The best way to drive a weed up insurance's ass with CPAP

[LSAT]

I don't understand why cpap supplies have to have a prescription in the first place. I think we should be able to walk into a drug store and buy a machine or mask if we want to. Maybe someone would buy a machine that didn't need one. So what would that hurt?

You can't just walk into a hardware store and buy a leaf blower and box of trash bagsm without a permit or licence can you, why would you be able to go into a drug store and buy a smaller version of the same thing. Sorry, it's seems you can! Jim

Good point....All these OLD CPAPs can be useful as leaf blowers.

[Goofproof]

I don't understand why cpap supplies have to have a prescription in the first place. I think we should be able to walk into a drug store and buy a machine or mask if we want to. Maybe someone would buy a machine that didn't need one. So what would that hurt?

You can't just walk into a hardware store and buy a leaf blower and box of trash bagsm without a permit or licence can you, why would you be able to go into a drug store and buy a smaller version of the same thing. Sorry, it's seems you can! Jim

Good point....All these OLD CPAPs can be useful as leaf blowers.

Also useful in blowing snow off the porch and steps, as long as it's not too wet, or refreezing. Jim

I even use one to clean the dust bunnies out of my computer case.

[wm_hess]

I think you are "poking the weed" up the wrong ass.

Insurers pay way too much money for sleep tests. And then they pay even more in excess for machines and masks. They would rather not, but other industries have them by the balls. Plus laws and regulations which require them to address this medical condition. Insurers want to spend as little money as possible to maximize their profits, but they cannot avoid paying the high costs involved in sleep apnea (except to pass a lot on to the insured through deductibles, co-pays, and premiums).

The "winners" of this crappy system are not the insurers.

Consider Kaiser Permanente HMO. It is both an insurer and a medical care provider. And that sets up a different scenario than other insurers, because while the insurer arm of Kaiser does not want to spend a lot of money on diagnosis and treatment of sleep apnea, it also recognizes the long term effects of NOT treating apnea are exponentially higher. People tend to stay members of Kaiser for generations, while its rare to keep other insurers for long periods of time so they may never see the long term benefits to treating apnea.

As a self-contained entity, Kaiser has devised ways to provide apnea care much more efficiently. The doctors who refer for sleep apnea testing are salaried employees of Kaiser, as are all the other people involved in the continuum of apnea care at Kaiser. They are paid the same whether they are exceptionally busy or sitting around twiddling their thumbs, so they might as well be kept busy. Kaiser owns its own home testing devices (in my region it's Itamar Watch Pats) which are easy to train patients how to use in a group setting taught by staff sleep techs. In my local Kaiser hospital, 10 - 15 patients are sent home with this testing device overnight 3 days a week. It probably costs less to test 50 people per week this way than your insurer paid for just ONE sleep apnea test. Then they do in home titrations. Again they have APAPs which are loaned to the patient for a week to determine optimal pressure in the patients own sleeping conditions. Plus, they weed out the non-compliant immediately. If someone can't use it that first week (and, yes, there techs offer lots of support) they aren't going to pay for a machine for that person. Also, if you are not a Senior Advantage member (Medicare), Kaiser buys the machine outright. They still have to do it Medicare's way (capped rental) for seniors, though. Outright purchase saves money in billing and tracking.

When it comes to equipment, Kaiser is the DME. They contract with an outside supplier (Crapria) but they negotiate for huge bulk discounts by limiting the "formulary" of equipment and supplies. Because the volume is so high, Crapria in turn can negotiate big volume discounts from the manufacturers. And Crapria is relieved of the responsibility for things like billing, compliance, fitting, adjusting that they have to do for other patients, so they have a wider profit margin.

I'm not reporting this because I'm a big Kaiser cheerleader (far from it), but just to say that there are ways to treat sleep apnea more efficiently and less expensively than the traditional pay through the nose model created by the bureaucracy of insurance companies and government regulation.

A company could operate on a similar model for home testing and titration for a fraction of the cost of the whole sleep lab racket. I believe there even are a few companies you can arrange your own home test through. And some insurers will even cover it.

