead]

my position is her HR lady said she could enroll this October, but realistically the HR lady is PROBABLY saying she can SIGN UP this October, and the effective enrollment date will be Jan 1 2015. I've been in this corporate world a long time, and bet you a box of donuts her HR lady will confirm it.

As you said above, this generally runs by calendar year. Just like Obamacare, the enrollment period is a few months before the next calendar year, unless there is a qualifying life event. Regardless of it all, the OP should keep trying with the DME and go thru insurance.

[sc0ttt]

my position is her HR lady said she could enroll this October, but realistically the HR lady is PROBABLY saying she can SIGN UP this October, and the effective enrollment date will be Jan 1 2015. I've been in this corporate world a long time, and bet you a box of donuts her HR lady will confirm it.

As you said above, this generally runs by calendar year. Just like Obamacare, the enrollment period is a few months before the next calendar year, unless there is a qualifying life event. Regardless of it all, the OP should keep trying with the DME and go thru insurance.

I understood that she had recently started a new job - if that's the case the waiting period for FSA coverage cannot exceed 90 days. The "life changing event" clause is for making changes in existing enrollments.

If that's not true and she's just signing up for a new plan at an old employer, they you're totally right; she must wait for open enrollment and next year's plan.

Health Care Reform prohibits group health plans, which includes certain Health Reimbursement Account (HRA) and Medical Flexible Spending Account (FSA) Plans, from imposing a waiting period in excess of 90 days. This means that any individual who meets the plan’s eligibility requirements must be given the opportunity to commence coverage on or before the 91st day after the date the individual satisfies the eligibility requirements. Medical FSAs that are excepted benefits* and retiree-only HRAs are exempt from the 90-day waiting period limitation.

I'm still not positive about using October funds on June expenses though.