CPAPtalk.com

clownbell wrote: ↑

Fri Feb 18, 2022 11:51 pm

With all due respect to Janknitz above, Kaiser has a procedure (in the SF area anyway) whereby the patient can request an item not in the formulary. The patient provides the justification and there is a committee that makes the decision on whether an exception will be made. That may not be true of Kaiser everywhere, but it is true in this area. OP, I suggest having a conversation with your Kaiser doc.

Interesting! They certainly don't tell you about it. In any case, ResMed Autosets are what they are dispensing right now. It would only be a problem for a mask not on formulary. And what a PITA, just for a mask!

Janknitz wrote: ↑

Fri Feb 18, 2022 3:41 pm

One exception to the "ask the doctor to write the script for what you want" is HMO's.

Another reason to avoid HMOs

Thanks Okie for your reply. I have yet to consult with my primary doctor, but he is generally receptive to my preferences. Keeping spares on hand sounds sort of expensive - in your situation, there is a good reason however, since you both use CPAP. I will keep that in mind.

Reasons to have backups:
---your DME is not open when you are USING your cpap. EVER
---your supplier decides (on a wild hair) to not carry your preferred mask, machine, etc.
---your insurance, also a wild hair, or some other lame excuse--will do a dirty deed--2U.
---Anything can break or die on a weekend. (Murphy wins--again!)
Be in control; because nobody cares for you, like YOU.

oklajohn wrote: ↑

Mon Feb 21, 2022 9:35 am

Thanks Okie for your reply. I have yet to consult with my primary doctor, but he is generally receptive to my preferences. Keeping spares on hand sounds sort of expensive - in your situation, there is a good reason however, since you both use CPAP. I will keep that in mind.

Once you get started good, it will be easier to start stockpiling spares items. If you have insurance coverage for your supplies, they will normally allow replacement items much quicker than they actually wear out. We both use a full face mask, and the cushion will last a year or more if it is taken care of. Insurance normally allows for a replacement every month. As far as spare machines go, many of us have purchased used machines that were found on Craig's list or Facebook Marketplace. I found my wife's spare machine here on the forum, and i found my spare machine on Facebook Marketplace. Just keep your eyes open for deals. You can also find replacement mask parts on eBay for less than what you pay at the DME. Even Amazon carries some CPAP supplies. We didn't stock up on spares right at the start, but have done so over the years.

Another reason to avoid HMOs

Don't be too smug. An equivalent may be coming to a medical practice near you, and you won't be given a choice of whether or not to participate: https://www.elderlawanswers.com/advocat ... care-18601

Janknitz wrote: ↑

Sun Feb 20, 2022 6:45 pm

Interesting! They certainly don't tell you about it. In any case, ResMed Autosets are what they are dispensing right now. It would only be a problem for a mask not on formulary. And what a PITA, just for a mask!

Our forum host CPAP.com have been running various 20% off sales on masks (and other supplies) for the past few weeks. $100 or so out-of-pocket wouldn't prevent me from using my mask of choice.

Our forum host CPAP.com have been running various 20% off sales on masks (and other supplies) for the past few weeks. $100 or so out-of-pocket wouldn't prevent me from using my mask of choice.

Personally I don't mind paying out of pocket for supplies (a machine is going to be more challenging). I feel like that old American Express Commercial:

Dealing with Crapria to get the wrong item and incorrect billing--$40
Buying a mask out of pocket without having to deal with Crapria--PRICELESS!

I'd rather pay than hassle, given the amount of my precious time and frustration I had to spend with EVERY interaction with Crapria. And some of the stuff I get is less expensive than my co-pays would be anyway.

Janknitz wrote: ↑

Tue Feb 22, 2022 7:26 pm

Another reason to avoid HMOs

Don't be too smug. An equivalent may be coming to a medical practice near you, and you won't be given a choice of whether or not to participate: https://www.elderlawanswers.com/advocat ... care-18601

I feel like if I am paying for the insurance then I have options and they won't ALL be HMOs.
In the business world there is always competition.

Are you thinking that one day Apria will be the only choice?

I feel like if I am paying for the insurance then I have options and they won't ALL be HMOs.
In the business world there is always competition.

Are you thinking that one day Apria will be the only choice?

Did you read the article?
DOCTORS are joining these "Direct Contracting Entities" and

Traditional Medicare beneficiaries will be enrolled in these networks, often without their knowledge or consent. The DCEs will be paid a set amount per patient, called a capitation payment, which will vary depending on a patient’s “risk score.” If the patient care costs less than the per-patient amount, the DCE keeps some or all of the difference. If it costs more, the DCE loses money.

So you won't be given a choice. Your doctors will be in these networks that will

extend key aspects of this model [HMO] to other Medicare beneficiaries in 38 states, Washington, D.C., and Puerto Rico, potentially covering 30 million of the 36 million beneficiaries in traditional Medicare. Beneficiaries will not be able to opt out of being “aligned” with a DCE. Medicare will assist the DCEs by searching the claims history of beneficiaries – again without patients’ knowledge or consent -- to see if they have visited a participating DCE provider with which they could be aligned. All this will likely be confusing for Medicare beneficiaries, many of whom will have three different entities processing their claims: the DCE, Medicare, and the beneficiary’s Medicare supplemental insurance (Medigap) plan.

As for Crapria, because I was stuck with Kaiser, that's the ONLY DME supplier I could use.

Janknitz wrote: ↑

Thu Feb 24, 2022 8:18 pm

Did you read the article?

Uncle...

SleepGeek wrote: ↑

Wed Feb 23, 2022 9:17 pm

I feel like if I am paying for the insurance then I have options and they won't ALL be HMOs.
In the business world there is always competition.