Re: Excerpt from my new insurance policy D:
Posted: Mon Jul 04, 2011 12:19 pm
I HATE sounding like a Kaiser cheerleader, because really I am not (I'm a very loud critic of some of their stupider policies!). But, I think they have it right when it comes to OSA, at least in my region (Northern California). They have an aggressive program to get people diagnosed and treated for OSA and related disorders.
Now, this costs Kaiser. Kaiser runs its own testing and titration and it is its own DME (assuming your plan has DME coverage). They do all this economically with home sleep studies and home titrations, but they do it. And they provide a significant amount of patient education along with good quality equipment and supplies, albeit from a limited formulary selections (your only choice for machines is Philips Respironics, there's a limited choice of masks). Because the volume of Kaiser members on CPAP is high, they can negotiate their own very beneficial deals with Crapria as the supplier. But I'm sure it's still costly.
Kaiser sees the value in this because if the CPAP treatment reduces or prevents complications from high blood pressure, atrial fib, obesity, diabetes, etc. they are WAY ahead of the game financially. This is one area where they really do a good job at being a health MAINTENANCE organization and practicing preventative medicine. Smart insurers should be doing this too, those who don't will not survive in the long term. It's one reason that Kaiser in my area has a huge saturation, munching up a large percentage of the employer and private insured market, and (sadly) putting other hospitals and private doctors out of business.
Now, this costs Kaiser. Kaiser runs its own testing and titration and it is its own DME (assuming your plan has DME coverage). They do all this economically with home sleep studies and home titrations, but they do it. And they provide a significant amount of patient education along with good quality equipment and supplies, albeit from a limited formulary selections (your only choice for machines is Philips Respironics, there's a limited choice of masks). Because the volume of Kaiser members on CPAP is high, they can negotiate their own very beneficial deals with Crapria as the supplier. But I'm sure it's still costly.
Kaiser sees the value in this because if the CPAP treatment reduces or prevents complications from high blood pressure, atrial fib, obesity, diabetes, etc. they are WAY ahead of the game financially. This is one area where they really do a good job at being a health MAINTENANCE organization and practicing preventative medicine. Smart insurers should be doing this too, those who don't will not survive in the long term. It's one reason that Kaiser in my area has a huge saturation, munching up a large percentage of the employer and private insured market, and (sadly) putting other hospitals and private doctors out of business.