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How to Replace Your CPAP in Only 666 Days
- sour-taste 3y agoThis made me furious. I would have given up long ago, which of course is what anthem wants. Congrats to the author for sticking with it.
- pockybum522 3y agoThis feels like every health insurance endeavor I have ever attempted. In any other industry, this would be called "fraud."
- legutierr 3y agoIn any other industry he would have switched to a company that was better run.
- gotbeans 3y agoCongrats on triggering my chronic anxiety. I dread the day I require anything complicated that requires medical/insurance bureocracy in this country. I've had already ungodly share of issues with Aetna because they capitalized my surname.
- chromakode 3y agoI had my first serious medical procedure a year and a half ago, which required a rare specialist. My insurance, Anthem Blue Cross, covered everything, and called and mailed me ahead of time confirming my hospital stay at UCSF was approved and in network. So, YMMV.
- joatmon-snoo 3y agoAnother avenue of escalation is also via your state congressional rep / federal congressional rep. Their offices should always have a constituent services function whose very purpose is to help their constituents navigate these bureaucratic mazes. (Disclaimer: I’ve never had to exercise this personally.)
- LegitShady 3y ago'don't buy anthem products, period, for any reason"
- spondylosaurus 3y agoWhat's crazy is that Anthem is genuinely one of the least-bad insurance giants in America right now. The bar is incredibly fucking low.
- vertis 3y agoI'll take the issues with Medicare (Australia) and the NHS (UK), both of which I have dealings with, over US healthcare problems any day of the week. Every healthcare system has issues, but universal healthcare beats the pants off the US system any day of the week.
- Ekaros 3y agoI take resource constrained over purposefully obtuse system. I can understand that people and medicine is expensive and inefficient(compared to farming and factories or tech). But at least these public systems seem to attempt to do stuff. And not be piled with bureaucracy to avoid paying out or increasing the prices.
- vertis 3y agoIndeed. The incentives are all in the wrong place in the American system.
- p_l 3y agoAn important metric in efficiency of systems is overhead. For health system, it would be how much money is spent on purposes other than the stated purpose of the system. Private insurance is never going to optimise for that, because low overhead means high utilisation of funds paid in, and low profits. Commonly complained about polish NFZ (which, unlike NHS, operates through contracting to semi-private and private providers), has overhead IIRC of around 1%. I don't have links on hand (maybe someone more recently versed on US insurance can check?), but I heard of common overhead levels in private insurers in USA being in range of 30%, mainly for claim acceptors/adjusters.
- spondylosaurus 3y agoHa, I know Carelon! It's their pharmacy division for specialty (read: expensive) medication. Not a clue as to why they'd be involved in a CPAP claim, but this story does ring far too close to home. I once spent months fighting United Healthcare to stop hounding me for a $2k bill that I categorically did not owe. Countless phone reps were unable to remove it from my account; I only solved the problem by making a big enough stink on Twitter for someone from corporate to get involved. Good times!
- logbiscuitswave 3y agoCarelon also does preauthorizations for various expensive procedures and such. I’ve had the displeasure of having to try to coordinate between my insurance provider and PCP’s insurance coordinator for authorizing some expensive blood tests. Insurance wanted the PCP to use Carelon, Carelon automatically denied it, the appeals process was designed to be as frustrating and opaque as possible. (Unlike the OP, I didn’t have the patience to spend two years navigating the kafkaesque nightmare they did. I finally gave up after a couple months of being stonewalled by all the parties who would refuse to talk to one another and me trying to be the middle man. I never did get the blood work done. So much for preventative medicine.)
- mikigraf 3y agoIt’s surprising to me that not only in my home country is the process of having a CPAP machine covered by insurance a long and complicated one. In my case, it took almost 12 months to receive my first CPAP machine, which then turned out to be refurbished. Initially, I had to visit a doctor, who had an available appointment in two months. He then referred me to a sleep laboratory (another two-month wait). After my sleep study, they sent me back to the doctor, who confirmed I had sleep apnea and said I needed to return to the sleep lab to test some settings—a further two months’ wait. Then, after more than a month waiting for the next appointment, the doctor informed me that the settings they had tried were too low and wanted to send me back to the lab. I disagreed, but he gave me the prescription, and two months later, I received a CPAP machine with incorrect settings that didn’t help much. Eventually, I purchased my own Philips Dreamstation Go because it automatically adjusts the pressure, and I’ve been sleeping well ever since.
