California Kaiser CPAP coverage?

grayghost4 wrote:Quote : I have visions of a seedy alley where people sell CPAPs to unsuspecting newbies out of the trunks of dilapidated cars... LOL

About half of my cpap's are out of the back of my car to Kaiser people, at Starbucks ... not a seedy alley .... and the car is not dilapidated.

If you are interested in a new or used unit from me . send a pm

http://sfbay.craigslist.org/eby/hab/5789958898.html

Question:

What if something is wrong with it or it smells from cigarette smoke?

avi123 wrote:

grayghost4 wrote:Quote : I have visions of a seedy alley where people sell CPAPs to unsuspecting newbies out of the trunks of dilapidated cars... LOL

About half of my cpap's are out of the back of my car to Kaiser people, at Starbucks ... not a seedy alley .... and the car is not dilapidated.

If you are interested in a new or used unit from me . send a pm

http://sfbay.craigslist.org/eby/hab/5789958898.html

Question:

What if something is wrong with it or it smells from cigarette smoke?

question:
What if you've lost your mind?

Hello everyone I just want you all to know that Anthem Blue Cross isn't any better through the unaffordale care act. I tried to find a Doctor who specialized in Sleep Apnea and they all took Anthem just nor Covered California. I thought Kaiser would work but after spending hours on the phone with them you are all correct. They do not cover CPAP. I guess they don't care if people die. I mean Hello I don't think my husband would choose to sleep with it just for giggles. I'm pretty sure it's to keep him from dying in his sleep. I am beyond angry.

Janknitz wrote:Neal,

1. All signs point to you not having coverage BUT don't assume that. Get that Evidence of Coverage booklet and find out for sure.

2. Crapria is a real Pain in the a$$ to deal with--they've earned their nickname. BUT it's worth checking out the Kaiser pricing. And Kaiser is now doing ResMed AirSense machines--but whether you can get an auto from Crapria is up to Kaiser (it's NOT up to Crapria, so don't even bother arguing with them--your DME is Kaiser, Crapria is only the supplier--this would not be the case if you were not a Kaiser member). Ask for the prescription in hand to see what it says and then find out from Kaiser DME what the Crapria price is.

Otherwise you can go anywhere (Secondwind is a good option, or our hosts if you want new) and you won't have to put up with Crapria's crap and almost 100% billing error rate.

BTW, NEVER give Crapria your credit card number. NEVER.
And don't believe a word they tell you. Act like a reporter for the Times--validate everything they tell you.

Hi - I just joined this group and this is the first post I see... about not giving Apria my CC #...which I just did. What did I just set myself up for by doing so?

Nancy, when I first started I didn't know any better either. I didn't have a problem with misuse of the card but did with them wanting to automatically ship supplies. I told the not to ship or call until I ordered. I think that helped with not having unwarranted charges. I monitored my CC account and made sure there was no unusual charges.

After my machine was paid for I told them to remove the card. I know they did remove it because when I reordered, they didn't have one on file.

Would I do things differently now sure. You could get the prepaid card with the total of your machine payments on the card, have them remove your old card and give them the prepaid.

I'm not sure if this will help anyone here but... It's correct that Kaiser doesn't cover any CPAP machines if you purchase your insurance through the ACA. However, if you receive Kaiser coverage through Medi-Cal you will be covered for whatever machine your Kaiser doctor orders. I was just seen by the new sleep specialist they have at the Woodland Hills center so sleep specialization is something new starting in the valley but Kaiser does have their own in house sleep lab at the Sunset location. Fortunately, being out of work so long I have depleted state disability and unemployment that I'm now poor enough to qualify for Medi-Cal administrated through Kaiser (I had Kaiser when I went on Medi-Cal so I was allowed to keep my Kaiser coverage).

Kaiser's at home sleep study had me come back with an AHI over 90 so I was delivered a new Aircurve 10 from Aprpia the other day at no cost and was surprised that it was a straight out purchase and not even a rental. My AHI is down to under 2.0 now and sleeping is like a miracle now! There really needs to be a way to bring these machines to everyone at a lower cost or made mandatory through the ACA DME formulary where it needs to cover everything that Medicare and Medi-cal do.

There really needs to be a way to bring these machines to everyone at a lower cost or made mandatory through the ACA DME formulary where it needs to cover everything that Medicare and Medi-cal do.

