Suggestions for dealing with Kaiser and Apria?

n5xmt · Post by **n5xmt** » Mon Mar 10, 2008 5:25 pm

Has anyone had to deal with Apria thru Kaiser for their CPAP?
I am wanting the M-series pro with C-flex, or the M-series Pro auto with A-Flex...
I have been bounced between apria and the Kaiser DME office probably 10 times today, with Kaiser telling me that they have no control over what I get, and I need to work a deal with apria to upgrade from the standard M-series plus with cflex that they supply and the M-series Pro (Either C-flex or Auto) and pay the difference at my expense...
Apria is telling me that they only carry the plus, so I asked the customer service goober if they could special order it for me... he said "No, we will only supply what we have in stock, and we do not do special orders"
is there a national number for Apria I could call that would have some say over the local office, or is there any number at Kaiser besides the DME?
Thanks

GumbyCT · Post by **GumbyCT** » Mon Mar 10, 2008 5:45 pm

Start your logbook.

djtowle · Post by **djtowle** » Mon Mar 10, 2008 5:54 pm

Hi,

Yes I have Kaiser and Apria.

They gave me an m-Series auto with C-flex for the first week for titration purposes. 'My' machine was a m-series plus, no data, no auto. While I did very well the 1st week on the auto, lost 5 lb....., blood pressure dropped on the plus I was doing poorly, bad nights sleep, tired all day, etc. I called the Kaiser 'sleep lab' right away, week or so and complained. They said give it at least a couple of months. SO.. some months later I called again described problems, tired all day, heavy legs, blood pressure up, not sleeping well, headaches, etc. They said come in next week we'll give you an auto machine next week to try for two weeks and see if you feel better, so right now I am trying an m-star auto with A-flex courtesy of the Kaiser sleep lab. When I picked it up she said when you bring it back we'll look at the data and see if you 'qualify' for an auto. Leads me to believe Apria does have them.

Now since round one with the Apria auto machine and round two with the Kaiser machine I no longer have DME coverage so I will be buying one myself here and don't expect any problems in two weeks with getting a prescription from kaiser to get my own machine. Fingers crossed.

The Auto with A-flex is by far the best of the 3. A-flex is way better then the C-flex, and the auto compared to straight c-pap is way more effective for me, and no bloating from swallowed air (even though this machine is saying my 90% is at 14-15 h2o as apposed to the 9 that Apria set me at). In 4 nights with this machine blood pressure is back down by 10-15 points, and lost 2-3 lb. of weight. Nice.

My suggestion(s) for you. Find the number of the Kaiser sleep lab. For me it was given in a folder (with a bunch of stuff) at the apnea orientation class. Every time I call there I get the same person. Talk to them about any problems you have and what you think might fix them. You may have to take the plus machine they provide at first and then go back when it doesn't work for you. Same with Apria, find out the name of the sleep tech that set you up with the machine, (I had the same one on both my visits) and stick to that person, if they aren't helpful ask for a new one.

Additionally you might try talking (Email) your primary doctor about your problems. Tell him you are getting the run around, you want an Auto A-flex because of.... and can he help you through the system, i.e. a prescription asking for that specific machine and who to talk to etc.

As far as I know Kaiser does not assign you a 'sleep doctor' so you will probably be justified in talking to your primary doc about these things, he may send you back to the sleep center, but if it comes from him with a name and a note, you may get some action.

Sorry you are having problems with the system, stick with it and I am sure you will get it worked through somehow.

I don't understand why Apria would only have 'what's in stock', and no auto m-series machines...

n5xmt · Post by **n5xmt** » Mon Mar 10, 2008 6:11 pm

Just emailed my Dr. and the Rcp. hopefully will get some response... I may go to the Apria facility tomorrow and see if face to face conversation may be more useful than phone tag. funny thing is, about 6 months ago, I interviewed with Apria for a Unix System Administrator position LOL

lawdognellie · Post by **lawdognellie** » Mon Mar 10, 2008 6:37 pm

Hi. I also have Kaiser/Apria. First, you need to look at your doc's Rx. Apria will not give you an auto machine unless your rx specifically requests it. Second, I know for a fact they will do special orders. I don't use any of the standard masks because I have a small nose and they special ordered the mask I use, once it was determined that Kaiser would pay for it. Each Apria usually has a special person that deals with Kaiser insurance patients. Try finding out who that is and dealing with them directly.

Also, when I had problems with Apria not wanting to call me back so I could get a new mask, I sent Kaiser Member Services an e-mail saying that Apria was not doing what they were supposed to. Kaiser called Apria and I immediately got a very helpful person calling me and "personally" making sure it was taken care of.

Where are you located?

