Kaiser Ins and Apria

[Java]

I have kaiser insurance, and I just received a phone call from Apria verifying my address because they are sending me my new machine via UPS. I asked what machine they were sending me and said they could not tell me (She didn't know), but it's what the doctor ordered. Does anyone else have Kaiser HMO with Apria? I'm just wondering why I get no say or information in what I get. The only good news is they are paying 100% and I don't have to pay anything. I just feel so left out in this really big change in my life. I was expecting someone to call me and tell me what type of machine I am getting and what my pressure settings are and such (CPAP? APAP? BiPAP? C-flex? SD card?) .. But nope, just getting a box from UPS. I was hoping for choices and options, I would of even paid extra out of pocket for certain features, had I been given any choices. I guess I have to just wait and see what they send me. Has anyone else had Kaiser/Apria and received their equipment recently, and if so, what did you get?

[LSAT]

I would ask for a copy of your doctor's prescription to see what he actually wrote. When you receive the UPS package check what they sent against the prescription. If the prescription was non-specific...be sure that the machine Apria sent was data capable...if it is not...do not accept it! Call them and send it back. Call Kaiser and ask what DMEs are in your plan. If Apria will not give you the machine you want...go elsewhere.

[Pugsy]

Send forum member Janknitz a PM and ask her what to expect from Kaiser if she doesn't respond to your thread this evening. She has Kaiser and I think is in northern California bay area I think. They gave her a full data PR System One APAP machine. I am thinking they do that for everyone because they are big on monitoring the data so they can save money by not doing repeat sleep studies.
With Kaiser you get what they offer and no choice in the matter if you want Kaiser to pay for it.
You can always go outside of the Kaiser network but to get them to pay for anything you have to play by their rules.
Kaiser only works with Apria...you won't have any other in network DME choices because of the way Kaiser does things.
Kaiser is an HMO and they do things a lot different than main stream insurance. Different animal entirely.

[Spektor]

Well isn't the issue really with the MD? If the doctor just said CPAP on the rx then you will get a mystery machine. But if he ordered something specific, they have to fill it as written.

What did your doctor order? Did you ask for anything specific?

[greatunclebill]

the doctor can order and you can pay out of pocket for anything you wish. when you are dealing wish insurance companies, it depends what the insurance company will authorize and pay for. some insurance companies even authorize the dme to give you a used machine.

[Java]

What did your doctor order? Did you ask for anything specific?

That's the problem with Kaiser, I have no clue what the doctor ordered!! I will be sure to ask when I see her again in November!! Kaiser has this huge sleep apnea clinic and they seem to be herding us through like cattle.. go here do this test then go here and do this test then go here and do this test now go home and wait for UPS. I had to attend a mandatory group class when I picked up my titration unit, and I seem to remember them saying I have to use Apria if I want them to pay for it. They gave me a free Quattro FX FFM size medium, and when I went back to re-do my titration (too many leaks), they gave me a Quattro FX FFM size small and said to keep both.

Let me clarify that I do like Kaiser. The doctors will run any test I ask for and then some. It's just their whole sleep apnea clinic seems very unpersonalized.

[LSAT]

By law...you are entitled to a copy of your prescription. Call and ask for a copy to be mailed to you...or...go and pick it up.

[MAXDRI]