- waltwalther 3y agoSounds like you are in the US.
- mikigraf 3y agoHaha, I’m in Germany
- mdekkers 3y agoAfter an initial round of bullshit with the local government insurance agency to get my CPAP including the multiple “two month wait for x”, then a 6 month wait to get the machine, and subsequently struggling to get it serviced, I bought my own for a few hundred EUR and been doing that for nearly 10 years now.
- ThePowerOfFuet 3y agoAt least people who don't have your means have another option.
- 3y ago
- thih9 3y agoCPAP = Continuous Positive Airway Pressure ventillation - a mask, a hose and a flow generator. Treatment for obstructive sleep apnea. https://en.m.wikipedia.org/wiki/Continuous_positive_airway_pressure https://en.m.wikipedia.org/wiki/Continuous_positive_airway_p...
- CaliforniaKarl 3y agoReading this depressed me: I imagined the title being “How to get your GMail/XBox/PlayStation account back in only 666 days.” I worry that, some day, tech companies will be under a regulating agency like insurance is today. If that happens, we’ll probably deserve it.
- quickthrower2 3y agoMet someone coming from US to Australia to visit and was nicely surprised you can just go buy a CPAP, cheaply with no referral. Just like buying a dishwasher or something. Makes me wonder if in the US a trip to mexico or canada or somewhere could make this easier.
- RecycledEle 3y agoBingo! As someone with multiple "pre-existing conditions" who cares for a stroke survivor (my wife) and a stage 4 chronic kidney disease patient (my mother-in-law,) I suggest we do the following: 1. make private health insurance illegal 2. pass a Constitutional amendment allowing every human the unlimited and absolute right to buy, make, modify, and sell medical things including importing and exporting those items. It is cheaper just to buy things than to use insurance. The stock holders need to loose all of their equity then go to prison.
- ThrowawayTestr 3y agoIs step 3 to eliminate the FDA? The idea of letting randos modify and sell medical devices is terrifying.
- RecycledEle 3y agoA CPAP is a simple device. It is a fan that generates constant air pressure, with a heater and a bit of water to humidify the air. The idea that the law prevents me from pulling defective foam out of a device I own is terrifying.
- elteto 3y agoTypical libertarian strawman. You can pull all the foam you want out of _your_ device. No one cares. The government least of everybody. You are free to hurt yourself due to the consequences of your own actions. You can't go modifying some types of medical devices and then sell them to _others_ without going through some sort regulatory process. Simple as that.
- verytrivial 3y agoYou can now understand why the UK is holding on the its NHS with white knuckles despite the Conservative push to dissolve it by stealth.
- FireBeyond 3y ago> despite the Conservative push to dissolve it by stealth I'd question the "by stealth" part of this.
- vertis 3y agoYes, Australia too. You can take my medicare system (NHS equiv) from my cold dead hands. It's the only way you're going to.
- klabetron 3y agoThough it’d probably take 666 days to see a sleep specialist and get your first CPAP machine… (which I suspect you’d agree is part of the stealth dissolution plan)
- p_l 3y agoDepending on how defunding worked so far in one's area, but NHS generally prioritised potentially dangerous issues. Means it's easier to be frustrated waiting and then getting a 10 minute talk when it's flu or something similar, but get seen to in 10 minutes after arriving at a walk-in centre because you're worried of bine fissure in leg (turned out to be inflammation fortunately)
- stavros 3y agoI went to A&E with symptoms of appendicitis. They took me in, put me in a bed, next day I was operated on, stayed one night and out the door. Everyone was great and seemed very competent. This was on a three-day business trip to the UK, which was extremely unlucky, but the NHS was fantastic.
- 3y ago
- thegrizzlyking 3y agoAre there any studies estimating the cost of this kafakasque nightmare? End of the day users pay for this via higher premiums. I am sure doctor's offices also face something similar.
