Re: Apria complaint— update from today 8-23-19;
I got a call this AM from Apria after I filled out their online form last night and forwarded part of my Apria complaint to Blue Shield. I had sent them the section details of my conversation with RT Michelle at Oceanside a few weeks back.
A woman named Karrie who said she was a manager called. She said that they followed Medicare guidelines for DME orders and would not fill the order my specialist had placed. She said the mask I use can only be shipped every three months— not two.
I told her the Michelle had told me she would place the order this time but in the future she would not work with me— that she had the right to do so. Karrie told me that the heated humidifier Michell told me was on the way had never been ordered.
I told her I have a rare immune condition and am allergic to the normal sleep apnea equipment. I told her I was considering leaving Blue Shield just so I don’t have to work with Apria.
She asked me how soon this would take place. I said— it would not turn over until the first of the year, and she still had to get the masks out to me. Again I said I have a rare immune condition and cannot use the standard equipment.
She said that I was using equipment off label and they followed Medicare guidelines and they would not provide the equipment I use.
Later I called Medicare to understand their guidelines, and spoke to Jose Flores. I asked how they could discriminate against a special needs patient.
He said as long as it had been determined it was medically necessary (with supporting documents following protocol) Medicare would cover what I need.
I called Blue Shield as well, who said the same: as long as a practitioner had determined/written it was medically necessary, the medical group approves it, authorizes it— then Blue Shield will pay it. As Apria is a contracted vendor to Blue Shield, they are obligated to serve the special needs patient. I have letters written by 2 MD’s stating my allergies to the standard OSA equipment, and an order from UCSD Sleep and Pulmonary Medicine stating what my needs are.
I assume this was all approved and authorized as Amber at UCSD Managed Care has been coaching me on how to best interface with Apria all along— setting up conference calls with Apria’s agent Chanel (who promised all of the equipment I need would ship).
Today Karrie told me Chanel had no authority.
So this is where we are at— I am frustrated— have spent over 23 hours trying to get this order filled— to get my 145.00 heated humidifier Fischer Paykel that I can no longer afford to purchase on my own. I am still using a crock pot to heat my tank because Apria is so difficult to work with.
Addendum: The complaint I filed with Blue Shield documented the equipment I have had to purchase on my own since starting with Blue Shield in Jan of 2015. Apria refused to supply it— and I thought they had the right to. Not so said Amber at UCSD’s Managed Care— Apria is bound by contract to supply the equipment themselves or source it elsewhere.
It totals 506.
and I have asked for Blue Sheild to have Apria to refund this money to me. It has actually been since 2012— and much more money out— but I was with another insurance company.
Product or Service Mentioned: Apria Customer Care.
Reason of review: Poor customer service.
Monetary Loss: $1000.
Preferred solution: Full refund.
Apria Cons: Every thing, Cannot seem to get my replacement parts, Incompetent staff, You name it.