I have been a Kaiser member since 1955, and, I will admit, you need to understand how they work. That is not a typo. I joined in 1955 after my twin daughters barely survived , due to errors at a prestigious hospital in San Francisco. I am now 83. I have found all of my Kaiser doctors to be very responsive to emails. I have had several sleep studies at the Santa Clara/San Jose Sleep center. The sleep specialist doctor who interpreted the results has always called me to discuss the report and to tell me which machine they were recommending and why. Usually it was the one they used for my sleep study. On two occasions, the machine didn't work out and the doctor prescribed a different one. Two months ago, I had a Titration study and this time I had to request a copy of the sleep study. The first two times, they sent the results without my asking. I have found the local Kaiser sleep office willing to let me try every mask they have. Currently they are special ordering one that is not in their formulary. I don't think Kaiser is a good fit for everyone. For me, they have been great. When I needed a specialty they couldn't provide within their system, they sent me to UC San Francisco to a specialist and paid his bill and a hospital bill of seven days. I could go on and on with my positive experiences. However, I repeat, Kaiser is not for everyone.
I have NOT been happy with Apria. Last night I attended an A.W.A.K.E support group. The speaker was from Apria and he spoke about all the services Apria provides for Sleep Apnea patients. After the meeting I told him about my experiences with the Apria office I deal with. I have found more help from this forum than I have from either Kaiser or Apria - about my current machine, a ResMed VPAP Adapt. Thanks to all.
Maxine

[kaiasgram]

Janknitz is not too far from me in northern CA, she'll back up what Pugsy is saying. I'm in the Sacramento area and the Kaiser sleep medicine dept. here is notoriously awful -- cattle call process to be sure. Like you I find some things about Kaiser to be very good, but sleep med is off the charts BAD. Everything is done via mandatory class and you may go thru the entire diagnostic and titration process without ever seeing a neuro, pulmonary, cardio or sleep doctor. I was able to get a copy of my Rx faxed to me by the sleep med dept., but I wonder if your primary could get it for you as well.

Then there's the whole issue of how KP diagnoses sleep apnea. Did you go home with a little device worn on your wrist with only a finger probe? It directly measures O2 levels and heart rate. There's nothing on your forehead and no straps around your chest/abdomen to measure respiratory effort. Sleep apnea is mostly inferred, not directly measured.

For better or worse my Kaiser plan doesn't cover DME so I had to buy everything on my own and haven't dealt with Apria, or as Janknitz refers to it, Crapria. Sounds like you'll have to really advocate for what you need but getting a copy of your Rx should be the easiest part.

With KP you really want a data capable machine because it's all too easy to fall through the cracks in their high volume sleep med dept.

[Java]

She has Kaiser and I think is in northern California bay area I think. They gave her a full data PR System One APAP machine. I am thinking they do that for everyone because they are big on monitoring the data so they can save money by not doing repeat sleep studies.

Funny thing is, when Kaiser/Apria gave me my first CPAP machine (REMstar plus M series) in 2008, it went straight into the closet and sat there till last month. I couldn't get past the claustrophobic feeling of a mask and can't use the nasal ones due to sinus problems. They never called or checked on me or asked me to come in for a follow up. I never heard from them again. Had they of been more on top of my care, I might have been able to work through my mask issues and prevented my sleep apnea and health from deterioration so much in the past 4 years. I won't give up this time around, I'm convinced sleep apnea is the root of most of my health problems.

[Java]

Did you go home with a little device worn on your wrist with only a finger probe? It directly measures O2 levels and heart rate. There's nothing on your forehead and no straps around your chest/abdomen to measure respiratory effort.

Yes for my sleep study they sent me home with a tiny device I wore around my neck, tiny nasal prong tubes, and a finger probe. They never told me the results, but told me to go to their mandatory class to pick up a titration machine. When I got to the class I was called up by the "teacher" and noticed I had the only bright red folder in the class. There was a post-it note on the front that said, "02 53% and fast heart-rate of 146." That's kinda shocking information to find on a post-it note. I was so scared. Inside my bag was a pulse oximeter along with my titration machine. I still have no clue if the CPAP raised my oxygen or what's going on.

[kaiasgram]

Yes for my sleep study they sent me home with a tiny device I wore around my neck, tiny nasal prong tubes, and a finger probe. They never told me the results, but told me to go to their mandatory class to pick up a titration machine. When I got to the class I was called up by the "teacher" and noticed I had the only bright red folder in the class. There was a post-it note on the front that said, "02 53% and fast heart-rate of 146." That's kinda shocking information to find on a post-it note. I was so scared. Inside my bag was a pulse oximeter along with my titration machine. I still have no clue if the CPAP raised my oxygen or what's going on.