- onetoo 3y agoNo, but, you see, the system is privatized, therefore it must be more efficient. /s
- eastbound 3y agoThe upside of inefficient privatized process is that you can replace them.
- genocidicbunny 3y agoWell the kicker here, is that the process is not inefficient. It's just efficient for someone other than your average person. If anything, for the people that care and can do something about it, the process is inefficient in the opposite direction -- it's not bleeding as much money from the consumer as it could be.
- ericjmorey 3y agoLOL If only.
- hyperpape 3y agoI don't know of anything like a comprehensive estimate, but there are people working on documenting and quantifying these costs: https://springboardpolicy.medium.com/getting-to-know-the-time-tax-6993b6a149c https://springboardpolicy.medium.com/getting-to-know-the-tim....
- kevincox 3y agoNot to mention Aphyr spent lots of (expensive) time on the other side. I think Anthem should have to compensate him for all the time that he had to waste.
- geekpondering 3y agoI move around a lot and have run into all kinds of weirdness when it comes to CPAP stuff. Any time you establish a new doc, if your CPAP prescription is more than 1-2 years old you need to do another sleep study, so I think I've done 6 different sleep studies over the years. The other thing to remember about CPAP is that it's not just the machine, you have to get replaceable supplies - masks, air tubes, etc every so often. While not nearly as bad as linked blog entry, my worst situation was with Kaiser in the SF Bay Area. I had gotten a CPAP through them and then a few years later moved to a different part of the Bay. I set up a new doc also with Kaiser, but the records don't easily transfer and since it's a different Kaiser respiratory team, I had to (of course) do another sleep study AND go through a CPAP orientation on how to use a CPAP despite me already owning and using a CPAP and just needing a new mask, etc.
- eek2121 3y agoI get my supplies from illegitimate sellers on amazon precisely because of this. I also learned how to adjust my machine manually because it was taking way too long to schedule new sleep doctor appointments and then appointments with the DME provider…I shouldn’t have to wait 6 months to a year in order to to get quality sleep. I will never understand why a prescription for my BiPAP or my glasses is required. It is all pointless bureaucracy.
- anjel 3y agoMoats are gonna do what moats are designed to do.
- RecycledEle 3y agoThis is too common. The author of the article asked for the wrong thing from the wrong people. He should have asked his sleep doctor (which he calls the sleep center) for a new CPAP. By asking for a repair from his insurance company, he caused himself lots of grief. I doubt he has a list if his doctors that his insurance companies or doctors would agree with.
- RecycledEle 3y agoFrom the article: > Listen, gobsmacked, as they explain that they decided your claim was in fact an appeal, and transferred it immediately to the appeals department. The appeals department examined the appeal and looked for the claim it was appealing. Finding none, they decided the appeal was moot, and rejected it. Tell me why this is not fraud. Tell me why insurance company employees are not facing prison time.
- woodruffw 3y agoThis was a nightmarish read. I'm glad he was eventually able to get the replacement paid for. On top of your state's DOI, there are a few agencies that can (typically) be used to bring insurance and other companies more swiftly into compliance with the laws they're meant to proactively follow: * Many state AGs are responsive to well-documented problems and will send a warning on official letterhead. * This won't work for insurance, but the CFPB[1] has a relatively smooth complaint process for financial issues, and (anecdotally) generally produces a rapid outcome. [1]: https://www.consumerfinance.gov/ https://www.consumerfinance.gov/
- londons_explore 3y agoPlease folks remember that it isn't compulsory to use a companies byzantine process. Instead, check your insurance policy wording that you are covered, spend the money on a new machine, send a single letter to the insurer asking to be reimbursed, and when they don't reimburse within 30 days file in small claims court. They'll pay. They don't want to physically show up in court or have you send bailiffs to their HQ over $3000 that they probably owe you anyway.
- genocidicbunny 3y agoUnfortunate that you cannot get additional damages against them. That sort of behaviour really needs to be heavily punished -- say, forcing them to cover every single CPAP prescribed for the next year for free, with the executives having to personally pay if the company can't afford to. Byzantine processes when dealing with medical issues should be punished with Byzantine punishments.
