Choosing a mask

[Scois67]

Thanks everyone for all the pointers. I have decided to buy the unit outright and use Kaiser/Apria for supplies. We shall see how that all works. I am hoping to secure the Resmed ASV unit in a couple of days from a local source.

[Janknitz]

I think you made a good decision and I agree that you should get copies of everything now so that when/if you leave Kaiser you don't have to do this runaround all over again.

It may be moot for you now, but given what the EOC says, I think they were all WRONG about the 13 month capped rental period, and good thing you bailed because it would be a nasty surprise after month 13, at which point they would all send you to the EOC and tell you "it says there in black and white that you will not acquire ownership of rented DME items no matter how many copayments you make for the item while a member of our plan'". And from what I am given to understand, they don't stop collecting co-payments after the 13th one.

You might be interested in this: https://www.aha.org/fact-sheets/2023-02 ... 20patients. Medicare providers are REQUIRED to provide transparency in costs of DME as well as other goods and services. Furthermore, when I got my first CPAP machine on a Kaiser PPO (not Medicare) plan, it was the DME department at KAISER, not Crapria who was able to tell me the amount of the co-payment. The co-payment is NOT set by the DME, it's set by the insurer, so sending you to Crapria to find out your share was a red herring. Kaiser should have been able to tell you with no uncertainty. Sounds like each department has no clue what another one is doing.

Yet another reason Kaiser will cease to be my provider in 1 year and two weeks. I'm literally counting the seconds. And boy I could tell you stories about how they treat the seniors that are my clients!!!!

[Scois67]

I purchased the AirCurve 10 ASV and everything went very smoothly. The unit was in stock. The seller setup the unit, showed me how to operate it, answered my questions and did a mask check. I used it last night with a P10 Mask and everything went pretty well. The new unit was agreeably priced. This is my first purchase of a CPAP and I am so glad I purchased from a local supplier.

[Steerpike58]

I wanted to share my experiences with dealing obtaining an ASV CPAP machine under the Kaiser Medicare Advantage Program utilizing the Kaiser Martinez California sleep lab and Walnut Creek physician. As a new sleep Apnea patient I found the experience overwhelming and i am trying to still comes to grips with it. Thanks for the contributors to this thread, they really helped.

Wow, thanks for posting this - sounds like you and I are on a near-identical trajectory in the exact same location! I have a Walnut Creek physician and I'm using the Martinez sleep lab, and I've just switched over to Kaiser MA plan as of yesterday!

Aside from the issues with Apria customer service and billing practices the lack of transparency in the whole process was difficult to come to grips with. Being told your machine has been ordered and you have no one explaining the rules and costs associated with the arrangement was difficult to deal with if you are the kind of person that likes to nail down specifics with some degree of certainty and accuracy. The perpetual rental arrangement is particularly difficult to swallow, especially as I plan to move to an area that is not served by Kaiser within the forseable future.

All of the Kaiser people i dealt with were super nice and tried to be helpful within the limits of the constraints they were working under. They have heard all the complaints about Apria and their program and seem to be sympathetic to the patient. They know what a mess it can be.

I had three in facility sleep tests. Two in Martinez, one with an independent contractor facility Kaiser uses. The end result was that the physician recommended an ASV machine. He told me he ordered it and almost exited our discussion before talking costs. He explained the perpetual arrangement of payments over thirteen months. He did not know the monthly costs of the machine noting the variation in types of plans.

"the physician" - to clarify, I presume this was a sleep-center physician and not your Primary Care Physician (PCP)? After my first study I received a call from a very helpful sleep-center physician who went over a good number of details, but - she called me when I was driving, and had no way to allow me to call her back, so I had to pull over and make the most of the call at a rather inopportune time (I guess I could have asked her to call me back, but I've had terrible results doing such things so decided to make the most of the call). She ended the call with 'do you have any questions?' and I didn't (I was overwhelmed by the details) but not 10 minutes later I remembered some important questions but ... too late. I tried to message her through Kaiser's messaging system but she was not a doctor on my list of contacts, and customer service confirmed that she could not be added - so I was effectively cut off from her, which really sucked.
"He explained the perpetual arrangement of payments over thirteen months" - 'how' did he explain this? 'perpetual' and 'over 13 months' are mutually exclusive concepts. I'm curious to understand how they convey this, since 13 months is not perpetual!

Next morning i called the Martinez sleep study facility and asked for costs. They declined to give any costs and referred me to customer service. I also requested a copy of the prescription for which i was told to contact the physician.

Following on from my comment above, how did you reach your physician? or was this your PCP?

