My experience with Kaiser Permanente

[juaquin]

Wanted to write this so others who have Kaiser know what to expect. Of course everyone's insurance plan is different, each sleep lab is probably different, etc. Take it with a grain of salt.

I mentioned to my general doctor (Primary Care Physician) that I occasionally had something like eye strain or (what I now understand was) brain fog, and that my wife had long complained about my snoring. He suggested referring me to the sleep lab, and mentioned they had at-home sleep tests. I agreed - better safe than sorry - and it was scheduled for a week or two later.

My appointment with the sleep lab consisted of checking in, waiting a little while, and then being pulled into a room with another patient where we watched a video about how the at-home test machine worked (it was a WatchPat device if anyone is curious). I took it home and did as instructed, then returned it the next morning.

A couple days later I got the results in a message (available via their app or the website). Moderate obstructive sleep apnea, 16 events per hour. Not unexpected, but also not a fun thing to learn. The message included instructions to call and schedule an appointment to pick up a machine. I booked an appointment about a week later.

At the appointment I met with the RRT who went over the results. He gave me a loaner Airsense 10 Autoset with a new humidifier tank, slimline hose, antibacterial filter, and a F&P Brevida nasal pillow mask. It was set to 4-20 and I would have it for two weeks for titration (normally one week but the next appt they had was in two weeks).

At the end of the two weeks I brought back the machine and the data was analyzed. The machine was preventing almost all OSAs and my events per hour was in the 2-4 range mostly. The RRT then gave me a brand new Airsense 10 Autoset, keeping the hose/mask/humidifier I had been using, and an Airfit P10 mask to try as an alternative to the Brevida. The pressure was set to 4-12. I asked for my prescription so I could potentially order a travel machine and they were happy to provide it.

I signed an Apria contract for the machine which listed the value as something like $2200, though the RRT changed that to somewhere in the $700 range and said that my copay (based on my specific plan) was 20% of that and I would be sent a bill. I have not yet been sent that bill a month later and will update this if/when I do receive it. I believe Apria is the "supplier" though Kaiser fulfills the role of "DME" - all requests for type of equipment go through Kaiser, though the actual fulfillment and reordering is done through Apria.

I received a brand new full Brevida mask a week later (via Apria). A week after that I decided I liked the P10 better and navigated the sleep lab phone system to ask them to change my mask in the "system" to the P10. They did so and I received a full P10 mask less than a week later, since you can change your mask once within the first month.

I had a one-month telephone check-in with the RRT, in which they confirmed they saw my data in ResMed's system and it looked like things were going pretty well (including compliance). They did not mention seeing that I had changed a bunch of clinical settings on my machine, including turning EPR off, setting the ramp pressure to 7cm so I felt like I could breath, and changing the range to 9-14 as Sleepyhead showed I rarely went under 10 anyway. During the call I mentioned that I had experienced some rainout and had ordered a heated hose and it worked great - the RRT was happy to order one for me and I received one from Apria about a week later.

Honestly I think overall it was a good experience. The cost to me was very little - $20 for the primary care visit (which was initially unrelated to sleep apnea), $0 for the home test and followup, $0 for the home auto titration and followup, and supposedly 20% of equipment costs (though I have yet to receive a bill and will update when I do).

I have only two complaints:

1) No substantial explanation of what was going on was provided until I met with the RRT to pick up the machine for titration. At the initial sleep lab visit, I wasn't told anything about the overall process or much about the possible conditions they were testing for beyond my own understanding of sleep apnea and what I read online. This could be improved.

2) The sleep lab process is not as well integrated as the rest of Kaiser. Appointments must be booked by calling the sleep lab instead of via the app/website or even calling the general appt line. You reorder supplies by calling a special Apria line instead of through the app/website (which you can do with drug prescriptions). There is no easy way to talk to your RRT - you have to call the sleep lab front desk and hope they can help you or put you through to someone, which for me took several calls. With my primary care provider, I can send them a message or schedule a video call through the app/website any time. It feels very archaic, which is unfortunate because honestly I will probably spend more time talking to the sleep lab than my primary care physician for the foreseeable future.

Anyway, sorry for the wall of text, but I hope this helps someone know what to expect and makes the process easier for them.

[Scluvsrain]

I experienced pretty much the same as you with my Kaiser facility here in the Sacramento, California region. It is indeed a PITA to try to get to the sleep lab to discuss results or ask questions when dealing with other areas in Kaiser are so nice and streamlined. Once you connect with the sleep center they are very helpful, but it takes a little doing to get connected.

