Kaiser in Colorado?

[Nooblakahn]

Hey... I haven't been on here in a LONG time. Therapy is still going great.

I recently moved to Colorado almost about a year ago.. and have switched jobs, with that comes new insurance. I have Kaiser Permanente.. and remember reading alot of negatives about them in regards to sleep apnea. Can anyone chime in to why? I have an appointment set up so I can have them go over everything so I can start getting supplies again, seems they only issue machines with efficacy data (though I will be keeping my s9 vpap adapt anyways) just curious.

Thanks!

[Nooblakahn]

Ugh.. looks like a search turned up an answer. Crapria...

[wm_hess]

Hi

I live in the Denver metro area, and I have Kaiser insurance. Yes they do use Apria, and I have not had any issues with them personally. I'm told that Apria only issues S9's autosets (this info is from a couple of years ago though). I have not had any issues with ordering supplies.

-Bill

[chunkyfrog]

Since the crapria here has said they are only handling P-R, it might depend on the location.
You might want to ask your doctor to specify make and model on the Rx.
Don't stop fighting for a machine with all the features you need.
Efficacy data is a necessity!

[sleep_quest]

Kaiser in Northern California provides PR 560s with humidifiers and your choice of mask. I have not had any issues with Apria regarding getting supplies. They ship out quickly and have not insisted on a credit card to charge to; instead they bill me for the balance after insurance is applied.

[Janknitz]

Kaiser has its plusses and minuses, and you give up certain choices to go with Kaiser. One of them is the choice of the DME (in reality, Kaiser is your DME, but there's a supplier and it seems to be Crapria almost universally). A second choice is that they have a limited formulary for machines and masks and if what you want is not on it, too bad. Northern California Kiaser is excllusively resprionics machnines, but I have heard some regions use ResMed, so you are lucky.

Qualify of sleep labs vary. I'm actually impressed with my local Kaiser sleep lab--techs do everything--they only have a pulmonologist on staff to sign the prescriptions but to my knowledge he doesn't even bother seeing the apnea patients. But the techs are great, and that autonomy is actually a good thing. They make adjustments to prescriptions and see you if needed. They have samples of all the masks in the formular you can take home to try before getting your mask on the insurance plan. And they must have a very sweet deal with Crapria pricewise, because my machine, which was then state of the art from PR ony cost me $120 as my 80% co-pay including humidifier and mask.

[Nooblakahn]

Oh.. sorry.. Didn't see your responses.

Seems here.. they don't have a sleep lab per se... they do at home studies. I'm doubting I would have ended up on ASV using their system. Glad I was diagnosed prior to having this insurance. I give them credit though.. at least they don't issue bricks, and I'm guessing If i still have kaiser when i need to replace my machine I'll be buying out of pocket. I wouldn't bank on them giving me a new ASV.

Glad to hear Crapria is just a supplier. Sounds kinda like what the lady at the sleep center told me. I guess if you want to switch masks they insist on fitting you for it... meh.. whatever. I'm hoping they carry that new AFIT F10, if not I'll get a new quattro FX and buy the AFIT OOP from Cpap.com with my FSA.

Oh. On a side note, while setting up the appointment while waiting for my sleep studies to be faxed to her, she asked me for my AHI from my baseline study. When I told her it was something like 120.. I could almost hear the yeah right eyeroll over the phone. Once I picked it up and read to her AHI 116 her response was "OH MY GOSH, thats probably why they have you on that machine"

WM_Hess, can I ask which sleep center you use? Is it the one downtown or the one farther north? Dang.. 120 for the machine? I hope my deal is that sweet.. should be able to walk out with a mask/hose/humidifier chamber for next to nothing if taking that into account.

Thanks all for the responses. Good to be back!

[Janknitz]

Kaiser does mostly home studies, but for a more complex apnea they may have some in lab testing arrangement. I prefer the home study, personally, but I have run of the mill OSA.

An ASV is going to cost a whole lot more than an APAP, I'm certain. Good luck!

[Nooblakahn]

Well.. for now I'm good. I have my ASV I got when I was first diagnosed. I've only had it a little over a year.

