Purchasing equipment from Apria vs online stores

I want to pass on shocking news about the prices at Apria.

While I was a Kaiser member with DME coverage, I received new masks every 3 months (for free). I changed to the Kaiser plan without the DME coverage. Since I am used to buying from Apria, I gave them a call first to order a new Breeze mask.

The Apria rep gave me a price for the Sea Breeze mask (I don't know why she used the word SEA, but whatever.)

She told me the price: $795.00

I asked her if perhaps there was a decimal out of place!

"Nope," she said, "And the nose pillows are $67.50/pair."

Needless to say, shop around online. I prefer: CPAP.com

Brick and mortar DMEs that bill insurance (so all of them basically) have to charge the same prices of cash customers that they bill insurance. Of course the insurance company has a deal going where they actually pay less than the billed amount, etc, but yes, going through a company that doesn't bother with insurance (cpap.com for example) is by far the best way to buy out of pocket.

I am currently in a complaint process with the Better Business Bureau about Apria. I have written 3 parts to the complaint (original, update and rebuttal) to Apria's only 1 response. When this complaint process is over I will share all of it here. I don't want to share now since I know there are employees of Apria that lurk here.

I am no longer dealing with them, I have taken the machine back to them and have a new "brick & mortar" DME that is absolutely wonderful. I have been told that the price I will be charged for ANYTHING at the DME is the same price as CPAP.com. I know they are not purchasing from them, but, they are not overcharging me or my insurance company either.

I have not paid them 1 penny yet, I have had a loner APAP from them for over a month free of charge. This was to get more information for the sleep doctor since we were not sure the PSG got the right titration. I get my machine this week and I will only pay $85 for a better machine that Apria was going to charge me $135 for (I pay 20%)

I have had a few mask issues which have required about 1 trip a week to the new DME. I have been pleasantly greeted, treated like family, and I have not complained.

The RT I'm dealing with is the owner of the company. He told me this week, I would not have to go back to the office or take time off work again. He has upgraded me to GOLD Customer Status and he will personally deliver anything I want or need to me at home or work for NO CHARGE. This is SOOOOOOO different from how I was treated at Apria.

Pathways Respiratory in Oklahoma City ROCKS!!!

This is not the first time I've seen posts saying good things about Pathway in OK.

To underscore the outrageousness of Apria's prices to outside customers not covered by Kaiser, let me clarify:

The Breeze mask retails online for: $ 79
Apria's price for the same mask is: $795
That is close to a 1,000% M-A-R-K-U-P!

I recently tried them for the first time (and I live down the road from their headquarters in lake Forest, CA). Needless to say, they stink and don't even take the time to explain things, let alone respect your time. As for purchasing directly from them, they told me that I could not and that I needed to get things from them via a prescription only. Mickey mouse.

Cpap.com has proven to be the nicest game in town... thank goodness.

- Julie

P.S. the only good thing about Apria is their nice logo.

I too had a rotten experience with Apria. When I first went in the RT didn't even have the equipment I had specifically ordered (via phone AND fax) and had taken time off work to get! When I called prior to possibly wasting my time again to check on the order, she was snippy with me saying "If it wasn't here I would have called!" This was after a fax and several phone calls asking her to confirm the equipment was there.

I should have tried the other DME approved by my insurance, but I had heard "OK" thing about them from a co-worker and they were right around the corner from my house.

I was told by the sleep lab that they would come to your house with a variety of masks, etc. and fit you in-home -- WRONG. The RT was pretty aghast that someone would even do that -- her response was that was only for seniors/housebound people. Hmmmph.

Thankfully my insurance covers 100%. I'd really like to know what they were charged for the CPAP - although they do lease it until the purchase price is reached

Linda

Linda,

You are lucky the insurance paid 100%. My crummy insurance (Aetna) pays 50%! And I don't think there is another DME choice. The RT was rushed and did not explain anything except that the cpap machine was "the latest model." He also tried to get me to accept the full face mask that the insurance approved. I said heck no and asked if I could privately purchase the one I wanted. He said no! Well phooey. Thankfully, I can deduct the cost of things because I am self-employed, but this is ridiculous.

Oh, also during my initial appointment I had to wait over an hour for the enjoyable, rushed experience with the RT. Ugh!

- Julie

$795 for a MASK???? A stock item mask at that!!! Not even a custom-made mask??? UNBELIEVABLE!!! I thought my DME was outrageous billing $175 for the Swift!!

Wile I am not a fan of Apria I find it hard to believe that they wanted to charge 795.00 for a mask. It doesn't make sense. I purchased a Hybrid from them for for 189.00. That's 10.00 more than I would have had to pay on line.
Any intelligent person should have asked to speak to the manager

komala wrote:.....
The Apria rep gave me a price for the Sea Breeze mask (I don't know why she used the word SEA, but whatever.)

She told me the price: $795.00

.......................

Yea it makes sense, the Sea Breeze mask is the upgrade: Breeze mask + four nights in ocean front condo = $795.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): breeze

oceanpearl wrote:Wile I am not a fan of Apria I find it hard to believe that they wanted to charge 795.00 for a mask. It doesn't make sense. I purchased a Hybrid from them for for 189.00

Was that your copay, or was that what they billed insurance?

Had a similar experience with Apria. They billed the insurance some outrageous price, to which the insurance said FU and paid them similar to what's on CPAP.com and my copay was a percentage of the reduced rate.

Maybe it depends on the insurance company because I didn't really see the point of charging such a high rate when they weren't going to get it.

Medicare is the major purchaser of CPAP equipment, probably the major purchaser of just about all DME equipment. As such Medicare pretty much sets the rates that can be billed for that equipment after input from lobbyists, various government officials, etc. Medicare then sets an allowed amount. Medicare then pays 80% of the allowed amount.

Most insurance companies pretty much follow Medicare. Those DME companies that accept Medicare (remember, usually the bulk of their business) can NOT charge less to others than they do to Medicare. Insurance companies negotiate w/the various DMEs for the amount they will pay for the various equipment. So always keep in mind that there is a BILLED amount, an ALLOWED amount and a PAID amount and that the three are NOT the same.

All billing and reimbursement is done thru billing codes, the HCPCS. There are two recognized and accepted HCPCS code numbers for xPAP machines. The first HCPCS code number is for anything from a straight, bare-bones, compliance data only, CPAP thru a fully data capable AutoPAP. The second HCPCS code is for the bi-levels (B-PAP is a proprietary brand name). Medicare and insurances pay the SAME amount for ANY brand or model CPAP thru AutoPAP. They pay the SAME amount for ANY of the bi-levels regardless of brand or model (but a higher amount than for CPAPS and AutoPAPS). It improves the DME's profit margin to give you the LOWEST priced model w/in the scripted HCPCS code.

If I remember correctly there are three HCPCS codes for CPAP interfaces: one for Full Face Masks, one for Nasal Cushions and one for Nasal Pillows. Again there is a Billable amount, an Allowed amount and a Paid or Reimbursement amount. And, again, it improves the DME's profit margin to provide you w/the lowest priced full face mask, nasal cushion or nasal pillows they can.