Question about Kaiser Device Options

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Roup1
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Question about Kaiser Device Options

Post by Roup1 » Wed Feb 25, 2015 7:07 pm

I am a Kaiser patient with very good DME coverage. My plan gets me a new machine every 5 years at no co-pay as well as masks and supplies on a regular basis. This is a new plan for me as my previous plan with them did not have DME coverage. I have been on CPAP therapy for 10 years and have previously purchased my own equipment. I went in to the local sleep clinic to take advantage of my new coverage and they gave me a brand new Phillips Respronics Auto CPAP with humidifier. They had the machine in stock in their "closet" program and gave it to me on the spot without having to go through Apria. I have not used it yet as I really wanted the new ResMed AirSense 10. The tech told me that ResMed is not on their formulary and that Respronics are the only machines that they give out.

Looking to see if anyone has experience trying to change the machine through Kaiser or is this something that I would have to do on my own? Any input would be appreciated.

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Krelvin
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Re: Question about Kaiser Device Options

Post by Krelvin » Wed Feb 25, 2015 7:16 pm

What is the model or Ref# on the unit. The description Phillips Respronics Auto CPAP is vague... Assumption it is a 560 but it could be an older 550.

It will be on the bottom typically of the blower unit (not humidifier). If attached to Humidifier make sure you remove the water tank first.

BTW you are now listing a Resmed unit which is not a Phillips Respronics product.
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Roup1
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Re: Question about Kaiser Device Options

Post by Roup1 » Wed Feb 25, 2015 7:29 pm

Thanks for the reply. I will post the exact model # when I get home tonight. I have not used my new Respronics machine yet.

Sorry for any confusion. My sig shows the machine that I am currently using: S9 Auto w/ H5i humidifier and ClimateLine. I love the S9 but I am interested in upgrading to the new AirSense 10.

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bwexler
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Re: Question about Kaiser Device Options

Post by bwexler » Wed Feb 25, 2015 7:39 pm

If you wanted the Airsence 10 you should never have walked out the door with the PRS One.
You loose most of your leverage once you walk out the door with a machine.
My brother in law is with Kaiser and he has a PRS 1 560. With a sample size of one that doesn't mean much.
Good luck with your quest. Hopefully you won't need to change your name to Don Quixoty.

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Pugsy
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Re: Question about Kaiser Device Options

Post by Pugsy » Wed Feb 25, 2015 7:45 pm

I think with Kaiser you have zero choice in brand or model machine if you are wanting a machine from them.
There is no negotiation with them for something else.

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adipasqu
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Re: Question about Kaiser Device Options

Post by adipasqu » Wed Feb 25, 2015 8:31 pm

Pugsy wrote:I think with Kaiser you have zero choice in brand or model machine if you are wanting a machine from them.
There is no negotiation with them for something else.
That is true. Kaiser is the DME for all of their patients and their formulary for the area (maybe all of California since its all PR up here in NorCal) is restricted to a single brand and only a few machines within that brand. I would guess the current formulary is restricted to the PRS1 560 (APAP), 760 (BiPAP Auto), and 960 (ASV) depending on medical necessity. If you want an Airsense S10, it's coming completely out of pocket if its not on the formulary. The PRS1 560, if that's what you got, is a perfectly fine machine and since it was $0 out of pocket, enjoy it!

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kaiasgram
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Re: Question about Kaiser Device Options

Post by kaiasgram » Thu Feb 26, 2015 12:14 am

Yep, there was no leverage to begin with, if you don't want what Kaiser provides then you're on your own. On the bright side I've never heard of Kaiser giving out bricks.

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Janknitz
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Re: Question about Kaiser Device Options

Post by Janknitz » Thu Feb 26, 2015 1:29 am

Yes, with Kaiser you get a choice of PR or PR. Nothing but. No use arguing as they are both your doctor and DME. If you want another brand you're on your own. It's part of what you agree to when you sign up for Kaiser.

The good news is that they do all data capable machines because they actually use the efficacy data to adjust your treatment if needed. PR machines are not bad except there's a known issue with the humidifier connections crapping out after a few years (past the warranty, of course). And you have to deal with Crapria for supplies. They ALWAYSscrew up the billing and the order and fixing it is a time suck.

If you want a different mask your RX needs to be changed and it has to be on their formulary.

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Roup1
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Re: Question about Kaiser Device Options

Post by Roup1 » Thu Feb 26, 2015 1:51 am

Yes, I can confirm that my PR is a REMstar Auto 560P (2014-11-21). The humidifier says System One Htd Humid

I have no complaints on my current ResMed S9 setup so I'll continue to use it. Luckily, they gave me a new ResMed Airfit P10 mask. I love it! It's the one that I wanted and is a nice upgrade to the Swift FX that I had been using.

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Roup1
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Location: SoCal

Re: Question about Kaiser Device Options

Post by Roup1 » Thu Feb 26, 2015 9:28 am

Thanks for all the feedback!

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adipasqu
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Re: Question about Kaiser Device Options

Post by adipasqu » Thu Feb 26, 2015 10:30 am

Roup1 wrote:I have no complaints on my current ResMed S9 setup so I'll continue to use it.
Just an idea: if your S9 is getting up there in hours of usage, you may want to consider making that your back-up machine and use your new PRS1 560 as your daily machine. This way you can have a reliable back-up if anything ever happens to your new machine. Also, since Kaiser provides the PRS1 560, the respiratory therapist you see may only want to read (or be able to read) data from that machine so that it can go into Encore Pro, which they use to track their patients. If you never plan on going in to see your RT and do everything on your own, then this really isn't an issue.

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I am a doctor...just not that kind of doctor.