Retired man stuck with medical bill

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By Jim Carr By Jim Carr

Wayne Rexroat said he knew something wasn't quite right with his health.

“I’d be driving through town and I’d get really sleepy and I’d just pull into a parking lot and doze for 20 minutes or something,” he said.

So Rexroat went to see his doctor who diagnosed him with sleep apnea, a dangerous condition where sleep is interrupted because you stop breathing. 

As a result, his doctor prescribed a medical device called a “CPAP” that he is supposed to wear to help him sleep.

It’s distributed by a company called Apria, which in turn was supposed to bill Medicare. But before Medicare would pay, there had to be proof that Rexroat was really wearing the CPAP.

"Their criteria before they sent it to Medicare was that for the first month you had to use it for at least four hours a night,” Rexroat explained.

Rexroat said the CPAP machine really helped him sleep but because of another medical condition, he was unable to wear the CPAP machine the required number hours of night. And because of a remote monitoring system, Apria knew Rexroat was not wearing the device for four hours.

"I got a phone call and they said for the first month you have to use the CPAP for at least four hours every night,” he said. “And I said I’m working on it and I explained what my situation was and I never heard from them."

Rexroat went back to using his CPAP device regularly and was happy with the rest he was getting until six months later when he started receiving bills for the CPAP device from Apria.

According to Apria, his CPAP was apparently "not medically necessary" because he chose not to wear it that first month. So, Medicare refused to pay for it.

As a result, Apria passed the $600 bill on to Rexroat.

3 On Your Side contacted Apria. They stated Medicare mandates that patients use the device a minimum number of hours in the first 90 days.

"If the patient does not meet the minimum hours of use required by Medicare, then Medicare will not pay for the CPAP device,” they told us.

Rexroat thinks it's ridiculous that he should have to pay for something that was prescribed to him.

“Who is it at Medicare that has a medical degree?” he asked.

I wish we could have helped out Rexroat. Unfortunately, if he wants to keep using the CPAP and have it paid by Medicare, he will have to undergo all the same tests he has already gone through in order to qualify again.