- thfuran 3y agoByzantine punishments were more along the lines of castration and facial amputation.
- genocidicbunny 3y agoWho's to say we can't get a little retro? Little late for the new year's stuff, but let's party like it's 499!
- spacecadet 3y ago[flagged]
- philwelch 3y agoReminds me of the funniest Crusader Kings bug of all time—a performance issue where the game laboriously calculated over and over again whether or not every character in the Byzantine Empire wanted to blind every other character in the Byzantine Empire.
- 867-5309 3y agoContinuous Positive Airway Pressure
- jawngee 3y agoYeah try importing a CPAP from the states into Vietnam if you want a real adventure. A $650 cpap machine costs well over $2K here. So I thought I'd import one. Apparently you need a prescription in the states? Ok, get a "prescription" from an online service that basically just asks you if you snore over a video call. Amazing. Buy machine and have it sent to a freight forwarding service. They fuck up the paperwork. It gets held in Vietnamese customs for almost 4 months. Go down to customs once a week to argue with the guy. One week you can't have it because it looks used. It doesn't look used. Next week you can't have it because they think I'm importing to resell it. Yes it's a very hot market right now. Repeat same processes with different people next successive weeks. Finally someone says to bring prescription. But they don't write prescriptions for CPAPs here. A lot of hand waving when you tell them that. Go back to cardiologist who told me to get the CPAP and ask for a prescription. Oh no, he says, we don't write prescriptions for that. Can you write a letter saying that you don't write prescriptions and that I need the machine? Oh no, he says, I can't do that. A couple of weeks later finally get someone at customs to agree that my sleep apnea test is proof enough. Bring the test in. Nobody looks at it. They still release the machine to me. I would still take this random bureaucracy over American insurance any day of the week though.
- petesergeant 3y agoIf you need to do this again, fly to Bangkok, they have ResMed and Philips authorised resellers with machines already in country, although incredibly enough you can also just order them off Lazada
- forinti 3y agoI don't know Vietnam, but to my South American sensibility, it looks like they were fishing for a bribe.
- lolc 3y agoFishing is not the phrase I'd used. Insisting on, maybe.
- 3y ago
- genocidicbunny 3y agoMedical, and especially medical related insurance stuff, is one of the few things that drives me up a wall enough to add to my 'burn this chickenshit outfit down' list. This is a great example of why.
- deleted 3y ago[deleted]
- HumblyTossed 3y agoHealth care needs an enema. I think one thing I would have done different when i switched primary I would have gotten a new Rx. Not sure how much trouble that would have saved in the end but that is just what I tend to do.
- tomohawk 3y agoAlternatively, try a low histamine diet. Many people who have been told they need surgery to correct "deviated septum" or need cpap have found their problems go away. Edit: to downvoters - why the closed mind?
- eesmith 3y agoI was not able to find any paper on Google Scholar about a study on the effect of a low-histamine diet on obstructive sleep apnea. How many is "many" and where is this documented? The few matches for low-histamine diet and apnea come from what I would consider fringe and untrustworth research, often suggesting a low-histamine diet helps a large number of medical issues, but not pointing to study giving numbers, describing the severity of the apnea, and other things I would expect. I was able to find papers which studied the effect of anti-histamine drugs on obstructive sleep apnea, like https://journals.sagepub.com/doi/abs/10.2500/ajra.2013.27.3921 https://journals.sagepub.com/doi/abs/10.2500/ajra.2013.27.39... for when people also have allergic rhinitis. "adding [anti-histimines] to this treatment did not show improved effects compared with placebo treatment". I presume people taking anti-histamines would have a lower amount of histamines in their body, so if there were a correlation it would have been seen. (Alternatively, it says that a low-histamine diet is not effective for CPAP when suffering from allergic rhinitis.) It is apparently quite hard to identify what "low-histamine diet" means. In "Low-histamine diets: is the exclusion of foods justified by their histamine content?" at https://www.mdpi.com/2072-6643/13/5/1395 https://www.mdpi.com/2072-6643/13/5/1395 , which specifically concerns "the symptomatology of histamine intolerance", notes the "great heterogenicity in the type of foods that are advised against for histamine intolerant individuals. Excluded foods were, in most cases, different depending on the considered diet. Only fermented foods were unanimously excluded." > The design of a low-histamine diet is challenging due to different handicaps. One of these is the lack of consensus on the histamine level below which a food is said to be considered low in histamine. Thus, variable histamine levels in food ranging between 5–50 mg/kg have been pointed out as potential thresholds, while other authors are much more demanding and consider foods with low histamine concentrations to be those that contain amounts below 1 mg/kg [ 12 ,26 –28 ]. Moreover, there is no specific regulation for the food industry to declare the occurrence or absence of histamine in food labelling, which could help histamine intolerant individuals to make suitable and informed choices. > Overall, providing dietary recommendations and guidelines in the frame of a low-histamine diet is difficult for healthcare professionals. If it's difficult for healthcare professionals to even determine what is low-histamine - and that's for people who are specifically histamine intolerance - and no studies to back up your suggestion ... why should anyone think your proposal has merit? There is a long history of using the "why the closed mind?" argument to sell snake oil treatments, so I would not advise using argument and instead point to supporting evidence.