I, too, paid about $120 for my Resmed Airsense 10. The one thing I didn’t get, because I didn’t know to ask at the time, was my prescription, but that’s on my to-do list for when I get home from traveling.


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[Stom]

"The sleep lab process is not as well integrated as the rest of Kaiser. Appointments must be booked by calling the sleep lab instead of via the app/website or even calling the general appt line."

Similiar to my experience, except I don't have DME coverage and at the post titration appointment they take back the titration unit and tell you to go buy one instead of handing you a new one like they do for people with DME coverage. Since I have moderate sleep apnea, going without a unit until i could source one wasn't a huge deal, but that system seems pretty stupid for patients with more severe apnea. They really should schedule some overlap, getting you a script and allowing some time to source a unit before they take back the titration unit.

Gotta say the appointment system is pretty wonky. I can almost never get a person at the appointment line. You have to leave a message and they eventually call you back, which is just weird given how easy it is to make other appointments at Kaiser. And the message they sent to me that said they try to respond to messages within 1 business day? Yeah, I replied with a question and never heard back from them. So they are a bit wonky.

But, even for patients with no DME they will give "mask fittings" and send you home with a mask. But the appointment isn't free, though the co-pay is less than you'd pay for a mask from a supplier like the forum sponsor. After that you are on your own to buy more of the mask that works for you.

[no_more_headaches]

I switched to Kaiser from Blue Shield this year because of the big jump in Silver plan prices in California. Next year I jump to Medicare and most likely back to Blue Shield.

The one big surprise I found out was that Kaiser under Covered California does not have a DME benefit so I have to pay for all CPAP supplies out of pocket but it beats paying an extra $4K a year to get Blue Shield which does have a DME benefit.

[beautifuldreamer]

My Kaiser Experience has been very positive, as my Kaiser coverage covers all the DME costs for my PAP equipment and supplies.

Whenever I have a question, I can message my RT and or Sleep Doctor, and both are very responsive. I do not have to pay a co-pay for meeting with my RT, but I do pay 15 dollars for visit with my Sleep Doctor.

When I had my first home study (which was in the North Bay area), I didn't receive much information after the titration, and I had to call and find out what was going on. Then they said that the titration with the auto cpap didn't seem to help my apneas. So, they sent me to an overnight study. After the overnight study, I received a phone call from a Sleep Doctor who explained a lot to me. I have to admit, I found out more information from this forum than anywhere else.

I wanted to try a BiPAP - was going to by a used one, and initially Kaiser was going to let me borrow one to check out how I did with it - and my plan was if I did well with it, I was going to buy the used one I saw for sale on this forum. After I finished my week with the biPAP from Kaiser in the North Bay, they looked at the stats and then said that they would write a prescription for me so I got one covered fully by the DME.

A couple years later, I had a sleep study to check out why I still had daytime sleepiness, and during the night study, they said I had centrals, and had what was called Mixed Sleep Apnea, and had to get an ASV device. This is also fully covered by my current plan, Kaiser pays Apria a rental fee, which I don't have to pay.

All this to say, I have actually had a very good experience with Kaiser related to Sleep Apnea. My sleep doctor is a very good listener and is trying to help me . . .Right now we are determining of I might be helped by using a dental appliance since I still experience day time sleepiness and have difficulty getting a deep night of rest during the night while using PAP. . . Also trying to see how the newest settings my Sleep Doctor adjusted for me might help me to sleep better as well . . .

My experience might also be due to using the San Jose Kaiser- my favorite RT who retired a couple of years ago, after I told her that since she was retiring I might shift to a Kaiser closer to where I lived and then she said that she wouldn't recommend that because the San Jose Kaiser had better service than the Kaiser I was thinking of shifting to-

Also to note, I have had good experience with Apria as well- could be because I pay nothing for my PAP equipment and supplies. On occasion, I do get the wrong supplies sent to me and then I contact them to get it resolved.

[Janknitz]

These experiences with Kaiser are pretty typical. Overall it's a pretty good system when I hear about the nightmares other people have gone through. The one bad point is dealing with Crapria--examine any bills CAREFULLY as mine have been wrong 100% of the time, or they don't send exactly what was ordered.