Unfortunately, you can kiss it all goodbye when they get done "fixing" the affordable care act. MAGI Medi-Cal (Medicaid expansion under ACA) that you are on will be the first program cut. Unless you qualify as medically indigent by owning less than $2000 worth of assets (not counting your home and one car) you'll be "invited" to join a high risk pool at an astronomical monthly cost you'll never be able to afford. And if block grants go through, your coverage for CPAP is likely to
End because of more pressing priorities. It will end of medical coverage unless you are very poor or very wealthy.

So stock up on supplies now and get all the preventative care you can. What we "need" and what we'll get are not the same thing. Enemy countries won't have to resort to terror, they can just watch us all die from lack of needed medical care.

I am currently going through the Kaiser Nightmare, premium coverage not through obummercare

Jan 19, overnite wrist thingy, diagnosed with SA
Jan 23 Overnite sleep study at the Manteca Sleep lab
Jan 27 Phone call & was told BiPAP was ordered thru apria (I remember she said its about $800 machine so my cost would be around $80)

Received denial letter due to my address

Feb 9 spent waaaaaay too long on the phone with my insurance broker and Kaiser DME
was told address issue is resolved, machine ordered and should ship 2-4 days

Feb 23 called DME, they should have a tracking number right? some idea where the machine is?
Nope, no clue, the yahoo I talked too had nothing except the original denial. No record of re-ordering, no record of anything my broker fixed.

Feb 23, unleashed the hounds

March 2, hourish ago broker called me with some information. the issue doesn't seem to be with kaiser with my address (right to work/live) but with apria. apria doesn't recognize the right to work/live, they just see my address and automatically deny it, and not tell anyone about the denial.
Broker promised me she would get some answers and issue resolved today.
fingers crossed


Kicker is, have a follow up appointment on the 22nd. you know, the appointment after one has had a couple months to get adjusted to life with a CPAP?
yea, thats not going to happen. will be rescheduling that appointment.

KenM wrote:I am currently going through the Kaiser Nightmare, premium coverage not through obummercare

Jan 19, overnite wrist thingy, diagnosed with SA
Jan 23 Overnite sleep study at the Manteca Sleep lab
Jan 27 Phone call & was told BiPAP was ordered thru apria (I remember she said its about $800 machine so my cost would be around $80)

Received denial letter due to my address

Feb 9 spent waaaaaay too long on the phone with my insurance broker and Kaiser DME
was told address issue is resolved, machine ordered and should ship 2-4 days

Feb 23 called DME, they should have a tracking number right? some idea where the machine is?
Nope, no clue, the yahoo I talked too had nothing except the original denial. No record of re-ordering, no record of anything my broker fixed.

Feb 23, unleashed the hounds

March 2, hourish ago broker called me with some information. the issue doesn't seem to be with kaiser with my address (right to work/live) but with apria. apria doesn't recognize the right to work/live, they just see my address and automatically deny it, and not tell anyone about the denial.
Broker promised me she would get some answers and issue resolved today.
fingers crossed


Kicker is, have a follow up appointment on the 22nd. you know, the appointment after one has had a couple months to get adjusted to life with a CPAP?
yea, thats not going to happen. will be rescheduling that appointment.

I know this as annoying as hell thanks to Crapria, but this will get resolved and fade into history. The good news is you have coverage, $80 out of pocket for a BIPAP (including hose and mask) is a piffle and you will soon be getting treatment for serious apnea. WIN!

Patience.
Know that in the ultimate justice of life and death, the turds who have caused you suffering will get theirs.

Janknitz wrote:

There really needs to be a way to bring these machines to everyone at a lower cost or made mandatory through the ACA DME formulary where it needs to cover everything that Medicare and Medi-cal do.

Unfortunately, you can kiss it all goodbye when they get done "fixing" the affordable care act. MAGI Medi-Cal (Medicaid expansion under ACA) that you are on will be the first program cut. Unless you qualify as medically indigent by owning less than $2000 worth of assets (not counting your home and one car) you'll be "invited" to join a high risk pool at an astronomical monthly cost you'll never be able to afford. And if block grants go through, your coverage for CPAP is likely to
End because of more pressing priorities. It will end of medical coverage unless you are very poor or very wealthy.

So stock up on supplies now and get all the preventative care you can. What we "need" and what we'll get are not the same thing. Enemy countries won't have to resort to terror, they can just watch us all die from lack of needed medical care.