As for your point about control, I HATED the Kaiser system because you, the patient, have NO control. When my doctor made the referral (he wore me down after years of refusal) I got a post card in the mail telling me what time I was to show up at the sleep clinic and no more info than that. I wasn't even contacted to find out if I COULD make that appointment, it was assumed I'd show up. I had a conflict that cost me nearly a half hour of telephone hell to get another scheduled. They don't even tell you if that's for a preliminary appt or if you'll be spending the night (no). Then I arrived to find a group of other people (I don't want my medical care in a group setting!) and we were issued testing machines that day to be returned by the following day at 10 am regardless of my busy schedule with no time to drive across town to return it. Results were mailed and we were required to attend yet another group for mask fitting and set up with a home titration machine. Throughout this process I was exceptionally ANGRY that I had no say, no control of this process.

But it worked. . .

I agree as far as Kaiser is concerned. Kaiser has been quite good as far as my apnea. It's very much like the armed forces, group and education then the home study, a quick in and out with the expensive doctor. Afterwards working mainly with technicians. It's a lot more cost efficient than the lab setting. They can weed out the garden variety apnea, get it treated and on my way with a data capable device. The more challenging varieties of apnea then can be treated more efficiently with more limited resources. Yes the regimentation can be irritating, but it is also more efficient and cheaper

-Bill

[bwexler]

I for one agree with today's Grumpy report.
I have been complaining to anyone who would listen for almost 20 years about the Medicare rent to own requirements that cause the price paid for medical devices to be multiples of what it should be.

Just had a fresh experience with my new oxygen concentrator. Bought it for $635 instead of 105 per month rental for ever. And the DME refused to sell me one at any price. Now I am battling the insurance company for reimbursement.

[palerider]

. . . I can be pretty good at manipulating, . . . conning people...

This says it all.

truer words were never written.

[Stormynights]

I think with the oxygen concentrators they are supposed to come out and check your machine and give you tubes and canulas. The only time I saw anyone from my supplier was when they brought out the machine. I can only get the cheapest and most worthless crap they make from them. If they would out right buy the machines and provide good quality hoses they would save a whole lot of money. I don't think they want to save money.

[MrGrumpy]

I bet you work for an insurance company or are related to someone who works for one. Anyone who takes the health insurance company's position on CPAP and sleep apnea....they are making money off it somehow

I think you are "poking the weed" up the wrong ass.

Insurers pay way too much money for sleep tests. And then they pay even more in excess for machines and masks. They would rather not, but other industries have them by the balls. Plus laws and regulations which require them to address this medical condition. Insurers want to spend as little money as possible to maximize their profits, but they cannot avoid paying the high costs involved in sleep apnea (except to pass a lot on to the insured through deductibles, co-pays, and premiums).

The "winners" of this crappy system are not the insurers.

Consider Kaiser Permanente HMO. It is both an insurer and a medical care provider. And that sets up a different scenario than other insurers, because while the insurer arm of Kaiser does not want to spend a lot of money on diagnosis and treatment of sleep apnea, it also recognizes the long term effects of NOT treating apnea are exponentially higher. People tend to stay members of Kaiser for generations, while its rare to keep other insurers for long periods of time so they may never see the long term benefits to treating apnea.

As a self-contained entity, Kaiser has devised ways to provide apnea care much more efficiently. The doctors who refer for sleep apnea testing are salaried employees of Kaiser, as are all the other people involved in the continuum of apnea care at Kaiser. They are paid the same whether they are exceptionally busy or sitting around twiddling their thumbs, so they might as well be kept busy. Kaiser owns its own home testing devices (in my region it's Itamar Watch Pats) which are easy to train patients how to use in a group setting taught by staff sleep techs. In my local Kaiser hospital, 10 - 15 patients are sent home with this testing device overnight 3 days a week. It probably costs less to test 50 people per week this way than your insurer paid for just ONE sleep apnea test. Then they do in home titrations. Again they have APAPs which are loaned to the patient for a week to determine optimal pressure in the patients own sleeping conditions. Plus, they weed out the non-compliant immediately. If someone can't use it that first week (and, yes, there techs offer lots of support) they aren't going to pay for a machine for that person. Also, if you are not a Senior Advantage member (Medicare), Kaiser buys the machine outright. They still have to do it Medicare's way (capped rental) for seniors, though. Outright purchase saves money in billing and tracking.

When it comes to equipment, Kaiser is the DME. They contract with an outside supplier (Crapria) but they negotiate for huge bulk discounts by limiting the "formulary" of equipment and supplies. Because the volume is so high, Crapria in turn can negotiate big volume discounts from the manufacturers. And Crapria is relieved of the responsibility for things like billing, compliance, fitting, adjusting that they have to do for other patients, so they have a wider profit margin.