I was told the equipment was being sent to my home and would arrive in four to six weeks. An appointment was set up for 30 days latter to go over the gear. Before exiting the conversation i asked what had been ordered on my behalf from Apria. I was told by the sleep center the following equipment had been ordered: ResMed Air Curve 10 ASV with Humid Air, ResMed Airfit P10 pillow, tubing and filter.

I called Kaiser customer service and they used their line to call Apria to obtain costs. We were connected in 15 seconds. Apria could not give any costs as they had not received the prescription yet from the physician. The Apria representive estimated an inaccurate amount of $300/month for the CPAP. She also explained the shipment process. Three calls are supposed to be made to the patient to obtain approval from the patient for shipment. Fees are discussed at that time. She was ambiguous as to whether a written confirmation of fees is sent to the patient. If the patient does not respond to any of the calls the order is placed in a suspended status.

I then contacted the physician for a prescription. The next morning I received an emailed pdf prescription with a hard copy coming in the mail. The prescription was well prepared and provided options for me to select my own mask and obtain an Equivalent Responics ASV unit.

Two hours latter the local Apria office representative contacted me on my cell phone and said he wanted to discuss the machine with me. I wasn't clear if the machine was available now or not. I told him to cancel the order. Feeling that I had not gathered all the information I needed I stopped by the Apria office and interacted with the Apria representative via the receptionist.

This sounds like vital info - where is this Apria office?! First time I contacted Apria, I was on hold for over 2 hours. Second time I tried, I was on hold for 3 hours and then got disconnected! Visiting an office sounds like a plan!

I learned that he had called to seek approval for a $134.50 "setup fee" I had never heard of that. The monthly invoice for thirteen months useage of the AirCurve 10 ASV with humid air was $80 per month under the Kaiser Medicare Advantage program. No additional costs were asked about.

I had decided to purchase the ResMed AirCurve 10 ASV outright. I may have underestimated the costs of buying the ASV unit as it is proving difficult to source a reduced price on the unit. It does not seem to receive that same price considerations in the open market that the Airseries 11 and 10 receive.

In later posts, you mention that you bought a machine from a local supplier and you were happy with the process. Could you share with me the vendor and pricing, perhaps, as I may go that route.

Thanks again for posting such relevant information!

[Steerpike58]

EDIT TO ADD: - update - I just spent 90 minutes on hold with Kaiser DME department to ask about the 'perpetual rental' details (I first called Kaiser's insurance people, they put me on to the DME dept). The lady I spoke to insisted that CPAPs are 'purchase' items, so you just pay the 20% copay and the machine is yours! She put me on hold and said she checked directly with Apria, and the Apria person confirmed, CPAPs are 'purchase items', not subject to rental. Totally contradicts what I'm reading here in the forums! I believe the forums, but I couldn't respond with anything concrete so had to leave it at that. I also asked if my Dr could specify the exact machine, she said no - you will be issued with whatever Apria has on hand at the time (which is typically Resmed Airsense 10 Autoset, but may be the '11' model). Doctor cannot specify make/model.

DME's lie like snakes. NEVER EVER EVER take their word for anything without checking. The "lady" may have been talking about NON-Advantage plans that have actual coverage for DME, not a Covered California plan and certainly not an Advantage plan (unless you also have some Employer Group Health Coverage Plans).

The Evidence of Coverage is the actual contract between you and your insurer, even though you never saw it or knew it existed. This is the RULE for how your insurance plan covers you, if it's in the book it must be followed, if it's not in the book it's not true.

Here's the Evidence of Coverage for Kaiser Senior Advantage in the Northern California Region for 2023 (2024 isn't up yet and may not be until January) :
https://healthy.kaiserpermanente.org/co ... e-ncal.pdf
Page 45 covers Durable Medical Equipment:

In Original Medicare, people who rent certain types of DME own the equipment after paying copayments for the item for 13 months. As a member of our plan, however, you will not acquire ownership of rented DME items no matter how many copayments you make for the item while a member of our plan, even if you made up to 12 consecutive payments for the DME item under Original Medicare before you joined our plan.

...

Hi Janknitz - resurrecting this discussion, as I finally got my 2nd sleep study done and spoke to the Doctor today. He's prescribed me an ASV through Apria, and told me to expect their call. So my fun with Apria begins!

I downloaded and read the Evidence of Coverage document you referred to above, and I spoke with Kaiser today about the insurance / payment situation. The woman I spoke to today confirmed what is said in the EOC - that you never own the device. But - she said you don't make payments in perpetuity. Reading the EOC, I don't actually see anything that suggests you have to keep making payments. The fact that you don't acquire ownership of the device doesn't definitively mean you keep paying for it, it just means it's never yours and you will have to return it if you leave the plan. I'll be calling Apria tomorrow to see if I can get more info.

