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I 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

I 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 ago
Agreed. 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 ago
I'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 ago
  My 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.)
- patja 3y ago
  I have Kaiser and when I need a new CPAP or supplies I just order from CPAPMan or whoever, and pay out of my HSA account. Not all plans allow HSAs though.
- FireBeyond 3y ago
  My girlfriend had the same experience literally this week. The whole thing was Kafkaesque. She got sent an at home sleep study kit. Set it up, did it. Waited, nothing. Had a run around between the sleep center and her physician. Eventually got a hold of someone. "Well, of course you don't have results, you need to send it back to us. And if you don't they'll charge you $1200 for it". "Uhh, the kit gave me a PIN and specifically said I could dispose of it afterwards" (she hadn't, yet, in case she needed to redo the test). "Oh, well, no-one told us that!" (How is this surprising to you?) In any case, someone reviews her study, diagnoses her with sleep apnea, writes a script for a CPAP. She surmises this, because she never spoke to anyone, or got any messages in her portal. She realizes when Apria calls her to verify and confirm details for the CPAP machine (I think she pays $170, then $19/month for 3 months to rent it while they establish compliance, and then if she is using it, Kaiser will pay for it). She confirms everything and waits. And after a while, sees it's still in "label created" tracking status. Calls them. "Oh, we're waiting for this form from you", that until now she's never been told about. She gets it emailed to her, signs, scans, sends. Asks questions about mask options. "Your provider will discuss that with you." Uhh, you're about to ship this now. She hasn't spoken to any provider, and the sleep center and the physician are debating over who should talk to her, I suppose? So she looks over them with me. I'm not a doctor, though I'm a paramedic. I'm experienced with ventilators and occasionally giving acute patients CPAP treatments. So I can talk with just enough knowledge to be dangerous. So we pick out a mask, and finalize. CPAP arrived on Friday. No-one's spoken to her about it, so she's like "I guess I just start wearing and using it". I had to adjust a few settings for her around pressure and ramp and EPR (expiratory pressure relief) to help someone new to therapy acclimate to how it works. So, ironically, though not good by any definition, Apria ended up being the best part of the process.
- ebergen 3y ago
  I was supposed to go through Apria during the shortage a few years ago. They kept giving me longer estimates for when a machine would be available. After calling and waiting a few weeks I bought my own online and had it the next day. It was worth the out of pocket to get a cpap sooner as I was barely able to function at work due to sleep issues. I refuse to do business with Apria. They’re the worst company I’ve ever dealt with.
lepus 3y ago
That works sometimes, but you could still get screwed if that out of pocket care is wildly expensive. A friend of mine needed a drug that costs about $85k total but was the only effective treatment at the time, and Kaiser doctors told him they wouldn't prescribe it until his condition started giving him organ failure(!), so he had to switch insurance to get it and luckily the timing worked out.

koops 3y ago

Agreed. 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 ago

I'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 ago
My 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.)
patja 3y ago
I have Kaiser and when I need a new CPAP or supplies I just order from CPAPMan or whoever, and pay out of my HSA account. Not all plans allow HSAs though.
FireBeyond 3y ago
My girlfriend had the same experience literally this week. The whole thing was Kafkaesque. She got sent an at home sleep study kit. Set it up, did it. Waited, nothing. Had a run around between the sleep center and her physician. Eventually got a hold of someone. "Well, of course you don't have results, you need to send it back to us. And if you don't they'll charge you $1200 for it". "Uhh, the kit gave me a PIN and specifically said I could dispose of it afterwards" (she hadn't, yet, in case she needed to redo the test). "Oh, well, no-one told us that!" (How is this surprising to you?) In any case, someone reviews her study, diagnoses her with sleep apnea, writes a script for a CPAP. She surmises this, because she never spoke to anyone, or got any messages in her portal. She realizes when Apria calls her to verify and confirm details for the CPAP machine (I think she pays $170, then $19/month for 3 months to rent it while they establish compliance, and then if she is using it, Kaiser will pay for it). She confirms everything and waits. And after a while, sees it's still in "label created" tracking status. Calls them. "Oh, we're waiting for this form from you", that until now she's never been told about. She gets it emailed to her, signs, scans, sends. Asks questions about mask options. "Your provider will discuss that with you." Uhh, you're about to ship this now. She hasn't spoken to any provider, and the sleep center and the physician are debating over who should talk to her, I suppose? So she looks over them with me. I'm not a doctor, though I'm a paramedic. I'm experienced with ventilators and occasionally giving acute patients CPAP treatments. So I can talk with just enough knowledge to be dangerous. So we pick out a mask, and finalize. CPAP arrived on Friday. No-one's spoken to her about it, so she's like "I guess I just start wearing and using it". I had to adjust a few settings for her around pressure and ramp and EPR (expiratory pressure relief) to help someone new to therapy acclimate to how it works. So, ironically, though not good by any definition, Apria ended up being the best part of the process.
ebergen 3y ago
I was supposed to go through Apria during the shortage a few years ago. They kept giving me longer estimates for when a machine would be available. After calling and waiting a few weeks I bought my own online and had it the next day. It was worth the out of pocket to get a cpap sooner as I was barely able to function at work due to sleep issues. I refuse to do business with Apria. They’re the worst company I’ve ever dealt with.

lepus 3y ago

That works sometimes, but you could still get screwed if that out of pocket care is wildly expensive. A friend of mine needed a drug that costs about $85k total but was the only effective treatment at the time, and Kaiser doctors told him they wouldn't prescribe it until his condition started giving him organ failure(!), so he had to switch insurance to get it and luckily the timing worked out.