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

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
MrGrumpy
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The best way to drive a weed up insurance's ass with CPAP

Post by MrGrumpy » Fri Feb 12, 2016 11:46 pm

Ive been thinking of this for a while. I work in the legal profession and I can be pretty good at manipulation, persuading, conning people...as well as just using logical persuasion.

Here it is. A lot of people sound unhappy with the way us sleep apnea patients get treated. Why is that? One of the main reasons, IMO, is we patients are not in control. And why is that? Because we cant test ourselves, for free or minimal cost with OTC tests.

Think about it. High blood pressure? You can test yourself with free high blood pressure machines at nearly every drugstore, Wal-Mart and many grocery stores. You can also buy your own blood pressure cuff OTC, no prescription needed and test yourself and go to your physician with the results.

Diabetes...there are OTC tests at your local drugstore that give you your blood sugar results and indicate whether or not you tilt type II diabetic. Again, you need no prescription and can take the results to your doctor if you test positive.

You suspect a family member, a son or daughter or your wife or husband are abusing drugs or alcohol. There are OTC drug and alcohol tests you can buy at your local drugstore to secretly test for drugz and booze in your household or your teens bedroom.

There are even labs where you can walk in off the street and pay out of pocket for routine blood work, check your iron levels, check yourself for anemia, check your thyroid, check your testosterone levels. In NC where Im at, there is a lab called "AnyLabTestNow." Ive used them once to check my iron levels, no prescription is needed, just cash and your ID. If it comes back positive, you can take the results to your doctor. They even can test you for the bacteria that causes ulcers.

But for sleep apnea? There are no OTC home sleep tests available here in the USA you can buy at your local drugstore. Resmed has not made apnea link OTC, you need an rx for it. I dont understand that. Seems like for $100, some company could come up with a reliable OTC sleep apnea home test you could do yourself, then download an SD card to your laptop or even your smartphone. And take the results to your doctor if you test positive for apnea.

Its a no brainer and its needed, now. Today. I should not have to get a prescription to get home diagnosed for obstructive sleep apnea, sorry I dont think I should have to go to a doctor to get a diagnosis. To get prescribed a machine, mask and a titration study? Yeah...for that I think you should need a prescription.

But seriously, what a better way to break the health insurance industry and to milk them dry than for some enterprising company to get a home sleep apnea test FDA approved, thats OTC and you could buy it at Walgreens. Maybe keep it behind the counter, but keep it OTC.

That would take the diagnostic part of it out of the hands of the insurance industry and the doctors and put it in YOUR HANDS. And it would snowball by itself. If you test positive, you gotta be treated or at least they gotta TRY to treat you. Even if you have to pay for the treatment yourself out of pocket, they gotta make that option available to you.

I cant think of a better way to drive a weed up the powers that be that are controlling who gets sleep apnea treatment or not than to get FDA approved, OTC home sleep apnea tests mass marketed. Like blood pressure cuff machines or diabetes test kits are OTC.
Id be dead by now if I didn't use my CPAP gear every night.

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

Post by Thatgirl » Sat Feb 13, 2016 12:17 am

You can buy a recording pulse oximeter and get a pretty good idea of what's going on with your oxygen at night. You could also set up a camera and video yourself sleeping and literally watch the apneic episodes. It's not difficult. But no doctor will prescribe insulin because you bought an A1c test at Walmart and no doctor will prescribe Metoprolol because you took your blood pressure at CVS, so I doubt you're going to have much luck getting a script to start CPAP treatment with either of these methods. And you can't get lab work over the counter in many states.

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49er
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Re: The best way to drive a weed up insurance's ass with CPAP

Post by 49er » Sat Feb 13, 2016 2:44 am

Thatgirl wrote:You can buy a recording pulse oximeter and get a pretty good idea of what's going on with your oxygen at night. You could also set up a camera and video yourself sleeping and literally watch the apneic episodes. It's not difficult. But no doctor will prescribe insulin because you bought an A1c test at Walmart and no doctor will prescribe Metoprolol because you took your blood pressure at CVS, so I doubt you're going to have much luck getting a script to start CPAP treatment with either of these methods. And you can't get lab work over the counter in many states.
For some reason I had the impression that getting lab work over the counter was quite accessible in many states. I know where I live, I can pretty much order what I want.

But your point is very well taken about what the doctor will do with it as he/she is not going to prescribe something just from the results of do it yourself tests. For example, when I told my former PCP that eating hostess cupcakes spiked my Blood sugar to near diabetic levels, she ordered an A1C test and nothing else.

Still, doing this was very beneficial as it made me realize I had a big time problem with metabolic issues no matter what the doctor said. And even though my A1C ventured into the lower end of the pre-diabetic range, apparently, that isn't alarming to doctors. But it was to me since it was going in the wrong direction.

