Cigna starting patients on CPAP by just sending box

[GrizzlyBear]

Oh, rats, the Mexican place was closed. I was really looking forward to some flautas. Ah, well, Indian instead - yummo!!!!! The weather forecast is for strong winds in Melbourne tonight!!!!!!!!

It's nights like this that I'm REALLY glad I'm on cpap, and wear a mask!!!!!!!!!!!!!!!

Regards,

Windy old GrizzlyBear

[roster]

..........
My own feeling is that at least SOME governmental or 'social' involvement is necessary to protect the rights of those involved with the system, ...

GrizzlyBear

Mexican, Indian, I haven't had breakfast yet and you are making me very hungry.

What are these "rights" you speak about?

[CalicoskiesNC]

I began CPAP 2yrs ago with Apria. I went to their office, they showed me how to turn on the machine, put on the mask, change the filter. About 15min later I was on my way home with everything in a carrycase. I got home, read the manual, plugged it in and basically learned everything on my own. In that 2yrs, Apria never EVER once called me, contacted me via mail or email or smoke signals to inquire how I was doing, IF I was doing. My dr did call me after 6mo to see how therapy was going and if I needed to see her. Everything was going well, but my point is...I taught myself. I researched online, read forums.

So, IMO the dme is a very INessential step.

[rwalther]

I have a "sort of" answer.

I talked my family doctor into writing me a generic "Auto-CPAP Machine" presecription based upon info from myself and wife about snoring, sleep issues, etc.

I used that to buy my stuff on CPAP.com.

Then I simply sent the CPAP.com invoice and copy of the prescription in with a claim form, and CIGNA reimbursed 80%.

It was very easy ... a very positive insurance experience, without all the annoyance of any other activity.

Rusty

[oceanpearl]

I don't know.

After some of the bad stories I've heard about the DME Apria (the cpap DME who refused to just send cpaps to cigna's customers) I think I'd rather have someone just send me a machine as long it was the one I wanted.

Come to think of it that is what I did do!

The best situation would be for the local DMEs to charge fair prices and give good service. Even when it is "THE INSURANCE" paying, it still all gets rolled into the high premiums you pay.

How would you determine the "fair price"??

It's sort of like the cigar manufacturing business. It cost us 26.5 cents to manufacture a cigar that retailed for 8.50 It wasa hard to keep our heads above water. There is a helluva lot that goes into a product, othere than material and labor cost.

How many machines a year do you have to sell in order to make the pay and benefits of a tech. How much rent, utilities, equiptment, insurance, advertising, training. etc, etc, etc

[Pilot_Ron]

You Guys are making me nervous, I have CIGNA,,,However, because I found CPAPTALK.Com before my titration test, I think I made some very important decisions prior to even beginning the ball rolling. First, I purchased my original machine out of pocket, and got yelled at by many users for having a non-data machine (I didn't have a prescription yet) When going in to the doctors office for my follow up with the doctor regarding my titration, I had a list of things that I was not going to "settle" on. These included make and model of the machine, humidifier, and mask.


APRIA will give you bare bones if they are not told exactly what you/doctor want. I spent an extra 10 minutes with the nurse at the doctors office going over the details of what I wanted to ensure that I got what I wanted. She wrote every detail down on the prescription.



My docotrs appointment was on Thursday, and I got a call from APRIA on Friday saying someone will call me within 48 hours to schedule an appointment with me to set up my machine, and that my order had been processed.



The doctor told me to call him if I didn't get my equipment within a week.


I have a follow up visit with him in 30 days to make sure I am getting positive results from my machine.


So for future xPAP users with CIGNA, this may be the way to go. Although I don't have my equipment yet, and have not done the celebratory happy dance yet.

[GrizzlyBear]

Hiya, Rooster.

What are these "rights" you speak about?

They are the rights to get a good service for the amount paid, the right not to get ripped off in the delivery of an essential medical service, the right to get a professional service from a person who claims to be a professional service provider, the right to get the insurance delivery you have been paying for, the right not to get grossly overcharged for materials and equipment essential to your health and well-being (while, in our society, still ensuring a reasonable profit for the service deliverer), etc., etc., etc.

There appears to be no independent authority out there adequately protecting any of these rights. However, if you don't accept that any of these are rights, that in our society it is always a case of caveat emptor (buyer beware), or if you are not prepared to fight for your rights, then I guess we get the system we deserve - which seems to be the system so many people on this forum complain of.

My predictions regarding Melbourne's weather report (at least that part of Melbourne in which I reside) were true. It's just as well the Aussie Open was played under cover last night!!!!!

REgards,

GrizzlyBear

[roster]

........

There appears to be no independent authority out there adequately protecting any of these rights. .........

I can't say for Australia, but the U.S. has plenty of laws that protect from things like failing to deliver what was contracted (even verbal contracts are legal), false advertising, misrepresentation, etc. There is also a huge supply of hungry lawyers wanting to help you sue companies.

