Kaiser Permanente coverage: advice please

More than 10 years ago I was diagnosed with mild to moderate OSA. I'm currently using a CPAP nightly.

I switched from a different health insurance provider to Kaiser Permanente (Silver HMO) a bit over a year ago. I asked if they covered CPAP supplies, and they said they didn't.

I'm going to follow up with them to find out if I can get discounted (rather than free with coverage) supplies from them, and also want to ask about getting a new sleep study done, as I haven't had one in about 8 years, and want to make sure my settings are optimum; or at least talk to a sleep doc to make sure I'm on the right track.

So before I reach out to them again, just wanted to see if anyone here had experience with Kaiser, and if they have any advice on getting any OSA-related coverage (supplies, consultation, sleep study).

Kaiser's Covered California Plan for DME sucks. I'm not even sure they'd provide a wheelchair if you could no longer walk, although they claim to have DME coverage. https://healthy.kaiserpermanente.org/co ... -ca-en.pdf Their Evidence of Coverage says they only pay for certain "base" items which include:

• Blood Glucose monitors and supplies
  Bone Stimulator
  Canes
  Cervical Traction
  Crutches
  Dry Pressure Mattress Pad
  Infusion pumps
  IV pole
  Nebulizers
  Peak Flow Meters
  Phototherapy blanket for a newborn with jaundice
  Some lactation

That's it, the entire list--no CPAP even though they claim to cover "medically necessary DME". And you NEVER own the DME with Kaiser, you have to return it when it's no longer needed. When you go on Kaiser Advantage plan, they charge rent perpetually for the machine forever, you never ever own it. Not even the Peak flow meters you can buy on Amazon for about $30.

If you live in another state, you might have a somewhat different plan because states can impose different requirements. Look up your state's Kaiser Silver Plan Evidence of Coverage to learn what is covered.

I don't know if you can get Kaiser discounted prices for CPAP supplies, but you have to deal with Crapria as that's their only supplier. You have to decide if you want to make getting the right supplies and correct billing your full-time job or not. I'm on a covered California plan and I've never been so happy to NOT have DME coverage because I buy my own, when I want, what I want, either from our hosts at cpap.com or eBay or Amazon. No hassle, no billing errors. When I had coverage, Crapria messed up the orders and the billing 100% of the time.

I recently got a brand new ResMed Austoset 10 from our hosts at cpap.com , paying under $400 on sale--right now they are selling them for $449. If Kaiser can't do better, DO NOT GO TO A TRADITIONAL DME, because they will charge $1200 or more for the same machine out of pocket. I got it with no hassle at all. I go on Medicare later this year. I'm not planning to stay with Kaiser, but if I'm stuck I will not play any Crapria games, my time is not worth the frustration. I will continue to buy my own supplies and a machine when necessary if my only option for DME is Crapria.

Thanks the reply, @Janknitz.

I bought my machine on Craigslist, and also buy supplies on ebay, suppliers listed here, etc. So I'll continue to do that. Bummer about Kaiser, but not surprising.

I have Kaiser thru my employer & my coverage includes DME I get my CPAP & all my supplies at no additional cost.

I have Kaiser thru my employer & my coverage includes DME I get my CPAP & all my supplies at no additional cost.

When we had coverage through my husband's employer, we, too had coverage. But none of the ACA plans have CPAP coverage, as far as I can see.

I personally have not had coverage with Kaiser in 55 years, since my daughter was born there.
However my brother-in-law died under Kaiser's care, and they had offered to allow him to die about 6 years earlier. My wife let them know they better get a doctor who knows what he is doing, and he got better.
I had a friend whose wife was under Kaiser care about 30 years ago. Kaiser told him to take her home and let her die. He took hare to a better hospital and paid out of pocket. I assisted him in sorting out $70,000 in medical bills. About 10 years ago I bumped into them at a casino buffet.

I had Kaiser as a kid, and my daughter was borne in a Kaiser hospital. But today I would chose a Witch Doctor over Kaiser.

As per Crapria getting things wrong 100% of the time. I would say that is very optimistic. I would estimate they get things wrong about 250% of the time. It often takes 4 shipments to deliver 3 items from a single order, Like a mask, a hose and filters.

I could tell a lot of Kaiser horror stories I encounter in my work, but a public forum is not the place. Just don't get old in the Kaiser system, enough said. Can't wait to see them in my rear view mirror.

bwexler wrote: ↑

Thu Mar 14, 2024 1:01 pm

I personally have not had coverage with Kaiser in 55 years

tell us how you REALLY feel!