- r2vcap 3y agoIt is interesting to see how CPAP is used and covered by insurance in different countries. In my country, South Korea, CPAP is available for rent if you have certain medical conditions, and the rental price is fixed. I pay 15 USD (20K KRW), and the Korea NHS pays 60 USD (80K KRW) per month. I've been using Löwenstein's CPAP, and it works great without any problems.
- mattmaroon 3y agoBut we can’t have public health insurance because the lines will be too long.
- ergonaught 3y agoHave been trying to replace my (recalled) machine for about a year, now, myself. Asinine.
- Havoc 3y agoMaking sick people jump through a million hoops takes a special kind of evil.
- bhoops 3y agoWhy dont you just ask someone coming from India to get you one ? They are available over the counter in India and there are a lot of Indian people hopping on a flight to the US all the time. I am sure there is someone in your office you can request, or someone in your locality.
- candiddevmike 3y agoYou really need a professional to configure the CPAP, otherwise it can mess up your lungs (too much airflow) or make your sleep apnea worse (not enough airflow). That's why these are considered a prescription--the prescription is the settings on the machine.
- jzig 3y agoNot at all. You can figure out how to configure one yourself with a few hours reading on /r/CPAP or watching YouTube. Source: myself after trying to acquire one and get it configured for months through a similar bureaucratic nightmare as the article.
- exhilaration 3y agoI'd love to try a CPAP, any suggestions other than asking an Indian coworker to bring one back? Is there a gray market? Maybe Mexican mail order pharmacies? I'm the US with health insurance but I bet it'll be more expensive to go the legit way.
- jzig 3y agoBuying/Selling medical devices is illegal so you won’t find any reliable website or marketplace. You can sometimes find people trying to get rid of one (for free or for sale) on /r/cpap and /r/cpap_swap Most of the time you have go through a sleep study to get one. I got very lucky during the pandemic and my allergist ordered one (no sleep study) after explaining that I was waiting months for a sleep study and having suicidal ideation from weeks of waking up every ~15min.
- 3y ago
- bytearray 3y agoInsurance companies are just legal scams. They take your premiums then come up with whatever excuses possible to avoid or delay paying out on legitimate claims.
- gorbachev 3y agoI had a similar story once on an medical insurance coverage situation, which only resolved itself when I dug up the contact information of an employee at the insurance company from Google/LinkedIn and directly contacted the person. Going through the official "process" was just handing me from one department to another until it went back to the original department, and the cycle started again.
- xyst 3y agoHave had similar experiences with UHC for some very expensive injectables. Fortunately, my doc’s back office handled the appeals process to get it approved. Keep in mind I am paying a higher premium for a PPO plan vs an HMO plan offered by employer. Doc’s back office submitted 3-4 “appeals” to get it covered. Each review was reviewed by UHC personnel. Probably someone like this guy [1] I fucking hate private insurance. It’s a useless middleman that is driving the costs of healthcare up. We can have the most advanced healthcare available but it’s largely inaccessible because of health insurance industry. They will make it as difficult as possible so you either give up or end up paying out of pocket. [1] https://m.youtube.com/shorts/YF6MDTvZlNA https://m.youtube.com/shorts/YF6MDTvZlNA
- tshirttime 3y agoForget the CPAP. If you're having trouble sleeping, just read this longwindedness.