"Independent authority" sounds like what we call the "nanny state". In case you don't use that term, nanny state is a government that helps you do the things that you should do on your own. Once you give up your responsibility to take care of yourself to a nanny state, you soon find the nanny state is also taking away your basic freedoms.

What to do? Stand up for yourself. Insist on getting what you contract for. Take your business elsewhere. In dire cases, sue as a last resort.

BTW, cpap therapy is in its 26th year and in my opinion is still in a very primitive stage. The pace of change will begin to speed up as a greater percentage of the population is diagnosed and more money is thrown at the problem. I would be willing to bet that a good radically new non-cpap treatment is developed in the next 20 years.

Best regards.

[Panhandler]

BTW, cpap therapy is in its 26th year and in my opinion is still in a very primitive stage. The pace of change will begin to speed up as a greater percentage of the population is diagnosed and more money is thrown at the problem. I would be willing to bet that a good radically new non-cpap treatment is developed in the next 20 years.

I think you've got that right, Rooster. We'll be seeing a lot of changes as knowledge of OSA matures. And we've got a front-row seat!

[roster]

.......
I think you've got that right, Rooster. We'll be seeing a lot of changes as knowledge of OSA matures. And we've got a front-row seat!

I just hope I don't sleep right through the movie like many movies before.

[GrizzlyBear]

Hiya.

'Nanny state'? That's a term used in my country by those who want to tie us to legal and business systems that constantly do down the little guy.

Yeah, we can sue - but who can afford to do that? I don't know what your financial situation is, but I can't afford to hire lawyers. In this country, even when you win, you lose most of the winnings to lawyers.

That's the purpose of what you call a 'nanny state' independent authority - it helps out the small guy against businesses who can afford the top lawyers, who can afford endless appeals to wear us individuals down, who can afford to sue us for libel and slander in cases that we MIGHT win, but which destroy our health and finances in the meantime. This isn't about 'nannyism', it's about sensible self-protection - nonsense labels only serve to misdirect attention.

Meantime, we have to put up with the crap. We complain, we take our business elsewhere (but find so many other companies the same), we get ripped off time and time again - and these sleep 'industry' bods laugh all the way to the bank.

And 25 years to develop a proper cpap system - or an alternative to cpap? That's supposed to be good?

While businesses make so much out of the system as it exists, it is not in their interests to research much more than slight variations on what we have. If we leave it to them, it will take some poor underfunded independent person decades to achieve what well-funded government-based or adequate independently-funded research could achieve in much less time. And even with cpap, I doubt I'll live to see much of that.

This whole sleep industry stinks - and while we accept it as it stands it won't change. So rest well in your comfort of knowing you're keeping out the 'nanny state' - and get used to an inadequately operating system.

Regards,

GrizzlyBear

[Jmark]

Grizzly,

This is an interesting discussion. From my perspective, it is too bad that some in Oz want to "Americanize" your medical system. There are a variety of views, each having validity, and I may have some views that differ from those of some others on this board.

As you may know, the U.S. and South Africa are the only two industrialized nations in the world that lack universal health care coverage. I believe that the U.S. has an enormously inefficient medical provider system causing:

1. By far the most spending on health care per capita in the world, but without commensurate results.

2. Increasing infant mortality rates -- we now have worse infant mortality than some third world countries.

3. Shorter life spans -- this too has been declining over the years, despite the highest spending.

4. For those who have medical insurance (fortunately, well more than half of us do), there are long lists of excluded conditions and treatments, deductibles and co-pays, and not infrequent hassling with insurance companies over denied claims, including some of the practice you've read about here. Health insurance premiums are very high. For employers who subsidize the premiums (most larger and some smaller employers), the high cost of medical insurance creates an economic burden and reduced competitiveness compared to businesses in countries that have a lesser burden.

5. A large minority of insured and uninsured people suffer and actually die due to the inability to get necessary health care, including "covered" but expensive treatment that gets denied or delayed. Again, you have no doubt read about some of that here on the board with regard to sleep disorders. The same problems exist for cardiac care, cancer treatment, etc. The more the insurer is asked to spend, the more the insurer is motivated to deny the claim even when care is needed. That may be good business, but is also bad public policy.

6. Overburdened emergency rooms, because the uninsured go there for critical treatment -- at enormous cost that is passed on to others. And, they get inadequate treatment, as only the most critical matters are attended to.

7. Physicians have to make economic choices as to the use of their time based on what insurance companies are willing to pay them, rather than providing what may be the most appropriate and cost-effective care for the patient.

8. Inefficiencies due to the bureaucracies and different requirements of the various health insurance companies. This has caused an enormous increase in back-office personnel requirements for medical providers, increasing the cost and diverting funds from health care to bureaucracy. Physicians too spend an inordinate amount of time trying to learn and comply with differing medical insurance company requirements. A large portion of health care dollars are diverted to pay the bureaucracies in medical provider offices and insurance companies, rather than being used for the care itself.

