Kaiser, Apria, and Me

[Mr Capers]

Just diagnosed with a "take-home" sleep study. A+H 236 total = 34.7/hr, 207 supine = 41.8/hr. Sleep report shows a mix of central and obstructive episodes.

I am in the 5th night of a 7 night home titration. Success is quite mixed - I seem to feel a tiny bit better in the morning, but have pressure points on face from Respironics nose mask and am very sleepy all day.

Does anyone know how Kaiser works this with Apria? My letter says I'm to return on Wed., they read my data, and send a prescription to Apria, who mails me my equipment in 10 days. Is this for real? How can I game the Kaiser system to get a data-capable xPAP? They told the 9 of us at a briefing that we would almost all get a straight CPAP. If that is all I need, fine, but I'm now convinced that data-capable machines are a necessity and that is not a straight CPAP, right?

Kaiser issues the most basic blood test meter for diabetics, but I traded up over the years to get data download meter. Can I do this with xPAP?

Confused, and hoping some of you have been through this and can advise a totally sleepy newbie.

Thanks,
Mr Capers

[Muse-Inc]

Welcome!!!

Great folks and info here. While I can't offer any suggestions for your particular situation, others likely will. Full efficacy data and not just compliance data is a real must to tweak your CPAP therapy, manage mask leaks, and log data to spot trends -- I regret having a compliance-only machine...it works, I just can't do the things I'd like to do . I hope you are able to get a full-data machine!

Again...welcome!

[Ganesha]

Mr Capers,

Welcome to the center of the CPAP universe. I can not help you with your questions since I have no dealings with Kaiser or Apria. However, I would be interested to hear more about the home titration study.

I have been on CPAP for three months and my titration was done in a sleep lab.
Feel free to ask anything. And the search function is a great resource for mining the group's collective experience.

Mark

[mattman]

Does anyone know how Kaiser works this with Apria? My letter says I'm to return on Wed., they read my data, and send a prescription to Apria, who mails me my equipment in 10 days. Is this for real? How can I game the Kaiser system to get a data-capable xPAP? They told the 9 of us at a briefing that we would almost all get a straight CPAP. If that is all I need, fine, but I'm now convinced that data-capable machines are a necessity and that is not a straight CPAP, right?

Thanks,
Mr Capers

To answer your specific question - yes a regular straight cpap can have full data capabilities. The ability to track and store data is seperate from the various types of xPAP machines.

The majority of patients generally do fine on straight cpap. Some patients require an APAP (auto adjusting cpap) for various reasons. It's impossible to say up front which type you would need.

Apria can be a difficult company to deal with sometimes. I would suggest asking your prescribing MD to specifically write your prescription for whatever machine he feels appropriate but to SPECIFY full data recording capabilities. That can help tremendously to make sure you get a machine that does so.

mattman

[roster]

......... I would suggest asking your prescribing MD to specifically write your prescription for whatever machine he feels appropriate but to SPECIFY full data recording capabilities. That can help tremendously to make sure you get a machine that does so.

mattman

Yep. Capers, to make life simple, I suggest you worry and work on that one point now. IMO, everthing else you are worried about can be handled if you get a machine which has software available to monitor your apneas, hypopneas, snores, pressure and mask leaks. APAP is more flexible (you can use it as CPAP) and often doesn't cost more than a fully data-capable CPAP. I hope your doc will help you with the prescription.

Apria can be "worked" if you are persistent, savvy and patient. I own three nice machines from Apria and collected them over three years and I never paid one cent for them.

You need to be willing to leave their facility without a machine (or refuse shipment) if they don't provide the right machine on the first try.

Like MattMan says, get the doc to be specific on the prescription.

One thing that you need to discuss with the doc is the centrals. Sometimes you get a few centrals that go away when you treat the obstructive ones. Other times it is more serious, so be sure to discuss the centrals with the doc.

Good luck and work hard to get what you need.

[Wulfman]

Go up to the Search line and type in "Kaiser" and you will get about 23 pages worth of posts/threads of other peoples' experiences with them to read through.

Good luck getting a data-capable machine from Kaiser/Apria.

Den

[roster]

Go up to the Search line and type in "Kaiser" and you will get about 23 pages worth of posts/threads of other peoples' experiences with them to read through.