- wsintra2022 3y agoI read how to replace your Crap and was interested briefly.. I got a lot of crap laying around that needs replacing
- sanarothe 3y agoReimbursement is the #1 barrier to bringing a novel therapy to market in the US for the company I'm working for. The technology is decades old and proven (the novel part is where it's being put in the body) - the clinical benefits are now proven. But it's a battle to get US insurance to cover the therapy - we have about 3x more patients confirmed as clinically eligible than actually get the therapy. (That is to say, US insurance rejects ~75%+ of claims). As a result, there is an entire segment of the org dedicated to reimbursement. We have a team of professional insurance-bullshit-waders - they call, they file claims, they follow up, and I hear them asking for Document Control Numbers and Call Reference Numbers. There are 'Government Affairs' people who lobby with the VA and Medica{re, aid?}. The payer barriers outside of US have been much lower. (But EU has it's own problems with medical device barriers... a rant for another day.)
- tylervigen 3y agoI've worked on the claims management process flow for payer like Anthem before. It's probably obvious, but this story hints at some serious deficiencies in the backend processes. One way to look at it is that this Byzantine process helps Anthem by trapping valid claims in a black hole of bureaucracy. That way they don't need to pay, right? It's not quite that simple. It's true that incentives are not usually aligned, but in reality the payment P&L impact is often far away from the claims processing administrative decisions. At many payers (like Anthem), the ultimate 'payer' for most of the cost may not actually be Anthem. They may be the third-party administrator charging back to an employer, or the Federal government. Even if it is Anthem, the owner of the cost center for this broken administrative process is almost certainly removed from whomever runs the actuarial accounting to decide what kinds of services to cover and how much to charge customers (except, as the author found, once they unite at the level of the CEO). Ultimately for Anthem, this claim cost them a lot more to handle than if they had just paid out in the first place - even if they were the ultimate payer. Consider how much time the author spent on the phone with customer service representatives. Many of those were almost certainly contracted out and charged to Anthem by the minute. Then consider the claims processing backend, also likely contracted through third-party claims processing and management systems. It would have been simpler to manage the first one straight through. Usually what it comes down to is that it is hard to estimate the ROI for investing in fixing a problem like this, because the benefits are spread out over many small cases. One way to prove it out is to highlight some of those small cases so that payers feel the pain and recognize the need for change. Thus, I am glad the author published this complete story.
- pas 3y ago> They may be the third-party administrator charging back to an employer, can you please elaborate on this? does this mean that some companies (employers) directly see and pay their employees medical stuff on their books? > Ultimately for Anthem, this claim cost them a lot more to handle than if they had just paid out in the first place ... well, of course, but the whole middleman game costs the US many many many serious percents of each year's GDP. and probably the whole culture of reimbursement despair makes a lot of money to insurance companies, and even probably keeps rates a bit lower than they ought to be, and keeps people sick (and of course eventually leads to more serious problems that in turn cost a lot more, but if those are shifted to pensioner age then they might be covered federally, right? again a win for the insurers)
- NelsonMinar 3y ago"Compliance" is the other half of the US insurance nightmare with CPAP. Often insurers demand access to logs of the machine to verify you are actually using it before they will reimburse you. CPAP machines have an elaborate tamper-proof logging mechanism including a cellular modem for data uploads outside your control. Largely to enable surveillance by US insurance companies. In addition to the surveillance being offensive and intrusive it also harms sleep apnea treatment. Some half of people who need a CPAP find they have a hard time learning to use it, difficulty sleeping with the mask on. It's mostly a psychological problem and one stressor for it is the fear that if they can't get it to work then they will be on the hook for $$$$. So they have a harder time sleeping and give up on the CPAP. It's hideous. All that being said, CPAP can be life-changing if you have sleep apnea. If you suspect you have a problem breathing while you're asleep please talk to a doctor about it. CPAP works well for a lot of people but there are other treatment options too.