My story exactly, except my "test" didn't involve the nasal prongs and I didn't get a post-it note! I later obtained my test report and titration report by going to their Member Services office and paying for them. Like you I don't know if CPAP is keeping my O2 up where it should be, but I do know that even on APAP during my at home titration week I had two nights where my O2 dropped -- once to 88%, and once to 74% with a max heart rate of 155. Very scary. I'm trying to get the Kaiser sleep medicine dept. to allow me to take an oximeter home for a few nights because even at 3 months on cpap with AHI always below 1, I'm waking up with bad headaches. You must be thinking "good luck with that!"

[Kody]

I have Kaiser in the North Bay Area. They do run you in groups like cattle, as they told us they diagnose over 50 patients a week with Sleep Apnea, so they are very busy. However I ended up with Complex Sleep Apnea, and they did refer me to 3 separate sleep studies at an outside sleep lab. You have to be persistent with their sleep dept. to get the help you need, or you can fall through the cracks. They were very good about trying different masks etc, so make sure you insist on getting what works best for you in your case. I didn't get any choice with my ASV from Apria, and of course ended up with their older model, but it does what I need it to do, and I'm only renting it. They have been good with the supplies when I've needed them. Keep on them about the mask that will work for you, good luck.

[wm_hess]

Hi

I've got Kaiser, and use Apria. I received a Resmed S8 Escape when I was originally diagnosed with sleep apnea. I decided to purchase a S9 out of pocket, out of network. When I wrote to my doctor, he said I could purchase the S9 directly from Apria, at Kaisers contract price for myself.

He also stated "They (the Apria folks) can probably get you a better deal on the S9 (which is now our standard machine--since early 2011)"

This is Denver metro area, but I would hope it applies to your location as well.

-Bill

[Janknitz]

Sorry, I didn't have time to log in yesterday so i'm just seeing this post. First let me say that every Kaiser region works a little differently, but somewhat similar. My experience is with Kaiser Northern California.

The first thing you have to understand with kaiser is that Crapria (Apria) is NOT your DME. Kaiser is. Kaiser is your insurance company and health care provider, including your DME provider. Crapria is merely the supplier.

The second thing you have to understand is that if you want Kaiser to pay for your machine, you have NO choices. Your kaiser sleep lab clinic will decide what features you need in a machine (CPAP, APAP, BiPAP, ASV) and will presecribe that. Their contract for supplies from Crapria is usually for one brand of machine bought in bulk. In the case of Northern california it's Respironics. No chance whatsoever of getting a ResMed (they may have recently changed brands, I'm not positive). And whether you get a data capable machine or not is entirely up to Kaiser's agreement with Crapria. I think (not positive) that they are giving all data capable machines in this region so that the sleep lab can read your card and help you if issues come up. They have the Respironics software in the local clinic and use it for EFFICACY as well as compliance if you're having a problem.

The nice thing about Kaiser is that they have sample masks in the clinic, and if you are having a problem you can call and ask for a new mask fitting. They will fit you (sitting up, which is dumb) and then let you take home the sample masks to try out in real conditions. No charge. When you find one you like, they will change your prescription. The bad thing is that the formulary is limited and you may not find the latest and greatest mask on it. Nor will you find the less common brands like sleepweavers and Hans Rudolph.

Crapria does one thing--supplies equipment (and ALWAYS screws up the billing and often the order, BTW). They drop ship everything to you. They don't want to see you in their store, they don't want to talk to you if you're having problems. Call Kaiser sleep lab if you need help.

When you sign up for an HMO, you give up a lot of choice. If you don't like it, you're always welcome to pay out of pocket for what you want. But don't expect choice in machines or how your apnea is treated from Kaiser, because you aren't going to get it.

Given that your report stated something about variable heart rate, there's an argument to be made for a data capable machine, so if you don't get one you can try squawking about that. But I don't know that you'll succeed. Hopefully, you will at least det a data capable machine.