Sarah

n5xmt · Post by **n5xmt** » Mon Mar 10, 2008 6:37 pm

n5xmt wrote:Just emailed my Dr. and the Rcp. hopefully will get some response... I may go to the Apria facility tomorrow and see if face to face conversation may be more useful than phone tag. funny thing is, about 6 months ago, I interviewed with Apria for a Unix System Administrator position LOL

Update,
FINALLY got the apria rep that is processing my order...
She says the prescription does NOT call out a specific machine, and that I can get the pro-auto (They do stock it).
She wants me to call her in the morning as she had shut down her computer and was leaving for the day.

n5xmt · Post by **n5xmt** » Mon Mar 10, 2008 6:39 pm

lawdognellie wrote:Hi. I also have Kaiser/Apria. First, you need to look at your doc's Rx. Apria will not give you an auto machine unless your rx specifically requests it. Second, I know for a fact they will do special orders. I don't use any of the standard masks because I have a small nose and they special ordered the mask I use, once it was determined that Kaiser would pay for it. Each Apria usually has a special person that deals with Kaiser insurance patients. Try finding out who that is and dealing with them directly.

Also, when I had problems with Apria not wanting to call me back so I could get a new mask, I sent Kaiser Member Services an e-mail saying that Apria was not doing what they were supposed to. Kaiser called Apria and I immediately got a very helpful person calling me and "personally" making sure it was taken care of.

Where are you located?

Sarah

Hi Sarah,
I'm in Lake Forest, CA. My Apria office is in Tustin, CA, and the Kaiser sleep center is in Yorba Linda, CA.

__________________________________

djtowle · Post by **djtowle** » Mon Mar 10, 2008 6:53 pm

n5xmt wrote:
n5xmt wrote:Just emailed my Dr. and the Rcp. hopefully will get some response... I may go to the Apria facility tomorrow and see if face to face conversation may be more useful than phone tag. funny thing is, about 6 months ago, I interviewed with Apria for a Unix System Administrator position LOL
Update,
FINALLY got the apria rep that is processing my order...
She says the prescription does NOT call out a specific machine, and that I can get the pro-auto (They do stock it).
She wants me to call her in the morning as she had shut down her computer and was leaving for the day.

Guest · Post by **Guest** » Mon Mar 10, 2008 6:54 pm

Apria buys roughly 100 million dollars a year worth of cpaps from their primary supplier Respironics. I think they might be able to get their hands on a DS500s. That in no way increases your odds of getting one. You see, the M series auto machine costs a bit more than the low end machine they want to provide.

n5xmt · Post by **n5xmt** » Mon Mar 10, 2008 6:56 pm

[quote="Anonymous"]Apria buys roughly 100 million dollars a year worth of cpaps from their primary supplier Respironics. I think they might be able to get their hands on a DS500s. That in no way increases your odds of getting one. You see, the M series auto machine costs a bit more than the low end machine they want to provide.

Wulfman · Post by **Wulfman** » Mon Mar 10, 2008 7:04 pm

If you're going to offer to "pay the difference", you might as well just buy what you want out-of-pocket, off of the Internet.
And, by the time you figure out how much TIME you're going to spend going back and forth between those entities......if your time is worth anything......that's going to really add to the cost of your machine.

Good luck!

Den

xyz · Post by **xyz** » Tue Mar 11, 2008 12:11 pm

> That's why my question to them has been to see if I can pay for the difference myself for the upgraded machine...

Nooooooo! Don't ask that question!
Instead get your doctor to write _exactly_ the machine that you need. Have them write "do not substitute" on the prescription.

I hear lots of complaints by Kaiser/Apria patients at the local AWAKE meetings. Does anyone know if that contact/arrangement is capitated?

n5xmt · Post by **n5xmt** » Tue Mar 11, 2008 12:58 pm

[quote="xyz"]> That's why my question to them has been to see if I can pay for the difference myself for the upgraded machine...

Nooooooo! Don't ask that question!
Instead get your doctor to write _exactly_ the machine that you need. Have them write "do not substitute" on the prescription.

I hear lots of complaints by Kaiser/Apria patients at the local AWAKE meetings. Does anyone know if that contact/arrangement is capitated?

xyz · Post by **xyz** » Tue Mar 11, 2008 1:15 pm

> Called the doc at the sleep center, he said he has no control

Make an appointment with the doctor. Difficult problems usually cannot be solved over the phone. Tell him/her in person what you have learned. Come prepared with exactly what you want. Have the exact manufacturer's _model number_ of the machine and any other equipment. Insist that the doctor write the model number on the prescription. And that he add "do not substitute". Get a copy of the prescription for you to take home.

If he won't do it, doesn't Kaiser have a Patient Advocate that you can complain to?

n5xmt · Post by **n5xmt** » Tue Mar 11, 2008 1:53 pm

[quote="xyz"]> Called the doc at the sleep center, he said he has no control

Make an appointment with the doctor. Difficult problems usually cannot be solved over the phone. Tell him/her in person what you have learned. Come prepared with exactly what you want. Have the exact manufacturer's _model number_ of the machine and any other equipment. Insist that the doctor write the model number on the prescription. And that he add "do not substitute". Get a copy of the prescription for you to take home.

If he won't do it, doesn't Kaiser have a Patient Advocate that you can complain to?