Good luck getting a data-capable machine from Kaiser/Apria.

Den

In that case, what is your deductible and out-of-pocket? You may be better off buying your own machine at a discount from an internet supplier.

[Mr Capers]

Thanks to everyone, what a wonderfully supportive group!

I'm convinced that data capability is the way to go unless one of you more experienced folks can sell me another option.

My initial experience with the Kaiser folks was diabetes diagnosis. Questions based on study were greeted with "don't go there," or a sort of "march until you are told to stop," attitude. Found the same generic attitude with sleep apnea group briefing.

Everyone is doing their best, I'm sure, but the system is not set up to deal with people who study beforehand, ask about sleep study graphs they don't talk about, machines they aren't contracted for, etc. Just keep marching.

Anyway, diabetes diagnosis got me the most basic blood test meter, and for years I typed in my readings and generated graphs with moving averages, process limits, etc. Now my blood test meter downloads to my computer, but I get 12 page dumb graphs and charts. Oh well, win some, lose some.

Thanks again for all your help.

Capers - the Universal seasoning?!

[araminta]

I've actually had the opposite experience with Kaiser sleep clinic: very knowledgable people, eager to help, willing to spend as much time as needed to discuss questions and concerns. The 2 models of cpap they offer are 2 of the top machines used by folks who post on this forum: both are recording all the data. (Tho my policy requires that I pay out of pocket for all medical equipment....which is a huge bummer.)

And prominently posted on the bulletin board in the meeting room is a flyer for Pad-A-Cheek's wonderful products.

[cinco777]

What worked for me was to refuse any machine that wasn't fully data capable (one that reports AHI, leaks, etc). Additionally, once you get Kaiser to approve and order the data capable unit, you still have to get Apria to send/give you that one. Get a copy of your order (it is sent electronically and you will have to push hard to get a printed copy) and tell Apria you will pick it up once they call and have it in stock. Take your order (specifying make and model of unit) with you and refuse to take anything from Apria other than what is specified.

If the Kaiser sleep folks won't authorize a full data capable machine, refuse to accept the "el cheapo" pseudo leaf blower unit that only tells you how long it is powered on with you breathing (compliance data). Get your PCP's support and/or contact Member Services and make your case for acquiring a full data capable CPAP machine. Don't give up. You need a full data capable machine to make your therapy work!

[roster]

I've actually had the opposite experience with Kaiser sleep clinic: very knowledgable people, eager to help, willing to spend as much time as needed to discuss questions and concerns. The 2 models of cpap they offer are 2 of the top machines used by folks who post on this forum: both are recording all the data. (Tho my policy requires that I pay out of pocket for all medical equipment....which is a huge bummer.)

............

Huh??????????

You think Kaiser is great because they allow you to get a "top machine" ........... which you are paying for with your own money? What swell guys those Kaiser people must be!

[john5757]

Not all Kaiser Plans have DME coverage but it is usually $2000 a year.

[Mr. Capers]

Thanks again for the advice and the words of support.

My Kaiser plan is that I have 20% co-pay with no limit. Does anyone know actual model #s for the "two top machines" Kaiser supplies? With that, I can find out if they are fully data capable.

Thanks,
Mr Capers

[sleepyinstlouis]

Kaiser is a private HMO, so I don't think they work quite the same way as regular PPOs do. Please don't quote or flame me on this as it has been nearly 15 years since I've had Kaiser, so things have most likely changed since I left California.

As far as Apria is concerned, I just don't care for them. Their business ethics leave a lot to be desired. There's just something about them wanting to take a disabled woman's wheelchair when she has a clear prescription from her doctor stating that she is to have it indefinitely that smacks of wrong in my book.

[araminta]

Just to answer the question re. Kaiser's equip:
The 2 primary options they have available all are fully data capable (at my Kaiser):
-S8 AutoSet II
-M Series Auto w/ A-flex
There may be other options for others, but I'm on the "moderate" side of the spectrum. And this is the only aspect I'm familiar with .

Hey Rooster,
about Kaiser. They ain't perfect, but they the entire system of health care in the US is kerflooey.
If ya wanna talk about that small issue, perhaps the discussion should continue under another topic.