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Did I just get played?
#11
RE: Did I just get played?
Those of you responding with affirmation of your experience with Kaiser, is all well and good. This is Medicare, a system that pays for abuse. This is the bureaucracy that prefers to pay $3000 for a test to demonstrate a $500 device is medically necessary in the name a savings. Need I say more? On your 65th birthday in the U.S. you are automatically enrolled and your private insurance becomes a thing of the past. Goodbye premium care, dental and optical. From now on, you WILL be cared for by the government, and the system pumps more money into trying to prove you don't need the care, than if it just paid for the care. That annual PAP smear, becomes biannual. My sister in law has Stage 4 cancer and is undergoing chemotherapy and surgery for something that might have been caught during her normally routine annual exam. Government healthcare is designed to shorten your life if you're not careful. It's up to you to fight for the frequency and quality of health care you used to take for granted. As simple and benign as a titration test sounds, it is contrived to either disqualify you from CPAP therapy or down-grade your device. If we keep going like this, we will look like some European country or Canada!

I have one question...If you could choose private insurance instead of Medicare, and the cost of your Medicare coverage would subsidize your premium, would you stay with Medicare? I didn't think so.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#12
RE: Did I just get played?
I'm on Medicare through Kaiser. I'm 66 years old. I don't feel abused. Actually I've received remarkable care far beyond what I pay in monthly premiums. A new knee; a hearing aid implant. Years ago, an ablation. Etc. etc. Minimal payment, life giving treatment. Merci Beaucoup!
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#13
RE: Did I just get played?
Hmm, maybe that's why my dopey doctor found that I no longer have COPD or severe Complex Sleep Apnea. All these tests were done with Medicare as my "death sentence insurance" verses all the prior tests (PFT, diagnosics, titrations) going through Medicaid.
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#14
RE: Did I just get played?
I am quite happy with Medicare (Original, not Advantage).  With my supplemental policy, all medical expenses are covered, for much less than I used to pay for an individual policy that cost much more. I have a better range of doctors available than I would with an individual policy. I can select whatever doctor or specialist I want without needing to go through any kind of gatekeeper. The only criteria is that the doctor must accept Medicare, but almost all do. Yes, some things are not covered, but my previous individual policy didn't cover everything either.
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Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#15
RE: Did I just get played?
Do you mean this Kaiser? It appears they generate money after the fact.

Quote:Government Intervenes in False Claims Act Lawsuits Against Kaiser Permanente Affiliates for Submitting Inaccurate Diagnosis Codes to the Medicare Advantage Program
The United States has intervened in six complaints alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees in order to receive higher reimbursements.

The Kaiser Permanente consortium members (collectively Kaiser) are Kaiser Foundation Health Plan Inc., Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group Inc., Southern California Permanente Medical Group Inc. and Colorado Permanente Medical Group P.C. Kaiser is headquartered in Oakland, California. 

“Medicare’s managed care program relies on the accuracy of information submitted by health care providers and plans to ensure that patients receive the appropriate level of care, and that plans receive the appropriate compensation,” said Deputy Assistant Attorney General Sarah E. Harrington of the Justice Department’s Civil Division. “Today’s action sends a clear message that we will hold health care providers and plans accountable if they seek to game the system by submitting false information.” 

Government Intervenes in False Claims Act Lawsuits Against Kaiser Permanente Affiliates for Submitting Inaccurate Diagnosis Codes to the Medicare Advantage Program | OPA | Department of Justice
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#16
RE: Did I just get played?
Don't know how insurance & warranty work's over there! but my 1st thoughts as if to requesting the Dr, give that in writing that "not trust the data produced by the ResMed device" that should be sufficient for a Warranty Claim to ResMed, or who ever supplies present machine?
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#17
RE: Did I just get played?
WHAT DID I MISS????

but my 1st thoughts as if to requesting the Dr, give that in writing that "not trust the data produced by the ResMed 

Are you saying ResMed dose not report the correct data?
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#18
RE: Did I just get played?
He is saying he trusts the numbers from his sleep lab more than he trusts the numbers I provided. Given the controlled circumstances that is understandable. But given the short sleep time during the study, I would question if all of the critical trend information I provided compensated for the short duration numbers taken in an uncomfortable and foreign environment.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#19
RE: Did I just get played?
I would trust the data you see (within reason) due to the facts that it's your home (higher comfort, etc.) versus a lab and over a longer period of time
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#20
RE: Did I just get played?
The jargon for why the doctor justifies not trusting the data from the sleep lab is "first night effect".

In other words, run this very expensive test, and then justify picking and choosing what data you want to believe with the justification that the test environment is highly artificial...

(or, to answer your original question, "sleep medicine" is all about us getting played all of the time.)
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