[babydinosnoreless]

I was totally ready to bail on Kaiser because I just don't like their medical offices, their in-house pharmacy, and their in-house labs. So I was all set to go United Healthcare insurance+John Muir Health as the HMO. But then this 'sleep' issue arose, and now I'm deep in the middle of an ongoing 'trial' situation - already had the at-home sleep study, the take-home machine trial, and now I've just had the overnight in-lab study (part 1) and I'm waiting for part 2. So - if I bail on Kaiser now, I'm going to have to start the whole process from scratch with a new medical system. This (sleep issues) is pretty much my only medical condition.

So I'm reluctantly considering sticking with Kaiser and switching to Kaiser Advantage come Nov 1, and then seeing where I am in the 'sleep trial' come mid-December, which will be my next 'bail' point.

I'm in Arizona so know nothing about Kaiser but I can tell you United Health is terrible. Co-pay are super high, cheeper to buy supplies off of amazon. They were impossible to get ahold of and when I was able to get a human it, they were out of a foreign call center and were impossible to understand they were so heavily accented. I would not recommend them to anyone.

[Janknitz]

Hi Janknitz - resurrecting this discussion, as I finally got my 2nd sleep study done and spoke to the Doctor today. He's prescribed me an ASV through Apria, and told me to expect their call. So my fun with Apria begins!

I downloaded and read the Evidence of Coverage document you referred to above, and I spoke with Kaiser today about the insurance / payment situation. The woman I spoke to today confirmed what is said in the EOC - that you never own the device. But - she said you don't make payments in perpetuity. Reading the EOC, I don't actually see anything that suggests you have to keep making payments. The fact that you don't acquire ownership of the device doesn't definitively mean you keep paying for it, it just means it's never yours and you will have to return it if you leave the plan. I'll be calling Apria tomorrow to see if I can get more info.

Keep us posted. And don't believe anything Crapria tells you.

[zonker]

Hi Janknitz - resurrecting this discussion,

thank you very much for resurrecting the discussion rather than starting a new one.

too many folks will have the same discussion going on in multiple threads. makes it kinda hard to keep up with them!

[Steerpike58]

Hi Janknitz - resurrecting this discussion, as I finally got my 2nd sleep study done and spoke to the Doctor today. He's prescribed me an ASV through Apria, and told me to expect their call. So my fun with Apria begins!

I downloaded and read the Evidence of Coverage document you referred to above, and I spoke with Kaiser today about the insurance / payment situation. The woman I spoke to today confirmed what is said in the EOC - that you never own the device. But - she said you don't make payments in perpetuity. Reading the EOC, I don't actually see anything that suggests you have to keep making payments. The fact that you don't acquire ownership of the device doesn't definitively mean you keep paying for it, it just means it's never yours and you will have to return it if you leave the plan. I'll be calling Apria tomorrow to see if I can get more info.

Keep us posted. And don't believe anything Crapria tells you.

I've had several calls, and several hours of listening to on-hold muzak, with Kaiser and Apria. I have had such amazingly contradictory information it's quite funny. Since I'm really in no hurry to get the machine (after a lifetime of poor sleep, what's a few more days ...) I'm just going to keep plugging away and see what I can get in writing! I'm taking notes but I need to clean them up before posting them, plus I'm going to visit the Apria office tomorrow, so I may get something in writing at last.

[Janknitz]

I've had several calls, and several hours of listening to on-hold muzak, with Kaiser and Apria. I have had such amazingly contradictory information it's quite funny. Since I'm really in no hurry to get the machine (after a lifetime of poor sleep, what's a few more days ...) I'm just going to keep plugging away and see what I can get in writing! I'm taking notes but I need to clean them up before posting them, plus I'm going to visit the Apria office tomorrow, so I may get something in writing at last.

Ugh, been there, done that. That's one of the many reasons I'm so happy to be free of dealing with DME through both entities. And why I do not want to go back to it next year when I go on Medicare. Hope you can get some answers. Sometimes the people in the local Crapria office are better to deal with than the people on their call centers. But still take whatever is said with a grain of salt (confirming memos cc'd to both Kaiser and Crapria might help with any future disputes).

[Steerpike58]

I've had several calls, and several hours of listening to on-hold muzak, with Kaiser and Apria. I have had such amazingly contradictory information it's quite funny. Since I'm really in no hurry to get the machine (after a lifetime of poor sleep, what's a few more days ...) I'm just going to keep plugging away and see what I can get in writing! I'm taking notes but I need to clean them up before posting them, plus I'm going to visit the Apria office tomorrow, so I may get something in writing at last.