Yeah, I'm fortunately (unfortunately?) falling into the extremely poor category so I will be able to get the proper medical care to keep me alive and a burden on society. Sarcasm and joking aside, it's a shame that our society seems to feel differently about the need for universal healthcare. I look at healthcare in the same light as public police and fire services, it's an essential need that should provided to those in need.

KenM wrote:I am currently going through the Kaiser Nightmare, premium coverage not through obummercare

Jan 19, overnite wrist thingy, diagnosed with SA
Jan 23 Overnite sleep study at the Manteca Sleep lab
Jan 27 Phone call & was told BiPAP was ordered thru apria (I remember she said its about $800 machine so my cost would be around $80)

Received denial letter due to my address

Feb 9 spent waaaaaay too long on the phone with my insurance broker and Kaiser DME
was told address issue is resolved, machine ordered and should ship 2-4 days

Feb 23 called DME, they should have a tracking number right? some idea where the machine is?
Nope, no clue, the yahoo I talked too had nothing except the original denial. No record of re-ordering, no record of anything my broker fixed.

Feb 23, unleashed the hounds

March 2, hourish ago broker called me with some information. the issue doesn't seem to be with kaiser with my address (right to work/live) but with apria. apria doesn't recognize the right to work/live, they just see my address and automatically deny it, and not tell anyone about the denial.
Broker promised me she would get some answers and issue resolved today.
fingers crossed


Kicker is, have a follow up appointment on the 22nd. you know, the appointment after one has had a couple months to get adjusted to life with a CPAP?
yea, thats not going to happen. will be rescheduling that appointment.

Hang in there, this is typical for Kaiser and Aprpia.

Kaiser sent me for to an outside sleep lab for a titration study to determine the correct pressure readings for my cpap machine except that I was never issued a cpap machine at the time of the study. The only good thing that did come out of the overnight study was the finding that my O2 saturation was dropping down into the 50's and 60's for a significant amount of time. Sleep apnea seems to be something new to Kaiser and they haven't developed their programs very well in response to the huge number of patients that are being diagnosed.

Also, if you need a bipap machine, Socal Kasier is using the AirCurve 10 which runs about $1750 not $800 (the $800 machine from Apripia is the AirSense 10 which is cpap only). Make sure Apripia gets you the machine your doctors order so you don't get stuck with something that won't help you the most. A 10% copay for DME is great too and a real bargain. Even after 25 years in a union job our Kaiser DME coverage had a 40% copay!

I've been a member of Kaiser Permanete in Norther California for 50 years. As to coverage for PAP is depends upon the Plan. In Northern California, I bought my BiPAP under private employer insurance. I lost my job and had to go onto MediCal. Under MediCal, everything PAP was free.

I was just shy of getting a new machine when Affordable Care Act kicked in and I qualified for it by $200 annually, instead of being on MediCal. Under ACA (Covered California), none of the plans covered any PAP supplies.

I'm now on Kaiser Senior Advantage (Medicare Supplement), PAP supplies are covered. But if I get a new machine, I'll never own it. Ownership will remain with Kaiser and they only replace it if it's unrepairable.

Under Kaiser coverage, no matter the policy, the DME is Apria. I haven't had any problems with Apria as DME with Kaiser. Under ACA, when I had no Kaiser coverage for PAP supplies, Kaiser gave me my Rx upon request and I went shopping around. I learned how to keep repairing my mask by finding the necessary parts (cushion, forehead bar, headgear, etc.) at discount and third parties (Craigslist, eBay). Now that I again have coverage, I order supplies when on time and have now a stockpile!

March 10th
Still being jerked around
Now Kaiser wants a appeal form?
I am starting to think this will take MONTHS.

I asked my HR if she can look into the possibility of reimbursement if I was able to obtain my prescription and order the DME myself online.
Don't want to go this route because of the hassle I went through last year with the eye doctor.

March 15
Apria Healthcare called today to verify the Kaiser prescription.
The prescription expired so had to call my doc to get it renewed.
The nearest Apria center makes their own appointments, they are supposed to call within the next 24 hrs to schedule a pick-up and fitting appointment.
here's hoping that I can get this done this week.


Oh, as for the overnite sleep study. I finally received the bill.
Total cost: $2,612
My Cost: $40

I'll pay that bill once I get my BiPAP