Kaiser, Apria, and Me

araminta wrote: .............
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.

Oh, there are lots of posts already started and I will start two more soon. Sad part is most people have their mind made up one way or another and are danged determined not to budge. I don't claim to be well educated on healthcare, but I can see on both sides there is great misunderstanding of a few simple basic economic principles.

As for Kaiser, I have nothing against them because I have no experience with them.

"Kerflooey" I like. May have to plagiarize it in a new post.

Regards,

araminta wrote:"Kerflooey" I like. May have to plagiarize it in a new post.

Yo Rooster,
I'm flattered.
How 'bout maybe just a lttle footnote citing the source for credit of eloquent linguistic ability?

I think kerflooey is putting it mildly. I like it though. I may have to lift it for post or two myself

ker-
1836, U.S. slang prefix, possibly from infl. of Ger. or Du. ge-, pp. prefix; or ultimately echoic of the sound of the fall of some heavy body. forming words suggesting a thump, thud, explosion, etc.: used as a humorous intensifier kerplunk, kerflooey

flooey adjective Etymology: origin unknown Date: 1905 awry, askew <go flooey>

way to go, rooster!
I see you also enjoy thumbing thru a dictionary.

Kaiser/Apria patient here. Got diagnosed and machine just 3 months ago. Kaiser here on the west coast does not give those two high end machines, or at least mine doesnt. they give the m series plus. no data.

When I was first diagnosed I told the tech's I wanted a data capable machine. I had done lots of research here! I was told no way. I asked if I could pay the extra and they said they would leave a note for the person who puts in the orders. My insuance pays all but 20%.

I went to Apria to pick up my machine after they called the very next day. M series plus. I told the apria person that I wanted a data capable machine. He said kaiser would not pay for that. I said I wanted to pay whatever was over the price of an m series that kaiser would pay, for the data capable machine. He said kaiser would not pay at all if I did not take the machine they wanted me to have. I left without the machine.

Next day I talked to my dme and was told that I had to take the machine they prescribed, or my sleep study would be unpaid by them and I would be marked as non-compliant. I was so tired, and so downhearted and just wanted to sleep. So I took the m series.

I've had alot of problems with masks, though I have a nasal mask I use now that mostly worked (which I paid for out of pocket because i was only allowed one change even in my first 30 days). I'm sleeping much better but not perfect...Still having problems with sleep. Husband still wakes me up a few times a week because I'm not breathing, still have a bit of a headache (though not the really bad one, most mornings) still tired. I've been back to the doctor 2 times for the sleep problems continuing. Doctor refuses to up my rate, and refused to give me a written prescription so I could buy my own machine with data capabilities so we could see what is happening. Told her it was my right to have a written copy of my prescription and she refused. I'm still fighting that battle. Though she did not give me a copy of my test even though I asked, she did tell me I had 68 ahi per hour both central and obstructive events.

If I had a data capable machine I would know what's happening and could show the doctor. I've been scouring craigslist to find something but everyone is selling the machine I have.

Just got in the mail a notification that I'm to have another cpap titration next week. Lets hope they get something right this time.

Your kaiser dme might be much different. Try your hardest to get the machine you want!

Such Great Support, Thanks to everyone for your thoughts,

Soverytired2: looks like our experiences are matching up pretty well. Tomorrow, I go back to Kaiser for a 15-20 min appointment. They read my data card, devise a prescription, and forward it to Apria. According to the original letter, Apria will mail me my equipment in about 10 days. I don't see too much mask fitting, adjustment to my particular circumstances, etc. etc.

Looks like I will get whatever basic xPAP Kaiser & Apria have contracted for. I am just the beneficiary of all these folks who will make my decisions for me. I'm not happy at all

I want to know: did I leak, my A+Hs, etc. Why can't I?? It is MY BODY! MY BREATH! MY HEART! If I don't get better, I die, not them. If I suffer the consequences, I damn well want to know more about what is going on with my therapy!

Sorry, but I needed to vent a bit.

Here's the most immediate question:

Do I take any basic xPAP Kaiser/Apria offers, just to have a machine/backup machine?
I still have to pay 20% of whatever price Kaiser has negotiated (Usually a pretty good deal, IMHO)

I show 46% central apneas on my take-home sleep lab, so am reasonably concerned that I could "pass" in my sleep.

Caught in "Catch 22"
Mr Capers

Mr. Capers wrote:...MY BODY! MY BREATH! MY HEART! If I don't get better, I die, not them. If I suffer the consequences, I damn well want to know more about what is going on with my therapy!...46% central apneas on my take-home sleep lab, so am reasonably concerned that I could "pass" in my sleep.

