CPAP and Kaiser

[sleepychick]

Does anyone have experience transferring to Kaiser from another insurance carrier or medical practice?
My insurance just switched to Kaiser effective 1/1/12 and of course my machine died on the 5th. My prior insurance carrier also went through Apria, but when I called Apria they basically said they won't fix the machine and that I need a new prescription from Kaiser. I saw a Kaiser Dr. on Friday the 6th and she sent the report I brought in to the sleep lab but didn't know how long it would take. It doesn't help that it's the weekend and so the lab is closed. I don't want to go through another sleep study, so I am wondering if Kaiser will just write a new prescription from my prior sleep study. I am exhausted. have been using a CPAP for about 18 months now and am finding it very difficult to sleep without it. I get little to no REM sleep without the machine which makes getting through the day difficult.

Any input regarding navigation of the Kaiser giant would be appreciated. Thanks.

[archangle]

Welcome. Please sign up for an ID on the board and fill in the equipment on your profile. See the link in my signature.

I think most CPAP machines come with a manufacturer's warranty, but I'm not sure about duration. I think 2 years is common. You may have to build a fire under Apria to send it back to the manufacturer and get it fixed. Sometimes, you have to call the manufacturer and complain about misconduct by their authrorized dealer.

Apria should be willing to process warranty claims no matter what Kaiser says if they sold you the machine.

[meli]

Thanks archangle, I am the original poster. (I think I am logged in now...)

I just realized I was off by a year which probably really changes things. I received my machine in 3/2009. I should add that about 3 weeks before it "died" I called Apria about what sounded like the motor making a funny noise. At that time they told me that Blue Shield (my insurance until last week) had "bought out the machine in 2010" which meant not that the warranty was up but "that warranty did no longer apply." Friday's call to them yielded the response of basically we won't look at the machine because you belong to Kaiser now and you need a new prescription from them.

Now wondering, do I have to wait for a new prescription or should they just transfer with me? Do most sleep labs have "loaner" machines? My PCP seems pretty willing to help speed things up with the lab, but I can't wait weeks. I never realized how much it has helped me until now sadly.

[squid13]

This is a good reason to have a backup machine if you can afford it. Craigslist is a great place to look for a cheap backup machine.

[Pugsy]

Forum member Janknitz has Kaiser. Perhaps she has more information as to the hoops you may need to jump through. The could very well require new proof of everything. If all they need is a current RX it shouldn't take long to get things sorted out since your PCP will give you the RX.

This is why we have backup machines. To avoid situations like this. In theory a DME could offer your a loaner machine with proof of RX from your PCP but they won't want to do it for free because they can't sell you something since they aren't in network for Kaiser.
Since you have Kaiser now any DME outside of Kaiser probably wouldn't do the loaner without payment independent of Kaiser. So you could probably rent a machine privately (pricey) from a local DME while sorting out the mess with Kaiser or if money permits go to craigslist in your area and see if you can find a cheap old machine to get you by till things get sorted out.

[Janknitz]

Kaiser is your DME, Crapria is merely the supplier. Crapria will not help you without Kaisers ok because then Crapria will not get paid. A few things to try.
1. Call the sleep lab at kaiser directly and explain the situation. Often the sleep lab tech run the show, and they may be able to cut through the layers of bureaucracy. The might even have a loaner machine.
2. If that doesn't work, call patient relations. Make a big stink about how important CPAP is and that your health depends on sleeping with your machine every night. Compare it to oxygen supplementation and emphasize that this is urgent--you can't wait weeks.

Kaiser is a bit like the government in that they have protocols and try to shoehorn everyone into them. They diagnose around 100 new patients with apnea every month at my local kaiser. So the dePartment is busy and the initial wait is long. Once you get into the sleep techs, though, they will respond quickly and advocate for you. Until they get your RX in the computer and sent to Kaiser DME (centralized for each region) nothing will ever happen. Your doctor is totally out of this loop. BTW. All he can do is make the referral.


And unlike the government, kaiser will respond to complaints.

[meli]

Thanks! I will definitely try to get to a lab tech ASAP. I had no idea where to start with this conglomerate!