9. Patients go bankrupt, and/or join the welfare rolls, due to high medical bills which they must pay themselves when they lack insurance or if coverage is denied or insufficient.

10. Medical insurance companies have experienced record profits. To ensure continued profits, employees of those companies often receive promotions and bonuses for successfully denying coverage. Denied coverage means that the companies do not pay for needed care, thereby shifting the cost to others (patients, providers, government), or, more often, causing needs to simply be unmet.

11. People with untreated medical conditions further hurt the economy due to their own reduced ability to be productive.

Others may have different views. But, my sense is that you in Oz should do what you can to keep your system intact. No system is perfect, but I suspect you do not want to emulate ours, which has great problems due to its enormous inefficiencies. In my view, universal coverage is cheaper, provides better coverage and health care, spreads the risk better, allows for more efficient delivery of services, and is better for the economy. Again, others will have different views.

Mark

[just one voice]

Well as both a CPAP User and a Therapist, I don't think anyone should be without a Therapist when it comes to this issue. However, with that said, what many people don't realize is that it is the insurance companies who create this problem. Here is the issue. 1 Insurance company X is going to pay a set amount of money for a CPAP. For arguments sake we will say it is $200. Now this is the base model of a machine, no bells no whistles, just the basic model. Let's say the machine costs the provider $150, now we are at $25, each patient takes about 1 hour to really familiarize properly in my estimation. Now most therapists make aroung $17-18 per hour, so now we are at $8 profit, but we still have follow up time in there that will take an additional hour, with correct follow ups in my opinion. so now we are at -$12, plus any fuel costs. So there is the delemma. The insurance companies simply don't pay enough to support the follow up and professional help that most CPAP patients need. Now these are just numbers but I promise you that this is not far off, and all too often the case.
It isn't that companies don't care about the patients, it is that they simply can't afford to provide the services. Sad to say, but too true. Insurance companies need to be realisitic too in what they are willing to pay. So now most patients are really stuck with the companies who are merely trying to survive. That is why the service seems so lax. We need to get rid of competitive bidding, and insurance companies need to pay good honest money for reasonable services instead of figuring out ways to save a buck at the patients expense.

[mcdover]

Well as both a CPAP User and a Therapist, I don't think anyone should be without a Therapist when it comes to this issue. However, with that said, what many people don't realize is that it is the insurance companies who create this problem. Here is the issue. 1 Insurance company X is going to pay a set amount of money for a CPAP. For arguments sake we will say it is $200. Now this is the base model of a machine, no bells no whistles, just the basic model. Let's say the machine costs the provider $150, now we are at $25, each patient takes about 1 hour to really familiarize properly in my estimation. Now most therapists make aroung $17-18 per hour, so now we are at $8 profit, but we still have follow up time in there that will take an additional hour, with correct follow ups in my opinion. so now we are at -$12, plus any fuel costs. So there is the delemma. The insurance companies simply don't pay enough to support the follow up and professional help that most CPAP patients need. Now these are just numbers but I promise you that this is not far off, and all too often the case.
It isn't that companies don't care about the patients, it is that they simply can't afford to provide the services. Sad to say, but too true. Insurance companies need to be realisitic too in what they are willing to pay. So now most patients are really stuck with the companies who are merely trying to survive. That is why the service seems so lax. We need to get rid of competitive bidding, and insurance companies need to pay good honest money for reasonable services instead of figuring out ways to save a buck at the patients expense.

Much truth in this post! Only thing I would add is that there are a LOT more expenses than cost of goods sold and the labor for the set-up and follow-up. To be a Medicare provider, you must be accredited. Care to guess what the cost of accreditation is? Then you have the state certification, electricity, all kinds of insurance, rent, marketing, etc... Everybody wants the best machines and a professional to be at the ready if they have a question, but nobody wants to address the 800lb gorilla in the room. Who is going to pay for all this? Want to know how online companies can operate with much lower prices than a brick and morter DME? They don't file insurance. They don't have to hire support personnel to file insurance and appeal denials. They don't have to repeatedly beg doctors for documentation, reports, and signatures on forms in order to get an insurance claim paid. They don't have to buy, insure, and maintain delivery vehicles. They are not at the mercy of insurance companies in regard to their pricing. If Respironics increases the price of thier mask by 10%, they can do the same. A DME cannot. A DME's prices are set by insurance.

[TalonNYC]

Yes, this happened to me. I have Cigna and they told me that Apria is the sole DME.

I was just told the exact same thing by Cigna today. They said I could buy anywhere and get reimbursed at the "out of network" rate by paying up front and submitting a form, but that only Apria could provide "in network" services for CPAP in my area (NYC).