I'm not reporting this because I'm a big Kaiser cheerleader (far from it), but just to say that there are ways to treat sleep apnea more efficiently and less expensively than the traditional pay through the nose model created by the bureaucracy of insurance companies and government regulation.

A company could operate on a similar model for home testing and titration for a fraction of the cost of the whole sleep lab racket. I believe there even are a few companies you can arrange your own home test through. And some insurers will even cover it.

As for your point about control, I HATED the Kaiser system because you, the patient, have NO control. When my doctor made the referral (he wore me down after years of refusal) I got a post card in the mail telling me what time I was to show up at the sleep clinic and no more info than that. I wasn't even contacted to find out if I COULD make that appointment, it was assumed I'd show up. I had a conflict that cost me nearly a half hour of telephone hell to get another scheduled. They don't even tell you if that's for a preliminary appt or if you'll be spending the night (no). Then I arrived to find a group of other people (I don't want my medical care in a group setting!) and we were issued testing machines that day to be returned by the following day at 10 am regardless of my busy schedule with no time to drive across town to return it. Results were mailed and we were required to attend yet another group for mask fitting and set up with a home titration machine. Throughout this process I was exceptionally ANGRY that I had no say, no control of this process.

But it worked. . .

[ChicagoGranny]

I have been complaining to anyone who would listen for almost 20 years about the Medicare rent to own requirements that cause the price paid for medical devices to be multiples of what it should be.

Someone who knows the Medicare rules can comment, but I will tell you my experience. Two years ago Medicare covered a new ResMed S9 AutoSet with heated humidifier/heated hose/Slimline hose. I paid $105 for three months rental, and Medicare paid $420. Then I was considered to own the machine/humidifier/heated hose/Slimline hose - $525 total cost, which was cheaper than I could have bought it from an internet supplier.

I don't believe Medicare is paying "multiples of what it should be" (paying).

[LSAT]

I have been complaining to anyone who would listen for almost 20 years about the Medicare rent to own requirements that cause the price paid for medical devices to be multiples of what it should be.

Someone who knows the Medicare rules can comment, but I will tell you my experience. Two years ago Medicare covered a new ResMed S9 AutoSet with heated humidifier/heated hose/Slimline hose. I paid $105 for three months rental, and Medicare paid $420. Then I was considered to own the machine/humidifier/heated hose/Slimline hose - $525 total cost, which was cheaper than I could have bought it from an internet supplier.

I don't believe Medicare is paying "multiples of what it should be" (paying).

I agree and have had a similar result. The last machine I received... S9 Autoset w/Himidifier, cost me about $12 a months for 12 months. This was my 20% co-pay. I paid about $144 (20%) and Medicare paid about $576 (80%)...the DME received about $720 which is right in line with Internet providers. bwexler is incorrect...that's why no one is listening to his complaint.

[MrGrumpy]

Most of you are missing my entire, long winded point.

I hate insurance. The reason I hate insurance, is because they do not want to pay for stuff and Ive learned the hard way, insurance is not your friend. They'd rather see you die than pay out money on you. Of course, you could never get them to say that out publicly. But if you could only hear private conversations some of those health insurance executives and claims adjusters have, especially when booze is involved and they think nobody is listening or caring what they say.

Here it is, for the dense among you:

If you remove the diagnostic part of sleep apnea from the tight rigid control of Medical Doctors and usually, the health insurance companies, you then put blame on health insurance.

You ask, WTF?

If you have a whole bunch of people who dont have to jump thru paperwork hoops to get diagnosed, and you do pay a $100 or $150 of your own hard cold cash to pay for a home sleep study and it comes out positive, then they gotta treat you. As long as you can afford the copays, rentals, whatever who gives a damn what you call it. Otherwise, its basically omission of care. Many of you are elderly and/or disabled. Withdrawing medical care to the elderly and disabled is considered bad form and is highly looked down upon in a jury trial if you die because of untreated sleep apnea.

Its a no brainer to me, get the diagnostic portion of sleep apnea OUT of the hands of the doctors. And the health insurance companies. And you will end up with way more CPAPers, more interest in the treatment, some will actually stick it out and like it because they learn for many of them it works well. And thats how to drive a weed up health insurance's ass. And drive their sorry asses out of business.

