Dealing with physicians and insurance companies

So, I recently had to replace my BiPAP (“Bi-level Positive Airway Pressure” device. Like a CPAP machine, only a bit more complicated, and needed by people such as myself in order to sleep properly. If I don’t have one of these, I essentially don’t sleep.).

The process was unbelievably screwed up, and not by me. This post is mostly for me to get the events of this situation straight. It might not be terribly interesting to read – but then again, the level of miscommunication and fuckupery might be amusing, so read on if you like.

n.b. there are a number of manufacturers, companies, and acronyms in this story. I’ll try to keep them straight for you.

I have a 3.5 year old PR (Philips Respironics) machine. It is dying; the humidifier died some months ago, and the air pump on this one is showing signs of failing. It was time for a new one. Since I have different insurance than I did, when I got the old machine, it was a more complicated process than it would otherwise have been. This is the order of events:

  • Call Cigna (my medical insurers), get information on replacement. Find out that they farm out their durable medical equipment (“DME”) management to another company, Carecentrix. (5 weeks ago)
  • Get a prescription from my doctor (“Dr. KR”), in this case, specifying the machine I wanted. I did a good bit of research and selected a machine from Devilbiss that was smaller, lighter and better for me than the PR one I have. (4 weeks ago)
  • Call the Bay Sleep Clinic, get forms to fill out to have my sleep study and related records sent to Carecentrix. (4 weeks ago)
  • Send prescription and related documents about the Devilbiss machine, and a letter explaining why I want that specific machine to Carecentrix. (4 weeks ago)
  • Wait a while.
  • Wait some more.
  • Get tired of waiting, call Carecentrix. (3 weeks ago or so)
  • Find out from Carecentrix that the prescription is incomplete; they are waiting on Dr. KR to get a new one. (3 weeks ago or so)
  • Call Dr. KR’s office, talk to Front Office Guy (“FOG”) – he promises to get this taken care of.
  • Wait some more. (2.5 weeks ago)
  • Call Carecentrix, get informed that the Devilbiss machine is not, nor ever will be covered by CIgna. FInd out that they are still waiting on prescription info from Dr. KR. Find out that the local DME vendor is a company call Apria. (2.5 weeks ago)
  • Get  a call from Apria; they are ready to proceed. (1.5 weeks ago). Have my wife finally pick up new machine on the 21st; it’s a ResMed CPAP. I did not realize that it was a CPAP and not a BiPAP as I was expecting a BiPAP and had no reason to expect anything different. Find out that the machine has a cellular modem attached to it, as required, I’m told, by Cigna. Massive pissoff begins.
  • On the 22nd, get in touch with my corporate HR people and complain, loudly.
  • Get a call Friday (the 23rd) morning from Carecentrix; am told that Apria has massively screwed up the order. The Modem is for first time users who are leasing their devices. Am told that it’s optional in any case. I remove it from the device. Am told by representative that he will attempt to find me a machine similar to the Devilbiss that is acceptable to both me and Cigna, and find out the Devilbiss has a feature that Cigna has deemed “not medically necessary” and that is why it is not covered. We then leave for trip to Seattle (see previous post).
  • During this time, I notice new machine is not working very well for me – I still haven’t realized that it’s a CPAP and not a BiPAP; this makes only a slight difference on my trip, as I don’t have to drive, and the trip itself is tiring and fun.
  • Get a call on the 27th (last Tuesday) from Carecentrix rep as a follow-up, and he asks me some questions – he’s realized that Dr. KR has massively screwed up in issuing a replacement prescription that is for a CPAP, not a BiPAP. Things start to fall into place; I’m as tired, frustrated, and angry as I’ve ever been. I demand they fix the situation, by Wednesday. They say they will, but they need a new prescription, for a BiPAP with pressure levels indicated.
  • Wednesday: not much happening. Various calls and assurances. I have plans for Wednesday night. I get a call from Apria HQ in the morning, saying the machine will be ready by the end of the day. I change my plans for the evening so I can go pick it up. As I am leaving that day, I get a call from Apria HQ: no machine today, they still haven’t got the right prescription. Freakout on my part ensues. Change plans back. Get shitty sleep with the stupid CPAP.
  • Thursday: my wife calls Dr. KR’s FOG; he assures her that the information will be sent to Carecentrix. My wife gets some disquieting information from the FOG; I call him. I get assurances that he’s sent Carecentrix the information. I call Carecentrix and complain, loudly to everyone I can talk to. Get phony-sounding reassurances and promises of a call back. I do the same with Apria’s corporate offices, and get the same. But am also told that the machine I’ll be getting is the very same Devilbiss BiPAP that was rejected out of hand earlier. The one that Cigna will “not cover”.  I am flabbergasted. What The Fuck? Also, I’ll actually be getting a stand-in machine for now, as they have to order the Devilbiss. I get told it will be ready by the end of the day – so I change. I wait, most of the day, until a bit after 2pm. No callbacks, from anyone. No answer at Carecentrix’ headquarters (in Hartford, CT) or Apria’s (in KC, MO). No answer from local Apria location in South San Francisco – on hold endlessly. Ask my wife to go by that location to see if they are even open. She calls that location before leaving, and gets through to them. She is told that the machine is not ready. Massive freakout #2 on my part. I leave work early. As I’m walking to my car, talking to my wife, she gets a call from the manager of the SSF Apria location, telling her the machine is ready. This is less than 30 minutes after being told it would not be.
  • I drive to SSF, talk to the manager there- I barely managed to keep myself from screaming at her. She gives me my stopgap machine: it’s another PR machine. She asks me if she should order the Devilbiss. I lose it and very forcefully tell her that she had fucking better order it, especially since I’d been told that it already had been.
  • She tells me that it will arrive Monday morning, and will be ready by the end of the day. Needless to say, I haven’t any faith that it will happen, but at least I have a working BiPAP.

So, that’s the story. I fucking hate insurance companies. I’m probably going to fire my doctor, who has been great up to this point. The situation has caused a lot of concern with my company’s corporate HR people – at least that is supposedly making Cigna unhappy (and I’m going to do whatever I can to convince them that CIgna is a worthless company and should be replaced).