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

Post by Thatgirl » Sat Feb 13, 2016 7:17 am

Maybe it's just a NY thing, but no diy labs allowed in this nanny state.

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

Post by Sonnyboy » Sat Feb 13, 2016 7:31 am

I believe the best way to do this is to be self insured which most of us can not afford.

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

Post by LSAT » Sat Feb 13, 2016 8:53 am


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

Post by ChicagoGranny » Sat Feb 13, 2016 9:06 am

LSAT wrote:This is his "post of the day"...He comes up with a new one every day...he must dream this stuff up.
Teehee. He is bored and doesn't have a Valentine.

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

Post by Cardsfan » Sat Feb 13, 2016 9:59 am

This reminds me of the "Seinfeld" episode with Elaine. The one where her Dr. wrote in her chart she was a difficult patient.

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49er
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Re: The best way to drive a weed up insurance's ass with CPAP

Post by 49er » Sat Feb 13, 2016 10:29 am

Cardsfan wrote:This reminds me of the "Seinfeld" episode with Elaine. The one where her Dr. wrote in her chart she was a difficult patient.
Sadly, I don't think you have to be like Mr. Grumpy to get that designation. Anybody who dares to question any part of the status quo even if they are being polite is a candidate.

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

Post by Janknitz » Sat Feb 13, 2016 10:56 am

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. . .
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flightco
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Re: The best way to drive a weed up insurance's ass with CPAP

Post by flightco » Sat Feb 13, 2016 11:11 am

MrGrumpy wrote:Ive been thinking of this for a while. I work in the legal profession and I can be pretty good at manipulation, persuading, conning people...as well as just using logical persuasion.

Here it is. A lot of people sound unhappy with the way us sleep apnea patients get treated. Why is that? One of the main reasons, IMO, is we patients are not in control. And why is that? Because we cant test ourselves, for free or minimal cost with OTC tests.

Think about it. High blood pressure? You can test yourself with free high blood pressure machines at nearly every drugstore, Wal-Mart and many grocery stores. You can also buy your own blood pressure cuff OTC, no prescription needed and test yourself and go to your physician with the results.

Diabetes...there are OTC tests at your local drugstore that give you your blood sugar results and indicate whether or not you tilt type II diabetic. Again, you need no prescription and can take the results to your doctor if you test positive.

You suspect a family member, a son or daughter or your wife or husband are abusing drugs or alcohol. There are OTC drug and alcohol tests you can buy at your local drugstore to secretly test for drugz and booze in your household or your teens bedroom.

There are even labs where you can walk in off the street and pay out of pocket for routine blood work, check your iron levels, check yourself for anemia, check your thyroid, check your testosterone levels. In NC where Im at, there is a lab called "AnyLabTestNow." Ive used them once to check my iron levels, no prescription is needed, just cash and your ID. If it comes back positive, you can take the results to your doctor. They even can test you for the bacteria that causes ulcers.

But for sleep apnea? There are no OTC home sleep tests available here in the USA you can buy at your local drugstore. Resmed has not made apnea link OTC, you need an rx for it. I dont understand that. Seems like for $100, some company could come up with a reliable OTC sleep apnea home test you could do yourself, then download an SD card to your laptop or even your smartphone. And take the results to your doctor if you test positive for apnea.

Its a no brainer and its needed, now. Today. I should not have to get a prescription to get home diagnosed for obstructive sleep apnea, sorry I dont think I should have to go to a doctor to get a diagnosis. To get prescribed a machine, mask and a titration study? Yeah...for that I think you should need a prescription.

But seriously, what a better way to break the health insurance industry and to milk them dry than for some enterprising company to get a home sleep apnea test FDA approved, thats OTC and you could buy it at Walgreens. Maybe keep it behind the counter, but keep it OTC.

That would take the diagnostic part of it out of the hands of the insurance industry and the doctors and put it in YOUR HANDS. And it would snowball by itself. If you test positive, you gotta be treated or at least they gotta TRY to treat you. Even if you have to pay for the treatment yourself out of pocket, they gotta make that option available to you.

I cant think of a better way to drive a weed up the powers that be that are controlling who gets sleep apnea treatment or not than to get FDA approved, OTC home sleep apnea tests mass marketed. Like blood pressure cuff machines or diabetes test kits are OTC.
You are nucking futs

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

Post by Stormynights » Sat Feb 13, 2016 11:24 am

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?

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

Post by ChicagoGranny » Sat Feb 13, 2016 11:31 am

Stormynights wrote: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?
Insurance companies require a prescription and proof of compliance to help avoid rampant fraud by us consumers.

Government requires a prescription for a machine because that is what governments do.

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

Post by chunkyfrog » Sat Feb 13, 2016 12:28 pm

MrGrumpy wrote: . . . I can be pretty good at manipulating, . . . conning people...
This says it all.

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

Post by Goofproof » Sat Feb 13, 2016 1:26 pm

Stormynights wrote: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
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