Kaiser-Permanente BiPAP Users

[BradfaG]

I have had sleep apnea for years but have not used a machine. After 3 months, 2 home sleep studies, and 2 sleep labs I decided to follow-up with purchasing a machine. Of course don'tcha know that the machine I need is a BiPAP AutoSV with humidifier that costs several arms and legs, unfortunately I only have two of each. This machine costs between $4,000 to $6,000. I was referred to Neighborcare that wants to rent me the machine. I don't like that idea at all. Just wondering who else may have this dilemma and what you did about it. I may have to switch insurance companies.

[Bons]

I have had sleep apnea for years but have not used a machine. After 3 months, 2 home sleep studies, and 2 sleep labs I decided to follow-up with purchasing a machine. Of course don'tcha know that the machine I need is a BiPAP AutoSV with humidifier that costs several arms and legs, unfortunately I only have two of each. This machine costs between $4,000 to $6,000. I was referred to Neighborcare that wants to rent me the machine. I don't like that idea at all. Just wondering who else may have this dilemma and what you did about it. I may have to switch insurance companies.

I highly doubt that you will find any insurance company willing to buy you an ASV outright. My insurance company will pay rental on mine for three months and then purchase it if it prooves to be the correct machine for me and if I proove that I'm using it regularly. They don't want to waste their money on buying something that might end up being thrown in a closet out of frustration - as I was tempted to do many times during the first couple of weeks.

And now that you have been diagnosed with sleep apnea, I don't think switching insurance companies would help you any at all - the ban on refusing coverage for pre-existing conditions doesn't kick in for another two years, so a new company can refuse to accept you or refuse to cover any expenses relating to sleep apnea.

[Janknitz]

If you change employee insurance plans during open enrollment without a gap in coverage, they can't deny you for a pre-existing condition. And if you are Medicare you can change plans during open enrollment as well--but do it carefully because if you don't go to another Advantage plan (Medicare Part C) you will need to make sure that you get Part D as well. The only time you can be denied for a pre-existing condition is in a private health care plan (you buy it yourself) and when you have had a gap in coverage.

Here in Northern California Kaiser only works with one supplier, Crapria, (they aren't really a DME for Kaiser--Kaiser is it's own DME). Not sure if Crapria is the provider nationwide, though.

In any case, you should call Kaiser patient services and find out exactly what the coverage is for bipap. You should make a formal request for your plan's "Evidence of Coverage" which is the real contract between you and Kaiser. That will tell you what the criteria is for DME coverage. Kaiser has more than one type of plan with differing coverages, so you need to check the specific EOC for YOUR plan.

If you NEED bipap and Kaiser has documented that, then it would seem they have to provide it, as it is medically necessary. Your co-pay may be high because those are expensive machines.

[GumbyCT]

I have had sleep apnea for years but have not used a machine. After 3 months, 2 home sleep studies, and 2 sleep labs I decided to follow-up with purchasing a machine. Of course don'tcha know that the machine I need is a BiPAP AutoSV with humidifier that costs several arms and legs, unfortunately I only have two of each. This machine costs between $4,000 to $6,000. I was referred to Neighborcare that wants to rent me the machine. I don't like that idea at all. Just wondering who else may have this dilemma and what you did about it. I may have to switch insurance companies.

You need to get copies of the results of all of those tests to see if you can use maybe just a bipap. You can check Craigslist - you just might come across an SV out the somewhere.

Here is a post from today - viewtopic/p539269/viewtopic.php?f=1&t=5 ... 61#p539261

Good Luck

[Breathe Jimbo]

Unless I am mistaken, ASV is not quite the same as BIPAP, but is more advanced and expensive than BIPAP. Are you sure you need the ASV rather than straight BIPAP?

[timbalionguy]

If you need an ASV machine, you need an ASV machine. Make aure you have all you paperwork, sleep study results, doctor's narratives, prescriptions, etc. ready because you will probably need them to make the case for this machine. Although the usual route to an ASV machine is failing other, less complex therapies, some things like frank central apnea or compSAS, or periodic breathing will land you in ASV territory right away.

Good luck. And I think you will enjoy the releif when all is settled!