Kaiser Permanente HMO

slumberer · Post by **slumberer** » Fri Dec 09, 2005 5:09 pm

I'd like to know how Kaiser serves (or does not serve) its sleep apnea patients...experiences both positive and negative.....especially any physicians with Kaiser in Los Angeles that are experienced with sleep apnea problems.

mikemoran · Post by **mikemoran** » Fri Dec 09, 2005 9:24 pm

I have Kaiser but on the East Coast. My experience was okay. My priomary care doctor had no hesitation sending me to the pulmonary department for screening. There I met with a sleep tech who did an initiial screening test then set up my Sleep Lab appointment. The testing was done by an indepent lab and the results were available in one week.

The biggest problem I had was the amount of time. 2 weeks for the initial screening, 5 weeks for the study and 2 months for the appointment to get my equipment. Kaiser will only issue CPAPs and only pass through humidifiers (only ResMed equipment was offered) but does give you a choice of masks. You do not get a new mask every 6 months like other insurances, but are entitiled to replacement inserts at that time. Also you get a new filter supply every year.

The most positive thing was I got no resistance to getting a prescription for an APAP. One phone call and it was in my mailbox the next day. My Tech clearly understood the benefit of it and how the improved comfort would help compliance. However, she was hampered by the limitations of the HMO and could not provide the equipment under the insurance. When she heard what CPAP.COM was charging for the rquipment she told me that it would be twice as much if I got it through her.

I thought about changing coverage this year to get better benefits, but the increase in cost far outweighed what I would be spending getting my own masks.

Hope this helps.

slumberer · Post by **slumberer** » Sat Dec 10, 2005 9:46 am

This is extremely helpful. I am Kaiser of Southern California and near their flagship operation in LA. I got an appointment for a Sleep Study after complaining about snoring bothering my partner. They sent me home with a StarDust recorder and I returned next day and took home a Resmed Auto CPAP for my titration. I had to wait five weeks for the results.

When they came a PA read the results over the phone to me rather than have me wait another month to schedule a doctor's visit. She sent in the prescription for a ResMed Plus with passover humidifier and Comfor Classic nose mask and chin strap. I asked for and received a copy of a summary of the sleep study which indicated a mild sleep apnea (12.3 AHI). It also indicated I complained of nasal congestion. Why they went ahead and prescribed a nose mask seems to reveal a cookie-cutter response to sleep study information. Lucky for me, this forum exists and I learned quickly of the importance of selecting the right mask. I've been through a couple of masks so far (Respironics ComfortFull and ResMed Mirage Full Face Mask). It seems the ResMed mask works fine, but I would like to try some others. Of course, it seems this will be at my own expense. I have an appointment with my Primary Care Physician the 23rd and will mention this discrepancy between what the sleep study revealed and what they prescribed for me as a mask.

I'll post the results of my visit. I want to get a RemStar Auto CPAP and Encore software to monitor my therapy. I suppose what I will ask for is a prescription I can take to a DME (I love cpap.com) and buy the machine and software myself.

Thanks, again for your response.

Todd

Wulfman · Post by **Wulfman** » Sat Dec 10, 2005 3:55 pm

slumberer,

Will Kaiser reimburse you, if you purchase "out-of-pocket"?
The CPT code is the same for CPAP or APAP. Purchasing from CPAP.COM would save your insurance provider a lot of money over purchasing through a local DME provider. I purchased my equipment from CPAP.COM and then submitted an invoice to my insurance provider and they reimbursed me 80% of my purchase (except for the software and cardreader).

Another thought about the specific machine you want is if you want a REMstar machine with C-Flex, get your doctor to write " with C-Flex" on the prescription. There's only one manufacturer that owns that trade name.....Respironics.
If you are prescribed at a "fixed" pressure, you can still get an APAP.....it would just be configured for CPAP mode and at the fixed pressure.....until you decide to change it to APAP mode.

Good luck,

Den

snork1 · Post by **snork1** » Sat Dec 10, 2005 9:16 pm

Ah, Kaiser. I literally grew up on Kaiser in the Bay Area in California.

You mentioned nasal congestion.
My experience is if your nose doesn't work, CPAP won't work.
I would pursue the nose thing with Kaiser to get that working.
Either as simple as getting allergies or whatever is causing the regular congestion fixed, or getting the turbinates reduced or septum fixed if that is the problem.
Kaiser used to be pretty good about stuff like that, IF you pushed it.
I had my first "nose job" done at Kaiser. They didn't do a great job, but that was back in the '70's, so I am sure they have improved.

Get that nose working! It is amazing how much better CPAP works with a working nose!

slumberer · Post by **slumberer** » Sat Dec 10, 2005 11:47 pm

I had never considered the idea that CPAP therapy's success was so heavily dependent on a clear sinus. I assumed that the essential thing was a clear airway and breathing from the mouth seemed to me the equivalent of breathing from the nose only from a different orface (there's a word I don't use very often!!).

Anyway, thank you for the idea. I have an appointment on the 23rd and this forum has been great in helping me to collect my thoughts when I visit my doctor.

Thank you for your words of support and education.

