California Kaiser CPAP coverage?

[BlackSpinner]

And what should be my next step? Can I get coverage? Do I just need to go to the street and buy my own equipment? Is there a market someplace where I can get it?

I have visions of a seedy alley where people sell CPAPs to unsuspecting newbies out of the trunks of dilapidated cars... LOL

This is a little overwhelming and Kaiser is failing.

You will need your prescription in hand.

Our host cpap.com - check this out no matter what you do because it will give you an idea of pricing - a lot of brick & mortar DME's will charge almost double this, however you may want to get your first masks locally.

secondwind.com

Or members on the board like grayghost STLMark

Actually buying from a bricks & mortar DME is more like buying from the sleaziest used car dealer in town, except that the used car sales staff usually at least know what they are selling you.

[Neal]

Thank you for the replies.

It is becoming evident I'll have to do Kaiser's job for myself.

So... where do I buy a machine?
Is it possible to finance the purchase?
Is there anyone or anything I should really avoid?
Any protips for a good buying experience?

I can't believe this is not covered by Kaiser. It's kinda bizarre. I wonder if they would cover corrective surgery!

[Janknitz]

Neal,

1. All signs point to you not having coverage BUT don't assume that. Get that Evidence of Coverage booklet and find out for sure.

2. Crapria is a real Pain in the a$$ to deal with--they've earned their nickname. BUT it's worth checking out the Kaiser pricing. And Kaiser is now doing ResMed AirSense machines--but whether you can get an auto from Crapria is up to Kaiser (it's NOT up to Crapria, so don't even bother arguing with them--your DME is Kaiser, Crapria is only the supplier--this would not be the case if you were not a Kaiser member). Ask for the prescription in hand to see what it says and then find out from Kaiser DME what the Crapria price is.

Otherwise you can go anywhere (Secondwind is a good option, or our hosts if you want new) and you won't have to put up with Crapria's crap and almost 100% billing error rate.

BTW, NEVER give Crapria your credit card number. NEVER.
And don't believe a word they tell you. Act like a reporter for the Times--validate everything they tell you.

[Pugsy]

I don't know of any online source that offers financing.
Most will accept a credit card though.
There are ways to get a machine at nominal cost through various "help the in need" agencies. If you want more information along those lines send me a note privately and I will go dig up the material.

You can buy privately. I don't think forum member STL Mark has any machines right now but I think that forum member grayghost4 has some. If you want to go that route just send him a note privately.
memberlist.php?mode=viewprofile&u=72737

You can get Kaiser's discounted "cash" price from Crapia (Apria) who Kaiser uses to supply equipment. That cash price will likely be less than online sellers like cpap.com but more than what you would pay to someone privately.

Checkout secondwindcpap.com for pricing on gently used low hour machines.

You are also going to need a mask and they aren't cheap. Grayghost used to have a few new masks so if you contact him you might ask about masks too. He is trustworthy....I wouldn't hesitate to buy from him if he had what I wanted and needed.

[Okie bipap]

You can find masks on ebay. I picked up two new masks for less than the price of one. I bought my backup machine from a member of this forum. The machine was brand new (usage hours was zero). He included a new mask which I couldn't use, so I passed it on to another member.

[Janknitz]

Kaiser sleep lab (at least the one in my region) will usually fit you for a mask--and give you the sample mask to take home for free. If it doesn't work for you, get an appointment to go back in and they will do the same with other masks. Then you only have to worry about cushion replacements.

[chunkyfrog]

Maybe we need to compile a list of insurance plans that do not have cpap coverage.
Or would that be too long?

[palerider]

I've dealt with Greyghost4, and recommend him whole heartedly, he won't steer you wrong.... send him a PM and see what he can do for you.

[Janknitz]

Maybe we need to compile a list of insurance plans that do not have cpap coverage.
Or would that be too long?

There are literally thousands of plans out there, and more now with the ACA. So it would be difficult to say. You can't say "Kaiser doesn't cover CPAP" because they do, just not on the ACA and other small group and individual plans. You would have to go plan by plan, contract by contract, to know what your coverage is.

I'm just going to reiterate what I said above. Unless you are on Medicare, the ONLY way to know whether CPAP is covered involves making a request for the "Evidence of Coverage" (EOC) from your plan. If it doesn't say so in that EOC, then it's not. The trouble is that you won't see the EOC until AFTER you've committed to the insurer, and only if you specifically request the EOC. Nobody just gets one without asking and most people have no clue it exists--the insurers sure aren't going to tell you to ask for one. I've learned to always request one EVERY YEAR. That way if I have to appeal a denial, I know where to look. I have had some favorable outcomes for myself and others by consulting the EOC.

[grayghost4]

Quote : I have visions of a seedy alley where people sell CPAPs to unsuspecting newbies out of the trunks of dilapidated cars... LOL

About half of my cpap's are out of the back of my car to Kaiser people, at Starbucks ... not a seedy alley .... and the car is not dilapidated.

If you are interested in a new or used unit from me . send a pm

http://sfbay.craigslist.org/eby/hab/5789958898.html

[palerider]

Quote : I have visions of a seedy alley where people sell CPAPs to unsuspecting newbies out of the trunks of dilapidated cars... LOL

About half of my cpap's are out of the back of my car to Kaiser people, at Starbucks ... not a seedy alley .... and the car is not dilapidated. l

I can confirm, there's nothing seedy, or alleylike with respect to grayghost4... except his pic, which does seem like it might have gone to seed.

[Janknitz]

The "seedy" buying experience actually comes from brick and mortar DMEs. Used car salesmen are angelic in comparison.

[BlackSpinner]

The "seedy" buying experience actually comes from brick and mortar DMEs. Used car salesmen are angelic in comparison.

And used car salesmen KNOW what they are selling LOL. They even know how to turn the car on!

[SewTired]

I'm confident this is the case. It's one thing that's not covered despite the fact this is a platinum plan.

If this isn't covered in the platinum plan, then what plan is it covered under?

Why don't they cover what is a fairly common item?

And what should be my next step? Can I get coverage? Do I just need to go to the street and buy my own equipment? Is there a market someplace where I can get it?

I sympathize. It's no different with the supplemental plans. My brother has the premium Medicare supplemental plan and it doesn't cover hearing aids or glasses while my bottom plan (same provider) covers them. Durable medical equipment is a toss-up. Covers walkers only if you are issued one at the hospital. My guess as to why cpap wouldn't be covered is the high patient abandonment rate.

Next step - if you do not have coverage, then get a copy of your prescription from your provider and order one online (our host or other online retailer). Or get a used one (poster Greyghost often has them) or secondwindcpap.com. Local DMEs will not give a cash price as low as an online retailer. For details about what specific machine to order, I'd peruse the threads FIRST, specifically the sticky threads, before ordering.

[Janknitz]

My guess as to why cpap wouldn't be covered is the high patient abandonment rate.

I don't know the stats for sure, but I would guess that Kaiser has a higher compliance rate than just about anyone. That's because they do auto-titration at home by sending you home with a borrowed CPAP machine for a week. They aren't going to prescribe machines in the first place to people who didn't meet the compliance requirements in that week of home titration. And they do give support for using one--you have to take a class to get the unit to take home for autotitration, plus you can call and see sleep lab staff for additional support during that time. They don't charge for any of these services. That's about 200X more support than the average person gets starting CPAP. And it weeds out many non-compliant individuals right at the beginning.

While it's no guarantee that someone will continue using CPAP, I'm sure it cuts down on the non-compliancy.