Insurance changed to Kaiser - new study?

[adrianne]

I've been a very happy CPAP user for about 4 years now, I can't sleep without it at this point! My insurance changed to Kaiser at the beginning of the year (not a problem, I actually like Kaiser), but my sleep study is 5 years old and she wants me to have a new one. I'm picking up a home study thingy on Monday morning. What should I expect? Will I have to sleep without CPAP to do the study? I wouldn't mind getting a new machine, but I read around here a bit and people are saying that with Kaiser you have to use a loaner machine for a week to titrate with no humidifier??? That's like criminal.

I'm grumpy and I just wanted a fresh mask and now I have to deal with all this shit. Hopefully the mask I like will be available from them.

[dreamzone]

Hi, adrienne - I also have Kaiser, but started from scratch, with no previous dx of OSA.

The Kaiser home sleep study is almost too easy. You wear a wristband and a pulse oximeter. That's it. And, I would imagine, that they would expect you to do it without your CPAP, if only to justify the fact that you DO need one. I know, sucky.

Then you get your loaner for a week, and no, there is no humidifier. BUT - if the loaner machine happens to be the same model you use now, perhaps you could use your own humidifier? Ask your Sleep Lab Tech.

They do need a certain number of hours of sleep to get their data from the wristband thingy, and they didn't get it from me. So I had to do the next level study - still at home. I had to wear three bands around my midsection, with an electronic box on my stomach, and - I think - a cannula somewhere near my mouth.... sorry, it was right after a head injury, so my memory is a bit fuzzy. THAT got them the data they needed to make a dx.

At least you have your own machine to use while going through the tests and waiting period for a dx, Rx, DME approval, and your new machine with correct titration.

In my very limited experience, it's very easy to get new masks to try. But since they give them to you at no charge, and our hospital has a LOT of apnea patients, sometimes the Sleep Lab is out of certain types of masks or sizes. They won't make you get anything unless you've been able to try it on during a scheduled "Mask Fitting" appointment, though. I have had nearly a dozen of those.

Good luck!

[adipasqu]

It kinda sucks that Kaiser can't accept your current Rx and issue you a new machine based upon that, especially if you can prove compliance and medical necessity by showing them your data. But that's Kaiser for you...the Kaiser way or fuggettabout it. You will have to be off of CPAP for the WatchPat test and, worse yet, you may have to stop for a few days before the test to make sure there are no residual effects from your current CPAP therapy for an accurate home test.

As for the titration machine: they gave me a Remstar M Auto way back when and I lasted about 30 seconds without the humidifier before my nose closed shut. I went back the next day, told them I needed humidity or I couldn't proceed, and they swapped it out for a Series One Auto with humidifier. Ask them for a humidifier, since you need one for your current therapy, and hopefully they give one to you.

[chunkyfrog]

Sleep on your back as much as you can, especially if your apneas occur in the supine position.

[adrianne]

Ugh. I'm a grad student. I can't afford time without CPAP therapy. I find it very hard to fall asleep without CPAP now and wake with miserable headaches.

I'm going to try to push them to accept my previous diagnosis of OSA and maybe I can just re-titrate? I'm willing to do that.

I'm also now becoming worried if they do make me do the full study - how do they determine diagnosis of OSA? I had low AHI in my previous study but a crazy high number of RERAs. The sleep doc said that my brain tended to wake me up before full-on apnea. Based solely on AHI from the previous study I don't think I qualify for a diagnosis of OSA.

[adrianne]

I'm also now becoming worried if they do make me do the full study - how do they determine diagnosis of OSA? I had low AHI in my previous study but a crazy high number of RERAs. The sleep doc said that my brain tended to wake me up before full-on apnea. Based solely on AHI from the previous study I don't think I qualify for a diagnosis of OSA.

I just found my titration report from 2009:

"Note that on a prior all-night polysomnogram, this patient was demonstrated to have severe obstructive sleep apnea syndrome/upper airway resistance with an overall Apnea/Hypopnea Index (AHI) of 3.2/hour and Respiratory Disturbance Index (RDI) of 82.4/hour."

[chunkyfrog]

I don't know if the Watch-Pat is capable of collecting data related to that.

[adipasqu]

I don't know if the Watch-Pat is capable of collecting data related to that.

It is. I received both an AHI and an RDI from both of my Kaiser WatchPat sleep studies, so she should be re-diagnosed unless something with her has changed physically (loss of weight, tonsillectomy, etc.).

[adrianne]

I don't know if the Watch-Pat is capable of collecting data related to that.

It is. I received both an AHI and an RDI from both of my Kaiser WatchPat sleep studies, so she should be re-diagnosed unless something with her has changed physically (loss of weight, tonsillectomy, etc.).

I've gained a considerable amount of weight, so if anything it should be worse. Not that I'm excited about the prospect of a CPAPless night of sleep. Last time our power went out I did not sleep well at all.

[adipasqu]

I don't know if the Watch-Pat is capable of collecting data related to that.

It is. I received both an AHI and an RDI from both of my Kaiser WatchPat sleep studies, so she should be re-diagnosed unless something with her has changed physically (loss of weight, tonsillectomy, etc.).

I've gained a considerable amount of weight, so if anything it should be worse. Not that I'm excited about the prospect of a CPAPless night of sleep. Last time our power went out I did not sleep well at all.

Not that this is a serious suggestion, but you could always enjoy an adult beverage to help fall asleep and get that AHI and RDI up a little.

Its situations like this I am glad I held on to that Ambien prescription that I never finished for my titration study. Will your PCP write you a prescription for a single Ambien pill to get through one night of hell? Never hurts to ask.

[kaiasgram]

I don't know if the Watch-Pat is capable of collecting data related to that.

I looked at my Watch-Pat report from a couple of years ago (also with Kaiser at the time) and it does report an RDI. But the Watch-Pat collects a limited amount of information and I don't know how accurately it will report the RDI and RERAs.

[sleep_quest]

By any chance have you checked to see what your DME coverage is with Kaiser? You may be going through all of this and find out you'll have to pay out of pocket for anything you get if you haven't met your deductible. If that's the case and you are just trying to get a new mask and/or a new machine it just might be cheaper to look elsewhere. If you are looking for a new prescription then your dentist may be able to help you with that. However if you are looking to build a relationship with your Kaiser primary doctor and the sleep staff then that answers that.

I am with Kaiser and got an unfortunate shock with the new year...my DME coverage won't kick in until I have paid a substantial amount of out of pocket expenses first. I'm resigned to getting my supplies off eBay or Amazon and I'm still kicking myself for not calling and ordering them in December when I'd planned to. I waited until 1/2 and was told they weren't covered.

Good luck!

[demogirl2015]

Does anyone know if caremore cover CPAP machine

[chunkyfrog]

@Demogirl: insurance companies make different deals with every employer. Every plan is unique.
Ask your personnel or benefits manager for an official print-out of your DME coverage.
Get it in WRITING!

[Janknitz]

They may let you skip titration if the data on your card shows good ahi control. If you do need titration they may use PRS1's and you can just attach your own humidifier.