- deleted 3y ago[deleted]
- _qua 3y agoAs someone who treats people with CPAP, it’s absurd how many people get them and then don’t use them hardly at all. Yes there’s an adaptation period where you need to get used to using it, but you do need to use it for it to do anything. It doesn’t seem crazy for insurance to want to not keep paying for something that is sitting under a pile of clothes in the corner.
- elric 3y agoI don't know. I feel like the compliance checks are more expensive than the machines at this point. They retail for around $/€ 500. I suspect that sleep centres (or whoever hands out CPAP devices to patients where you are) get significant volume discounts. Say they last for 5 years. That's a near zero cost. Of course, someone is upcharging somewhere, but that's hardly the patient's fault.
- prepend 3y ago
- yegle 3y agoI too had my bad interaction with my insurance company. Out of blue they start rejecting my doctor's prescription for a very common (and cheap) medication. It took me more than 1 month with my awesome primary care doctor's persistent to figure out that the 1000mg version of my medication is the reason it got rejected. My doctor has to prescribe the 500mg version and I simply take two pills. But no communication from the insurance company told me that.
- francis_t_catte 3y agoI had a similar experience with a common, cheap medication, where my insurance started denying the prescription out of the blue. it took several weeks of back and forth with my doctor, and then a lengthy amount of time on hold with the insurance, company where the exasperated pharmacist and I were eventually told that only 15, 24, and 90 day in person pickup supplies were now covered. my prescription was for a 30 day supply.
- ncallaway 3y agoI think every denial from an insurance company (that’s denying care prescribed by a doctor), should be required to come from a named and licensed doctor, who is responsible for your care as if they are the treating physician (and thus subject to the same medical malpractice laws). A denial should be required to come with either an alternate treatment plan, or an alternative diagnosis and treatment plan. If a doctor issues a denial after reviewing your case for 3 seconds (as has happened in the past), they should be liable for medical malpractice lawsuits. In your case, that would mean the denial would be required to come with an alternative treatment plan, which would say 2x500mg.
- EasyMark 3y agoGot rid of mine by going on keto/16-8 fasting by dropping 80lbs over about 9 months.
- deleted 3y ago[deleted]
- Glyptodon 3y agoThe longer I've had a CPAP the more I've thought they should be more over the counter because literally any problem is unresolvable without it taking too long. Though this case is extra insane.
- dmazzoni 3y agoI use Kaiser Permanente as my health care provider. For those who aren't aware, it's one of the few "integrated care" providers in the U.S., meaning they act as both the health insurance and health care provider. Now, Kaiser is FAR from perfect - they have their share of problems. But....this sort of nightmare is not one of them. With Kaiser, doctors are free to prescribe whatever they think is medically necessary, and if they prescribe it, it's covered, guaranteed. There's no separate claims department. Obviously there are some exceptions, like if it's an emergency and you need to get care outside of Kaiser and then submit a claim. But, the vast majority of the time it just works. Now, sometimes we aren't happy with what Kaiser offers. So then we go outside of Kaiser and pay out-of-pocket. Our friends sometimes tell us we're crazy when we do that. We just spent $1200 out-of-pocket to see a specialist because Kaiser didn't want to refer us. What they don't realize, though, is that we saved $3000/year by choosing Kaiser over the next cheapest health insurance provider from our employer. So we're still coming out ahead. And most importantly, we have the peace of mind knowing that any time we end up in a Kaiser hospital, we'll never once see a bill. I think we really need more integrated systems like Kaiser. Imagine if there was actually competition in that space, where you could choose between competing hospital systems that came with complete integrated coverage, no middle man.
- koops 3y agoAgreed. The best part is that you don't need to second-guess decisions wondering whether or not the course of action is better financially for the decision-maker.
- seattle_spring 3y agoI'm a Kaiser member and have to get CPAP supplies through a company called Apria. It has been the absolute most godawful experience I've ever had dealing with a company. Worst than a thousand Comcasts. I genuinely don't understand how you could be a CPAP patient with Kaiser without dealing with Apria?