Agree..your body, your life, AND, most importantly, your study results. Those centrals are a BIG deal...I'm too ignorant about centrals to offer any intelligent comments 'cept to say...those centrals are a BIG deal and you need to be especially sure to get the right equipment right from the gitgo. Thanks for posting, helps me learn. I'm keeping my fingers crossed ya get some expert help on this.

Hi Mr Capers - Maybe you'll be one of the lucky ones who gets a good machine from Kaiser. I have heard of others who did, so keep good thoughts when you go.

Also, though kaiser told me Apria would mail me the machine, apria called me on the phone the day after I was originally titrated. I asked them if I could come pick up the machine and supplies and they were fine with that. When they delivered a replacement mask for a problem mask, it came very next day, so I think perhaps you wont have to wait for the 10 days.

I have to say that even though I got the basic machine which tells me nothing, and have had problems getting the right mask, I still feel SO much better with the cpap than I did for years and years. So much better, and have high hopes this titration study will go well. I do hate hate hate that for whatever reason my kaiser group doesnt want to share my test info except the very basics, and doesnt allow me to be a partner in my treatment, and won't (so far) give me a paper prescription so I can purchase my own machine or mask. I'm not giving up though

I completely understand your frustration with the kaiser system and your experience with your sleep study and resulting care. Venting it here is perfectly fine, as many of us understand and sympathize. Be sure to let us know how it goes tomorrow. I'll share after my titration results come in.

Paula

Mr Capers wrote

I still have to pay 20% of whatever price Kaiser has negotiated (Usually a pretty good deal, IMHO)

Check your math. Your Kaiser/Apria negotiated "good deal" will likely be over 2 times the price that you would pay online. That was the math for my Kaiser/Apria machine, as their "good deal" price was 2 1/4 times what I paid for my backup machine online. I received both within the same week, 2 days delivery from the online vendor, 900 miles distant (free S&H), and 7 days delivery from the local Apria, 25 miles distant. Please realize that for your higher Kaiser/Apria price (vs an online vendor), your 20% copay is really 45%.

You might want to rethink taking the standard Kaiser/Apria basic machine (one that only reports compliance data) and paying 45% versus buying a full data capable Auto CPAP from an online vendor. You may also decide, as I did, to be very assertive with Kaiser - you will have to get down and dirty - so that they finally give in and approve an order for a full data capable machine (one that reports leaks, AHI, etc.)

I/ just went thru this problem with Apria. Instead, i went to my dr and gave him the verbage to use on the Rx. I some aerophagia issues and the respiritory therapist told me an APAP would do the trick. Then i passed this to my Dr. who wrote an Rx with the terms APAP & FF mask in it with the correct codes to submit to the Insurance company. I also obtained a copy to use later at cpap.com.

In the end insurance covered the APAP, but if money isn't an issue then i would just get the Rx and go thru Cpap.com.

DYNE540 wrote:I/ just went thru this problem with Apria. Instead, i went to my dr and gave him the verbage to use on the Rx. I some aerophagia issues and the respiritory therapist told me an APAP would do the trick. Then i passed this to my Dr. who wrote an Rx with the terms APAP & FF mask in it with the correct codes to submit to the Insurance company. I also obtained a copy to use later at cpap.com.

In the end insurance covered the APAP, but if money isn't an issue then i would just get the Rx and go thru Cpap.com.

You fought a good fight and won. Mr. Capers you will do yourself a big favor to emulate this.

cinco777 wrote: ............You might want to rethink taking the standard Kaiser/Apria basic machine (one that only reports compliance data) and paying 45% versus buying a full data capable Auto CPAP from an online vendor. .........

Excellent point. If a persistent effort fails to get the right machine through "insurance channels", Mr. Capers you will do well to refuse the machine, take the 45% savings and buy a machine from an internet supplier such as cpap.com.

Hi Everyone,

Here's the story on my Kaiser encounter. They were quite embarrassed. Because of my Central apneas, the Dr. (who I've never seen) wants me to be on a ASV!

So, I've been titrated in error for a week on a straight CPAP which "reduced" my total apneas from 35 to 30!! I did get a chance to find out about cold air blowing up my nose, and a mask that doesn't fit, etc.

They had no ASV to give me, (their only one had just been checked out for two weeks) so they are trying to borrow one to use to titrate me. When it looked like I would walk away with nothing at all, I got a BiPAP to use which won't help a lot, but I guess it is better than nothing.

I've never seen such a supportive group. Thanks to all of you who responded with such helpful advice. I'm going to start a new thread on my initial ASV questions so the title will reflect what it is about.

Many thanks again
Breathless Mr Capers