Todd

Mackdog · Post by **Mackdog** » Sun Dec 11, 2005 10:26 am

I'm also with Kaiser and do have a auto cpap and heated humidifier. My process of getting auto cpap was getting a request from my dr and going thru Apria with the help of the resp. therapist. Kaiser will give you the passover humidifer first to see if that will work for you. The heated humidifer request is usually rejected and then you have to go thru the appeal process. The appeal process is just a letter from you and a medical necessity form sign by your dr.

slumberer · Post by **slumberer** » Sun Dec 11, 2005 2:16 pm

One question.....how did you convince your primary dr. that an auto cpap was necessary? were there compliance issues with the cpap?

thanks

Mackdog · Post by **Mackdog** » Sun Dec 11, 2005 4:38 pm

My primary dr is not familiar with cpap equipment. He would order anything that i wanted. Kaiser is not good with any follow up, so you will have to be proactive with your condition. Apria (DME) or my dr. never check to see if I was using my cpap or not.

slumberer · Post by **slumberer** » Sun Dec 11, 2005 5:57 pm

That has been my sense..."Well, he's got his equipment; that solves that!" is the sense I get.

Roger... · Post by **Roger...** » Tue Dec 13, 2005 6:54 pm

Over the weekend a friend mentioned that when he talked to Kaiser about his sleep problems, they made him make an appointment to get some equipment he would take home. After waiting in line for weeks, his turn arrived, he picked up the equipment and performed the test. The next day he returned the equipment and was told they would contact him in a few days. When he didn't hear back from from them after a few weeks, he called and was told they needed him to do the test over.

He has now made another appointment to get the equipment and should be able to take the text again sometime in January-06.

When he asked why the test needed to be taken again, they would only tell him there were problems with his test. When he asked what kind, they didn't really know because there wasn't any report available.

He likes Kaiser, but I'm not sure they aren't too busy to be attentive and careful.

CheapButterChicken · Post by **CheapButterChicken** » Tue Feb 10, 2015 3:46 pm

I just got my APAP from Kaiser -> it's a loaner though.

I had a dental visit, where my dentist was able to correlate some cavities to sleep apnea/dry mouth and my responses to the sleep apnea survey. She wrote a letter to my doctor at Kaiser and he scheduled a visit with the Pulmonary lab at Kaiser. They gave me a take home machine (which I am told traditionally produces more false negatives than false positives). You take it home for the night, and then come in the next day -> you can either do a drop-off, or you can stay and get assessed. I chose the latter.

They determined that I stop breathing on average 18.1 times per hour over a 6.5h period. They gave me a loaner APAP machine and talked me through the setup of it. I will use it for a week and then go in to talk to them. If they determine that the APAP made a quality difference for me, then they'll put one through on my insurance (if my insurance covers it)

This is now the part where I am stuck -> will my Kaiser insurance cover an APAP machine? Don't know. Kaiser's client portal won't let me find that info easily.

Wulfman... · Post by **Wulfman...** » Tue Feb 10, 2015 4:18 pm

CheapButterChicken wrote:I just got my APAP from Kaiser -> it's a loaner though.

I had a dental visit, where my dentist was able to correlate some cavities to sleep apnea/dry mouth and my responses to the sleep apnea survey. She wrote a letter to my doctor at Kaiser and he scheduled a visit with the Pulmonary lab at Kaiser. They gave me a take home machine (which I am told traditionally produces more false negatives than false positives). You take it home for the night, and then come in the next day -> you can either do a drop-off, or you can stay and get assessed. I chose the latter.

They determined that I stop breathing on average 18.1 times per hour over a 6.5h period. They gave me a loaner APAP machine and talked me through the setup of it. I will use it for a week and then go in to talk to them. If they determine that the APAP made a quality difference for me, then they'll put one through on my insurance (if my insurance covers it)

This is now the part where I am stuck -> will my Kaiser insurance cover an APAP machine? Don't know. Kaiser's client portal won't let me find that info easily.

Have you asked THEM?
But, instead, you've resurrected a nine year old thread to ask this question?

From what I've heard about Kaiser.......not likely........but you won't know for sure until you ask them.

Den

.

Janknitz · Post by **Janknitz** » Tue Feb 10, 2015 7:31 pm

Kaiser has many plans. If you are Medicare Kaiser--known as Kaiser Senior Advantage--most definitely yes. Otherwise it depends on your plan. You can call Member Services and they will tell you your DME coverage. If you have DME coverage with Kaiser, prepare yourself. You have NO choice in machines because technically Kaiser is your DME. They choose the model and the brand and if you don't like it you can buy your own without ANY Kaiser coverage.

Then Crapria (Apria) is your supplier. No choice.

In some respects no DME coverage is best with Kaiser because then you buy what you want and where you want, BUT you get no help paying for it from Kaiser. If you still choose to take the machine Kaiser prescribes from Crapria at least you may get Kaiser's steeply discounted cost (I think).

Leland · Post by **Leland** » Tue Feb 10, 2015 11:37 pm

My old CPAP broke a few years ago and Kaiser got me a Respironics System One with a heated humidifier, and a Swift nasal mask. I requested a heated hose, which they issued, but said I would have to pay for it myself. But they never billed me for the hose. Now I get replacement heated-hoses with no question. Everything comes out of Apria. Dealing with Apria is easy. When I need a supply, I call them and the item shows up on my doorstep a few days later.

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Additional Comments: Pressure Range=7cm---15cm Avg. AHI 0.6