And then we are all back to square one, like back in the fifties. Doctors can only charge for what people can afford. And health insurance will go back to being what it used to be used for, hospitalization and major trauma.

[LSAT]

Most of you are missing my entire, long winded point.

I hate insurance. The reason I hate insurance, is because they do not want to pay for stuff and Ive learned the hard way, insurance is not your friend. They'd rather see you die than pay out money on you. Of course, you could never get them to say that out publicly. But if you could only hear private conversations some of those health insurance executives and claims adjusters have, especially when booze is involved and they think nobody is listening or caring what they say.

Here it is, for the dense among you:

If you remove the diagnostic part of sleep apnea from the tight rigid control of Medical Doctors and usually, the health insurance companies, you then put blame on health insurance.

You ask, WTF?

If you have a whole bunch of people who dont have to jump thru paperwork hoops to get diagnosed, and you do pay a $100 or $150 of your own hard cold cash to pay for a home sleep study and it comes out positive, then they gotta treat you. As long as you can afford the copays, rentals, whatever who gives a damn what you call it. Otherwise, its basically omission of care. Many of you are elderly and/or disabled. Withdrawing medical care to the elderly and disabled is considered bad form and is highly looked down upon in a jury trial if you die because of untreated sleep apnea.

Its a no brainer to me, get the diagnostic portion of sleep apnea OUT of the hands of the doctors. And the health insurance companies. And you will end up with way more CPAPers, more interest in the treatment, some will actually stick it out and like it because they learn for many of them it works well. And thats how to drive a weed up health insurance's ass. And drive their sorry asses out of business.

And then we are all back to square one, like back in the fifties. Doctors can only charge for what people can afford. And health insurance will go back to being what it used to be used for, hospitalization and major trauma.

Now you are starting to sound like a Socialist...go to bed.

[Cardsfan]

Most of you are missing my entire, long winded point.

I hate insurance. The reason I hate insurance, is because they do not want to pay for stuff and Ive learned the hard way, insurance is not your friend. They'd rather see you die than pay out money on you. Of course, you could never get them to say that out publicly. But if you could only hear private conversations some of those health insurance executives and claims adjusters have, especially when booze is involved and they think nobody is listening or caring what they say.

Here it is, for the dense among you:

If you remove the diagnostic part of sleep apnea from the tight rigid control of Medical Doctors and usually, the health insurance companies, you then put blame on health insurance.

You ask, WTF?

If you have a whole bunch of people who dont have to jump thru paperwork hoops to get diagnosed, and you do pay a $100 or $150 of your own hard cold cash to pay for a home sleep study and it comes out positive, then they gotta treat you. As long as you can afford the copays, rentals, whatever who gives a damn what you call it. Otherwise, its basically omission of care. Many of you are elderly and/or disabled. Withdrawing medical care to the elderly and disabled is considered bad form and is highly looked down upon in a jury trial if you die because of untreated sleep apnea.

Its a no brainer to me, get the diagnostic portion of sleep apnea OUT of the hands of the doctors. And the health insurance companies. And you will end up with way more CPAPers, more interest in the treatment, some will actually stick it out and like it because they learn for many of them it works well. And thats how to drive a weed up health insurance's ass. And drive their sorry asses out of business.

And then we are all back to square one, like back in the fifties. Doctors can only charge for what people can afford. And health insurance will go back to being what it used to be used for, hospitalization and major trauma.

[Stormynights]

FYI you never own an oxygen concentrator. The rent just goes on and on.

[bwexler]

FYI you never own an oxygen concentrator. The rent just goes on and on.

You are correct that is what the DME and the medical group and the insurance company told me. I ignored them and went out and purchased the concentrator from an out of state on line provider. I now OWN my concentrator.
I am now asking the insurance company to ignore their silly/expensive rules and reimburse me the 80% they should pay.
6 or 7 months of rental and they would be at break even. From that point forward both the insurance company and me will be ahead of the game for at least the five year warranty period and possibly a few years beyond that.

I have had similar experiences with wheel chairs and other devices going back 20 years when we took care of my 90 year old in laws.

Some day I will be bored and go to my congress man and senators.

[palerider]

FYI you never own an oxygen concentrator. The rent just goes on and on.

I own the one that is in the spare room, bought, paid for, no extra money.

of course, it wasn't paid for via insurance.