Lied to by DME (Apria), not sure how to proceed (2025)

AlgebraicMisery

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Sex: Male
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05-02-2025, 08:59 PM

Lied to by DME (Apria), not sure how to proceed

Recently I got a prescription to get a new BiPaP to replace my current Resmed one that's about 4 and a half years old and malfunctioning (though thankfully not in a critical way). I wouldn't have gone for it normally but I won't have my current insurance (I'm on my parents insurance) by the time the biPAP turns 5, and the new work insurance that will replace my current one, is substantially worse since my job is just a restaurant job.

The DME that provided me the biPAP is Apria, and it seems a lot of people on this forum as well as reddit's r/cpap have also had problems with them. Getting the biPAP from them I was deceived multiple times. I admit it was partially my fault not thoroughly checking things over, but I did not have this problem at all when getting my original biPAP from a different DME.

I first approved the payment because they said insurance had already approved it. Later on insurance said they had not even received a claim for it from the DME. Later on when insurance denied it I contacted Apria who said they would appeal it and if it failed I could get a full refund. Now insurance is telling me they did not get an appeal, and when I contacted Apria again, they said they would not be appealing and furthermore, I cannot get any of my so far paid payment back should I choose to return the machine (about $600). My sleep doctor is also refusing to appeal on my behalf.

Right now I am planning on submitting an appeal myself, but am not sure what words to say. I am also wondering if I should cancel my credit card to stop the payment since money is very tight right now, but that might be a bad idea. Please advise. Thanks

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srlevine1

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05-02-2025, 10:26 PM

RE: Lied to by DME (Apria), not sure how to proceed

From what you have posted, you may not meet the criteria for a replacement machine, and it appears unlikely that you will prevail in an appeal. [...about 4 and a half years old and malfunctioning (though thankfully not in a critical way)]

What is your preferred outcome? Refund? How much are you willing to settle for?
Have you tried Apria's Patient Satisfaction Line? Patients can contact Apria's Patient Satisfaction department at 1-800-260-8808.
Have you documented your concerns at https://www.apria.com/contact-us?

I found Apria to be professional and responsive for years. It depends on knowing what you want (within reason), establishing a single point of contact, and documenting everything.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius

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SarcasticDave94

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05-03-2025, 08:36 AM

RE: Lied to by DME (Apria), not sure how to proceed

Lawyer up and make a fraudulent business practice claim against Apria. They very likely did this intentionally, knowing you'd have to pay them for the new machine. 4.5 years is not the same as 5, obviously. I doubt seriously they ever tried to run any claim paperwork through your insurance, knowing it's not acceptable. They lied and you will pay unless you get legal representation ASAP.

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Positional Apnea

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

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srlevine1

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05-03-2025, 06:34 PM

RE: Lied to by DME (Apria), not sure how to proceed

@SarcasticDave94

Lawyers are the last thing you should consider. The costs far outweigh the benefits; the risk of losing under the circumstances described, even in Small Claims Court, is high, there is probably an arbitration clause hidden in the background, and above all, what are your provable damages? This is not a defined class. And no lawyer would want this case.

Try for a "courtesy settlement" and be more vigilant the next time.

The overall impression I got was that the user tried to game the system and lost.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius

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SarcasticDave94

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Sex: Male
Location: Nowhere near Normal IL, US, probably in PA drinking coffee

05-03-2025, 10:32 PM

RE: Lied to by DME (Apria), not sure how to proceed

Ok yes I get it.

OP you're going to need to talk with the customer support, satisfaction department. Try to work the best scenario for yourself you can. You'll need to calculate what's cheapest overall on your bank account. I do think you'll likely find paying out of pocket for the CPAP to be extra expensive with a DME.

Mask Primer

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AlgebraicMisery

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Sex: Male
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05-06-2025, 05:44 PM (This post was last modified: 05-06-2025, 05:57 PM by AlgebraicMisery. Edited 1 time in total.)

RE: Lied to by DME (Apria), not sure how to proceed

(05-03-2025, 06:34 PM)srlevine1 Wrote: @SarcasticDave94
Lawyers are the last thing you should consider. The costs far outweigh the benefits; the risk of losing under the circumstances described, even in Small Claims Court, is high, there is probably an arbitration clause hidden in the background, and above all, what are your provable damages? This is not a defined class. And no lawyer would want this case.
Try for a "courtesy settlement" and be more vigilant the next time.
The overall impression I got was that the user tried to game the system and lost.

I asked them for a replacement machine. If I was not eligible for it they should have just told me. Insurance approvals work in bizarre and unpredictable ways and are usually handled by people who didn't even go to med school; my dad got a replacement machine even though his was not even 3 years old. If insurance had not approved it they should not have told me otherwise. Absurd to call me gaming the system when the system is rigged.

https://oig.hhs.gov/fraud/enforcement/ac...practices/

It's not rare either. People complain about apria at an abnormally high rate to the point where it's infamous.

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srlevine1

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05-06-2025, 06:20 PM

RE: Lied to by DME (Apria), not sure how to proceed

Sorry for any bad feelings.

If there is functional damage to a machine, the DME's choice of repair or replacement, based on circumstances, is perfectly reasonable. However, the poster indicated "...and malfunctioning (though thankfully not in a critical way)," leaving lots of wiggle room for the DME.

I believed that this statement was an attempt to game the system, "I wouldn't have gone for it normally but I won't have my current insurance (I wouldn't have gone for it normally but I won't have my current insurance (I'm on my parents insurance) by the time the biPAP turns 5, and the new work insurance that will replace my current one, is substantially worse since my job is just a restaurant job."

Consider all systems, procedures, contracts, rules, and regulations rigged to protect the interests of the offeror(not the accepting) party.

As for the promises made by customer service representatives involving insurance reimbursements, you have learned a valuable life lesson: check with your insurance company for approvals, in writing, before placing an order.

Like any other big business with thousands of customers, there are bound to be dissatisfied individuals,and social media makes it easier than ever to complain or leave negative reviews for the slightest transgression. I have had good luck with Apria, maybe because I personalized the CSR contactand documented each transaction.

BTW: You can dispute the charge with your credit card company and submit your documentation or a statement to back your claim. Just canceling the card may notwork as new charges are often passed through to the new number.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius

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Nightynite

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05-06-2025, 07:14 PM

RE: Lied to by DME (Apria), not sure how to proceed

This happened in 2020.

Acting Manhattan U.S. Attorney Announces $40.5 Million Settlement With Durable Medical Equipment Provider Apria Healthcare For Fraudulent Billing Practices

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srlevine1

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05-06-2025, 08:57 PM

RE: Lied to by DME (Apria), not sure how to proceed

(05-06-2025, 07:14 PM)Nightynite Wrote: This happened in 2020.
Acting Manhattan U.S. Attorney Announces $40.5 Million Settlement With Durable Medical Equipment Provider Apria Healthcare For Fraudulent Billing Practices

The lawsuit did not involve individuals per se, but violationsof the Federal False Claims Act (FCA), along with numerous state anti-fraud laws, by seeking Medicaid reimbursement for ventilation machines that were not medically necessary or reasonable. Essentially, they provided machines to people who were ineligible, did not use the machines provided, or did not comply with compliance requirements.https://oag.ca.gov/system/files/attachme...eement.pdf.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius

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Lied to by DME (Apria), not sure how to proceed (2025)

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