Sleep Disorders Support Group

Hi,

I am not really a newbie at this. I have had some experience using different types of masks and machines but it’s been awhile but I have almost no experience with the decision I have to make now. I have United Healthcare insurance. UHC uses Apria Healthcare to administer their respiratory DME in my area. I went to Apria last week to get fitted for a mask and look at a PAP machine. The sales woman at Apria, fitted me with a mask (which felt extremely comfortable) and demonstrated the APAP machine, did an excellent job of presenting this product. However, she didn’t seem prepared when I refused to sign the agreement when she tried to close the deal. I told her that I wanted to take the contract home to read it before I signed it. She said if I wanted to do that then I couldn’t take the machine home. I said no problem. She told me she wasn’t even sure I could “take home a contract,” so she went and got her insurance “person.” When the claims processor came into the room she too looked at me a bit puzzled. She had that, “why would you ask to take the contract home to read it before you sign it” look on her face. Apparently this doesn’t happen much ‘round there. Well, short story is… they let me have a copy of the agreement to take home.

Basically, according to the Apria presentation, the choice I have is to rent this machine; pay some “up front costs” for some of the hardware and then pay a monthly rental fee of $35.00. I’m supposed to do this until it is determined, by my compliance, that this mask and machine are a successful fit. At that point, UHC pays for a portion and I pay for a portion. If the mask and machine “don’t work” for me then it’s on to the next mask and/or machine.

My question is... I’m wondering if wouldn’t be cheaper just to buy a mask and machine? What are my options here? I have read some posts on this but am not sure where to begin in terms of questions to ask; information I need to be gathering and numbers I should be crunching.

Thank you,

Chuck

Well Chuck, welcome to our site. I'm sorry you are here. The attitude is caused by 3rd party pay. That is mostly you are not the payee, medicare or medicaid or insurance is mostly the payee and we are a copay to the insurance. So the contract is mostly not in our name.

Now the trial period is serious because you don't want a bad fitting mask and you can only change every 3 or 6 months. I'm not sure where we are on that now.

A mask costs about 160-210 with headgear. A CPAP machine 800-2000 per machine.

Go the the web site for the manufacturer of the equipment and look it up and that is the most you have to pay.

There are several companies you can get to but it from just look on the web and get a price.

I'm sorry you are having this trouble but Apria is a DME Durable Medical Equipment supplier and there are not many of them and they are notorious to be hard to get along with.

I am not a Dr nor am I medically trained but do have some experience tucked under my belt. Do not linger as Apnea can cause other diseases, some very serious. Do your stuff quickly. Now I not talking days but I am talking weeks.

Best of luck.

Cicero

My machine was picked and prescribed by my doc and my insurance just payed almost 900.00 a month. I now own this 9000.00 machine which when I looked up its price on different med sites was only around 3000.00. you should have 30 days to change masks if you don't like it. i hate it and sleep apnea. just had 4th sleep study have to go up in pressure and I lost almost 50lbs. anyhow, I did not get a choice, but the apap machines are intuitive with my breathing. I don't smoke or drink just overweight. my machine has a card reader which my insurance and doc like to see cus it gives them info on compliance and if I was not compliant enough they would not pay. sorry to rant. insurance companies are stupid thats why we pay so much can't shop around cus they only work with certain companies, so you may not get a choice on companies. still new to apnea

Well I do have to give you this, apnea is a bear and the cure / control is a pain! First there is the money. And with it Medicare and insurance. By all means rent is cheaper than purchase as they probably pay for most of their rental units in less than 6 months. Now they are in it for the masks and the continuing money from them. It is a shame/

Now there is the how can it help you. Well in my case I have Pulmonary Hypertension and it does make sleeping easier and more pleasant.

The makes are the Devils play toys. Just designed to male us lose our religion.l

Other that that its all good!

However as bad as it is change masks til you get the one that is closest and if then make that primary. If yuo have not tried them all continue until you have 2 good masks and then alternate nights.

Don't let the system win, you are smarter/harder than that.

Best

Cicero