Ugh, been there, done that. That's one of the many reasons I'm so happy to be free of dealing with DME through both entities. And why I do not want to go back to it next year when I go on Medicare. Hope you can get some answers. Sometimes the people in the local Crapria office are better to deal with than the people on their call centers. But still take whatever is said with a grain of salt (confirming memos cc'd to both Kaiser and Crapria might help with any future disputes).

Sequence of events, so far ...

• Nov 25, 2023 - Sleep Study performed.
• Dec 13, 2023 - Sleep doctor called me to go over the results of the study, and said he was issuing a prescription for an ASV machine. I asked him if he would be naming the device on the Rx, he said "no, but they only work with Resmed devices so it will be a Resmed AirCurve 10 or 11". He told me to expect a call from Apria.
• Dec 14, 2023 - received a call from Apria, went to my voicemail. Asked me to call them to arrange for a machine. Called the number given (got through quickly - their 'sales' line is obviously better staffed than their billing questions line). They told me I will need to pay $101.93 when I pick up the machine. She couldn't tell me if this was a one-time or recurring payment, nor give me a breakdown of what that number represented - equipment, supplies, payment, rental, etc. She couldn't even tell me what machine I would be getting ... "whatever the warehouse has" was her explanation. She tried to reach someone internally who could answer my questions but no luck. She said she would call me back within 15 minutes - never heard back!
• Dec 15, 2023 - I called Kaiser's DME line. On hold for an hour. Asked for clarification of the '$101.93' I was being asked to pay. She didn't know but tried to find out. At one point, she told me, it was a recurring, perpetual payment as long as I have possession of the device. I said this didn't make sense (after 5 years I would have paid more than the cost of the machine). She said she'd research it and get back to me. Later that day she called me to say she's been told it was a one-time payment of $101.93 - no more payments required after this one! I said that sounded too good to be true. She said she'd research some more and get back to me - never heard back from her.
• Dec 15, 2023 - I emailed a manager at the local sleep lab, someone I was told was very knowledgeable about billing issues. She replied with "When it comes to “rental” machines, patients pay for 13 months and then the payments stops until the life of the machine. If the machine breaks within 2 years, then Apria will replace/repair free of charge. If it breaks after the 2 years, then you’ll need Kaiser to put in a new order and the 13 months payment will start over. " She got back to me later with "Apria said your monthly will be $69.03. This is for the machine only. supplies are extra.".
• Dec 15, 2023 - received a call from the local Apria office, saying they had a machine ready for pick-up - a Resmed AirCurve 10. I told them I'd be able to stop by Dec 20.
• Dec 20, 2023 - I visited the Apria office in Concord, CA to pick up the machine. The gentleman behind the desk was doing his best with an endless flow of customers (he looked overworked and underpaid, and I felt sorry for him). He gave me the machine, and had two documents for me to sign; one for the humidifier, one for the main ASV machine (Resmed AirCurve 10). The humidifier was a purchase, the AirCurve was a 'rental'. Both reflected a 20% copay of a bigger number (Humidifier - 'full price' = $164.48, 20% copay = $32.90; AirCurve - 'full price' (monthly) = $345.17, 20% copay = $69.03). So what is now clear is, I'm paying a recurring monthly of $69.03 for the device. One thing nailed down at last! The paperwork (7 pages) made no reference to any limit of payments (the elusive '13 months' one hears about). I asked for clarification, but there was no-one available to explain it to me, and this was way beyond the poor guy's comprehension. He promised to have someone in the office call me with more information.
• Dec 21, 2023 - Called Apria Concord office, as advised by front desk guy yesterday. 925-827-8800 - option 4. Was hoping to reach Danay (Branch coordinator) but after about 30 mins on hold, was forced to leave a voicemail and disconnect.
• Dec 21, 2023 - called Apria Billing number, printed on yesterday's bill - 800-327-4691. This number had a better queueing system - told me my wait time was only 9 minutes. Got through even quicker. Lady I spoke to confirmed that the $69.03 was for "bipap rental", and that those payments last for 13 months. But she could not provide me with any documentation that would confirm this. She tried to pass me on to 'Pat' for more info ... put back on hold ... then disconnected.
• Dec 21, 2023 - called the number on the KP website for Medicare members 1-800-443-0815 - got through immediately. Lady there was very sympathetic to my desire for confirmation of the 13 payments, and said she'd file a complaint with the Grievance and Operations Department. I will get a letter with a case manager and their phone number.