[wm_hess]

[quote="Nooblakahn"]Oh.. sorry.. Didn't see your responses.

WM_Hess, can I ask which sleep center you use? Is it the one downtown or the one farther north? Dang.. 120 for the machine? I hope my deal is that sweet.. should be able to walk out with a mask/hose/humidifier chamber for next to nothing if taking that into account.


I did a home sleep study. Kaiser had several people come in for a class on how to assemble and conduct the home sleep study. I went to the northern Kaiser facility (Rock Creek in Lafayette) . Home study consisted of nasal canula, finger oximeter and 1 or two (I think 2) belts around belly and chest.

When I received my first machine (2010) I paid 157.00 for a brick S8 (humidifier extra), which was 20% co pay. In 2011 I decided to purchase out of pocket an S9 so I could get the data. I spoke with Kaiser at that time and they said that they only prescribed S9's and I could purchase one at their contracted price. When I did, cost was around $800 for S9 autoset, climateline hose, and humidifier. 20% of the 800 is $160.00 so I'm guessing that's what I would have paid if I'd been eligble for a new machine.

-Bill

[njmilam]

I had a sleep study to verify narcolepsy and found out it only monitored sleep apnea. Never received my results.
When I first went in Dr Michael Darnell wanted to immediately change my meds that I have been on for 20 years.
Ended up not changing it but adding to it. Every time I need a refill I have to jump through hoops to make sure I get it
filled before I run out. I absolutely hate requesting my refill as I can guarantee that I will end up calling and emailing and no response
I end up without an authorization on Friday night so go through the weekend without meds. I don't understand.
I have a disease and need the medication to function. I am unable to work my second job then on that weekend as I cannot get out of bed.
That is my take of the clinic. Tired of struggling with doctors to just authorize a prescription that I need to treat narcolepsy

[Janknitz]

I had a sleep study to verify narcolepsy and found out it only monitored sleep apnea. Never received my results.
When I first went in Dr Michael Darnell wanted to immediately change my meds that I have been on for 20 years.
Ended up not changing it but adding to it. Every time I need a refill I have to jump through hoops to make sure I get it
filled before I run out. I absolutely hate requesting my refill as I can guarantee that I will end up calling and emailing and no response
I end up without an authorization on Friday night so go through the weekend without meds. I don't understand.
I have a disease and need the medication to function. I am unable to work my second job then on that weekend as I cannot get out of bed.
That is my take of the clinic. Tired of struggling with doctors to just authorize a prescription that I need to treat narcolepsy

Don't cut Kaiser any slack. File a complaint. I suggest a complaint with your state managed care overseer rather than an internal complaint through Kaiser. Kaiser has to respond if it's through an oversight agency. Express what you want--a policy for a simpler process for refills so that you don't have to go without your medication. Remind them that if you are out of the medication when you did what you needed to do to get it, the liability is theirs for something that happens as a result of your narcolepsy.

[Torgo]

I also live in the Denver area and have Kaiser as well and my dealings with them have been good, it did take a while to get my initial diagnosis but once they
determined I had sleep apnea they set me up with all the equipment in fairly quick order. My dealings with Apria to get new supplies have also been
fine I call them once a month or so and order my supplies, and they show up in 3-4 days usually. I have had no out of pocket (other than copays) to get all my supplies and equipment so that seems to be a plus as well.

[chunkyfrog]

I have found that plenty of advance planning can help eliminate running out of a med before getting a refill.
Always note if there are refills allowed on the label. Get 3 month or 90 day fills whenever possible.
Know in advance when a doctor's appointment is needed for renewal, and git er done.
When people space off returning calls, just showing up tends to shake things up a bit.
At work, I was exposed to epoch calendars--now I write the epoch days on my first new calendar of the year.
If a prescription is filled for an odd number of days, I immediately calculate the adjusted refill date--and write it down!
Most of my drugs can be filled up to 10 days ahead. This allows me to get ahead enough to cover the unforseen.
Find out how soon your prescriptions can be refilled--and write it down.
Good luck keeping your health on track.