The Kaiser ACA plans do have DME, but other than crutches or canes they don't seem to cover anything. So on an ACA plan you are out of pocket for CPAP and supplies. BUT, if you are willing to deal with Crapria you get Kaiser's pricing on the stuff and that might save you some money. I was actually thrilled when I lost DME coverage (fortunately right AFTER I got a brand new machine) because I no longer have to deal with Crapria for my supplies. I buy them off of Amazon--decent prices, no hassles!

The telephone contact is a PITA. We end up in an endless game of telephone tag because I'm not always available to take calls due to my work. And nobody EVER gives you a direct number, so you ALWAYS have to deal with their department's general voicemail box. When I am returning a call is about the ONLY time I have to talk to them and I never get a human.

[Stom]

BUT, if you are willing to deal with Crapria you get Kaiser's pricing on the stuff and that might save you some money.

That was my dilemma with Kaiser. The special "no DME" Kaiser pricing from Apria with a 4 year warranty was the better than any authorized on-line pricing. ResMed tightly controls their advertised minimum pricing by contract, and the standard warranty is 2 years. But, to actually use the extended warranty from Apria I'd have to go through, ahem, Apria...the company that is almost universally reviled for terrible service. And I'd have to give Apria my credit card number to buy the machine in the first place, which I've read is a terrible mistake when dealing with Apria, which will attempt to auto ship supplies on the max medicare schedule (the one used by many other insurance plans). So I skipped Apria to save some grief.

[SnoringInOregon]

Location, location, location.

This is a situation where location matters. "Kaiser" isn't the same everywhere.

E.g. in Oregon, Kaiser itself is the DME. I obtained my Dreamstation by walking into a Kaiser Permanente facility and walking out with a machine. Apria not involved at all.

[Stom]

Location, location, location.

This is a situation where location matters. "Kaiser" isn't the same everywhere.

E.g. in Oregon, Kaiser itself is the DME. I obtained my Dreamstation by walking into a Kaiser Permanente facility and walking out with a machine. Apria not involved at all.

Interesting. In CA, I've heard that Kaiser is the DME, but Apria is their contractor. People with DME coverage walk out of their titration debrief at a Kaiser titration department with a new ResMed, but resupply is through Apria as Kaiser's supplier. Apria may not be the "DME" per se in CA for Kaiser, but patients still have to go through Apria for some supplies and Apria can still have terrible service, as the yelp reviews from Kaiser patients using Apria show.

[jamesbond007]

Surprised to hear a borderline good story about Kaiser. All I have noticed first hand are a bunch of incompetent doctors and lab technicians as far as general care is concerned.

[Scluvsrain]

Surprised to hear a borderline good story about Kaiser. All I have noticed first hand are a bunch of incompetent doctors and lab technicians as far as general care is concerned.

I’ve had absolutely outstanding care from my Kaiser. In every aspect. Labs, RX, primary care, vaccinations, surgery and even the ER.


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[ChicagoGranny]

I will probably spend more time talking to the sleep lab than my primary care physician for the foreseeable future.

If you use the resources here, this is little to no reason to speak to the sleep lab.

[hobbs]

Next year I jump to Medicare and most likely back to Blue Shield.

It's not cheap, but I have paid $0.00 for anything except precriptions, including a new Airsense 10 Autoset, when I turned 65 in December 2015.

Medicare Supplement in California:

2016 = $138.60 a month
2017 = $153.70 a month
2018 = $179.15 a month
2019 = probably more $

[juaquin]

Surprised to hear a borderline good story about Kaiser. All I have noticed first hand are a bunch of incompetent doctors and lab technicians as far as general care is concerned.

I’ve had absolutely outstanding care from my Kaiser. In every aspect. Labs, RX, primary care, vaccinations, surgery and even the ER.

I have to agree, myself and several family members have been very happy with the overall level of care Kaiser provides.I'm sure some locations and doctors are better than others of course. If anything my "complaints" with the sleep lab compared to the rest of the operation show how much I've come to expect from Kaiser.

If you use the resources here, this is little to no reason to speak to the sleep lab.

While the resources here are great, especially for those who don't have a competent healthcare provider they can trust, I still think it's a good idea to keep a professional in the loop if possible. It doesn't cost anything, and this is my health after all. Plus, going through insurance gets me free/reduced supplies, and you need to go through the sleep lab to modify your "approved" supplies. Would much appreciate if they built messaging the RRT and ordering supplies into the app/website though!

[m421]

Interesting to hear they let you change your mask. I’m in week three, went in to try different masks, and they told me I just have to get used to what I have. I’ve been going to the Santa Clara location.