- logbiscuitswave 3y agoMy DME used to be Lincare was equally terrible. They were awful. They never had replacement consumables in stock, and I had to deal with months worth of delays to get things I needed. That’s why I went to CPAP.com (like OP) for a time. It was annoying having to coordinate with my insurance company to get reimbursements since they didn’t direct bill, but at least I would always have my equipment on time. (As a bonus, it was cheaper than Lincare to boot.)
- pgraf 3y agoMight have been useful to establish a paper trail instead of calling them. Have a look at the great article by patio11 for ideas how to establish one: https://www.kalzumeus.com/2017/09/09/identity-theft-credit-reports/ https://www.kalzumeus.com/2017/09/09/identity-theft-credit-r...
- dramm 3y agoAnthem Insurance staff just following their Claims Manual, Section U.
- steve-atx-7600 3y agoI'm fortunate enough to afford to buy my machines out of pocket. Just trying to obtain a machine the insurance way was taking weeks (before covid even) and I got pissed off and figured out with my Perscription I could buy one on cpap.com with Amazon like service. However, obtaining the equipment was just the first hurdle for me. Thereafter, I approached finding the right settings as a search problem and eventually got some relief. Since I was not a severe case - at least by the "average of bad events" metric from the machine - I wasn't able to get much attention after trying several providers. I eventually bought a bipap machine after reading forums and hoping that more knobs to turn on the machine could yield better results. This helped a lot and again I'm lucky to be able to afford a new one without insurance. There's a lot of opportunity for improvement in this medical tech space.
- anonu 3y agoI ended up just buying a CPAP. Ultimately, its not easy to sleep with one. I use a MAD now and my experience has been substantially better in terms of persistence in using it and less snoring. However, it has caused my teeth to move which is a tradeoff I can deal with.
- blincoln 3y agoHaving one's tonsils and adenoids removed and getting palette-hardening RF treatment seems like it would be a lot easier and more permanent than this rigamarole. Worked for me, and I suspect it would for a lot of other folks too.
- elric 3y agoI don't think advocating for invasive surgery is a good way of dealing with awful insurance bureaucracy. With OP's luck, he might need 666 days to get his hospital fees sorted by insurance. Snark aside, AFAIK palate hardening is not terribly permanent, it works by creating scar tissue, which can become more floppy than the original tissue as you age. It's only useful if a floppy palate is causing obstructions/snoring. Removing tonsils and adenoids will may free up some space in the airway, but it's not going to make any difference if they're not the cause of the obstruction, and this may weaken your immune system. While I'm sure you were trying to be helpful, I do wish people would stop treating sleep apnea like it's something that's easy to fix. Just have these body parts removed. Just lose weight. Just get on CPAP. Just fix your allergies. Just have your jaw broken and moved forward. Just have an electrode implanted. Etc.
- dekhn 3y agoI have one rule when it comes to these things. Play dumb. Don't try to be smart. It's remarkable how the system detects people trying to be smart and considers it abuse and deals with it using high latency. I found any number of people I worked with were much more productive (car repair, internet service, insurance) if I avoided any speculation about what the problem was, or what the solution could be. Like other folks in this thread, I identify as mildly autistic, and dealing with normies in the service industry took a lot of retraining my mental model of how things work.
- ivraatiems 3y agoGod, reading this is awful. I have a CPAP and I would not be willing to go one night without it. I'd buy the parts/machine out of pocket and make insurance pay for it later. The impact on my health and quality of life is way too high. But I'm privileged to be able to do that. I can shell out $1,000 for a medical device in an emergency, and my doctors are local and return my calls. Not everyone is so lucky.
- globallyunique 3y agoFor those who are looking for a cpap now in the US (maybe for other countries - haven’t tried) - https://cpapx.com/collections/resmed/products/airsense-10-autoset-auto-cpap-with-humidair-heated-humidifier-card-2-cloud-version https://cpapx.com/collections/resmed/products/airsense-10-au... You can order one for 450 before taxes there. You will have to email your prescription though before they process the order. Ordering a backup one (or more) is very useful to leave in your travel suitcase etc