So I'm still looking for any official document that refers to '13 payments'!

[bwexler]

We are about to head to my "favorite DME, Crapria" to pick up my wife's first APAP and mask.
I have already determined it will be an Airsense 10 Auto with heated tube.
Crapria informed me they no longer allow patients to actually try on a mask before the select it. They measure your face for size, discuss some qualifying questions and provide you the mask of "their" choice.

I have 2 dozen different masks, so I know how important/difficult it is to get the "proper" mask.
I know my wife is NOT me and she is unlikely to like any of my masks.

Anyone have any experience with Crapria and mask fitting recently, that could shed any light on how they deal with "this mask doesn't work".

[Steerpike58]

We are about to head to my "favorite DME, Crapria" to pick up my wife's first APAP and mask.
I have already determined it will be an Airsense 10 Auto with heated tube.
Crapria informed me they no longer allow patients to actually try on a mask before the select it. They measure your face for size, discuss some qualifying questions and provide you the mask of "their" choice.

I have 2 dozen different masks, so I know how important/difficult it is to get the "proper" mask.
I know my wife is NOT me and she is unlikely to like any of my masks.

Anyone have any experience with Crapria and mask fitting recently, that could shed any light on how they deal with "this mask doesn't work".

In my case, all the mask selecting / experimenting was done with the Sleep Lab. Presumably, your wife must have gone through some kind of 'study' to determine she needed a CPAP? In my case, I had a crappy 'at home' initial test, followed by a 'test machine' from the lab to take home for a month, followed by an 'overnight' study. It was during these periods that I got about 5 masks to try; they just kept giving me new ones if I said things weren't perfect. So ... in your case, did your wife not go through any trial period at all with an actual machine? I wouldn't trust Crapria to select a number from 1 to 10. However, having said that - will they let you keep trying? What's their policy on exchanges - how many, how long, etc?

I just got done cataloging my mask collection, all from the past few months. I started with the F&P Vitera, which was not bad, but exhibited 'mask farts' when pressure was high, so tried a 'small' version, not much better; so they gave me the Resmed Airfit F20, which was pretty much the same. I then got a 'small' mask to try, instead of the 'medium'. Slight improvement. Then I went for my first overnight study and they gave me the F&P evora, which looked intriguing but I never got that far in the study - but they let me keep the mask anyway. Then I went for my second overnight study, and the tech gave me yet another one to try - the Resmed AirTouch F20, and that seems to be the best of all - has a 'memory foam' lining against the skin rather than the silicone lining (but I only used it once so early days ...).



So I'd hit up your sleep doctor / technician / lab rather than rely on Crapria!

One thing I picked up - they may try to say the mask 'is working' if they can read the data from actual usage and it shows no leaks. I told my sleep clinic that there may not be measurable leaks from the data they read, but there was enough of a leak to create the mask farts (trumpeting) and they agreed and gave me a different one.

[bwexler]

So I'd hit up your sleep doctor / technician / lab rather than rely on Crapria!

My wife had a home sleep test mailed to her.
We mailed it back.
A few days later we got the report, signed by a doctor we never met, in our email.
We got the insurance approval Tuesday and we will be going to Crapria Friday to pickup the Airsense 11 Auto, hose and mask.

The closest thing she has to a sleep doctor is me.
I am well aware of Crapria trustworthiness, especially when it comes to money and credit cards.

I was simply looking for a heads up on what to expect with regards to how Crapria will react when faced with This mask didn't work.

[bwexler]

Well, we are home from our visit to Crapria.
They were true to form. They brought us into their conference room offered us a seat and slid a nice Resmed travel case across the table and told us it is all programed and ready to go. I said I'll just open it up and take look.
Surprise, SURPRISE, it was an Airsense 10 autoset. I told Josh I had ordered an Airsense 11. He said the 10 is just as good. I said I am not accepting anything but the 11.
Josh had to go get approval from his boss and check inventory to be sure they had one. 5 minutes latter he comes back the AS11 all set up.
I can't imagen why they would want to provide me with a $319 AS 10, instead of an $800 AS11, since the get the same reimbursement from my Advantage plan either way.
Then we got to the mask. I think he had selected an N10 which is probably a great mask.
My wife is a very active sleeper. I think she will do better with a mask with a top of head hose connection like an N30i or a P30i. We wound up with the N30i.
I asked if there was a nasal mask that did not actually touch the nostrils and had a top hose connection. He said NO.
We asked Josh what if the N30i doesn't work? We have thirty days to get ONE replacement Mask.
When we got home, I pulled out my Dream Wisp and a brand new sealed backup Dream Wisp.