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My experience with Kaiser Permanente and their sleep study process
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Winterfrost Offline

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Post: #1
My experience with Kaiser Permanente and their sleep study process
Wow. I am astonished with the incredible speed, efficiency and cost of Kaiser Permanente Northern California's sleep study process. Here’s how it went:

Saturday 1/23/16, night – Emailed my doctor, describing symptoms of apnea and asking if she thought a sleep study would be a good idea and if so, to refer me. (Was hoping this carefully-worded email would save me a $25 office visit.)

Monday, 1/25/16, morn – Doctor replied that she’d entered a referral into the system, the sleep clinic would be calling me, and meanwhile I could watch a video about apnea and the services Kaiser could provide. Sleep clinic called about 5 minutes after I read my doctor’s email. I could have set up a same-day appt if I wanted, but scheduled for Wednesday. Watched the video that night.

Wednesday, 1/27/16, morn – Surprisingly, appt was a group thing, 4 patients. Technician issued us each a wristwatch-like device for plethysmography/pulse oximetry and respiration rate, and showed us how to use it. We were to wear it that night and return it the next morning before 9a. They also scheduled a follow-up appt for everyone for either the next Monday or Thursday, our choice. We were told this appt would be automatically cancelled if results didn’t indicate apnea. No charge this time either.

Thursday 1/28/16, 7am – Dropped off device.

Friday 1/29/16, morn – Checked my medical record via Kaiser’s online system, discovered a diagnosis of Obstructive Sleep Apnea had been entered.

Monday 2/1/16, morn – Follow-up appointment to learn about results. Another group, this time 15 patients. We were each handed a sheet with our results and seated at a U-shaped table with a CPAP unit for each participant. Senior doctor talked about apnea, the various types, its prevalence (30% of the population; now I understand why they’re handling us in groups!), history of diagnosis and treatment, all the myriad dangerous conditions it’s been linked to (including heart failure/attack, stroke, diabetes, insulin resistance/overweight, and even Alzheimer’s). We were told what the reference ranges were for mild/moderate/severe, and got a quick explanation of the other items on our results sheet. A hand-written number at the top right was our co-pay % for equipment if we decided to go with CPAP therapy. (People had varying amounts of durable medical device coverage depending on the specific plan they had. My out-of-pocket % was 0.) We were each issued a Respironics APAP for a week, were shown how to fit the nasal mask and operate the on/off and ramp buttons, and sent on our way. No charge for this visit either. Appts to return the machine were automatically set for the following Monday at 9a.

When I got home that evening, first thing I did was examine the machine, note that it had an SD card, and look for software that would read that card. I like being informed and involved in my own care, and it annoys me that these devices are dumbed-down for the patient, hiding most or all of the data and making the settings/adjustments accessible only by a doctor. Found the (free!) SleepyHead software (let us all sing its praises!) and set it up.

Monday 2/8/16, morn – After a week of reading this forum (thank you all! You've been of immeasurable help) and monitoring my data, I knew exactly what was going on during my sleep. I knew I wanted an APAP, knew I wanted to try a nasal-pillows type of mask, etc. I figured that there’d be a long delay after returning the test machine, during which I’d be negotiating with Kaiser and Apria. I was tensed for battle.

But it wasn’t necessary! Arrived at 8:45a for a 9a appt and was shown right in, where a doctor and a technician were each sitting behind laptops like two bank tellers waiting for customers. Turned in the case with all the equipment, and was told the mask and hose are mine to keep. The card was read, I was told what I already knew about my average AHI for the week, and then I was handed a brand-new case with a brand-new Respironics APAP. What’s more, I was also given a ResMed AirFit P10 nasal pillows mask which comes with three sizes of pillows. I didn’t even have to ask. So now I have two kinds of masks! They also handed me information about a drop-in support group, and they set up one more appt about 6 weeks out, to learn more about the device, including how to clean it and how/when to reorder supplies. No charge today either!

So, the whole process of getting diagnosed and equipped took only 2 weeks and cost me nothing except the time away from work to attend the appts. And now I am officially a Hosehead. Bigwink
(This post was last modified: 02-08-2016 02:38 PM by Winterfrost.)
02-08-2016 02:33 PM
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mrkdilkington Offline

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Post: #2
RE: My experience with Kaiser Permanente and their sleep study process
I had a polar opposite experience with Kaiser Southern California.

Last year I went to my PCP Dr. and told her I was having trouble staying asleep (waking up every 30-60 mins throughout the night and sometimes not being able to go back to sleep for an hour), and extreme fatigue. I asked her for a sleep study and she refused, giving me a prescription of trazadone instead. Pills did nothing so I emailed her 2 weeks later and asked again for a sleep study, she refused again, and gave me the contact info for the psychiatric department. Apparently Kaiser doctors think it's impossible for a 29 year old male weighing 170 pounds to have sleep apnea.

Meanwhile I am talking with my friend's wife who works at a sleep clinic and she is able to get me a sleep study for $500. The study indicates I have OSA and I try to get reimbursed by Kaiser. They deny the reimbursement not once but three times before I get my money back from them (saying I should've gotten a referral if I wanted to go outside Kaiser). On top of that, my "Gold" Kaiser plan through California Choice has 0% DME coverage for literally any type of sleep apnea treatment, due to my plan only having basic DME instead of formulary. Most personal and small business Kaiser plans only have basic DME.

A little while later I did a dental device based sleep study at Kaiser on Sunset Blvd and it took them literally 5 weeks to get the results back. Then my Dr. wouldn't even give me the report, I had to go on a wild goose chase to find the right department phone # to obtain it. The report was erroneously missing basic information like sleep architecture percentages, which they weren't able to provide me after making an inquiry. Needless to say I am on Anthem BCBS this year and will never step foot in a Kaiser again.
(This post was last modified: 02-08-2016 03:13 PM by mrkdilkington.)
02-08-2016 02:59 PM
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Winterfrost Offline

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Post: #3
RE: My experience with Kaiser Permanente and their sleep study process
So sorry you had such a bad experience, mrkdilkington. It does seem that it all depends on who you have for your main doctor. I've often heard of people who had to fight with their Kaiser doctor to get anything. Probably if your doctor had just listened to you and set up the referral to their sleep clinic, your experience would have been similar to mine. Plainly Kaiser's been overwhelmed with the number of apnea patients, which has resulted in this bizarrely-efficient process (even down to the issuance of the more-expensive APAP devices -- a little extra upfront cost for them, but avoids the greater cost of individual followup with patients to set up and monitor their device's pressure!).

I've been lucky enough to have one who responds readily to email, and who respects that I have a brain and might just possibly know what's going on and what I need. She's been really good about ordering my routine lab tests for me too -- I just tell her what I want and she enters the orders.

I'm glad that you did finally get your study and your reimbursement. I don't blame you a bit for changing providers.
(This post was last modified: 02-08-2016 03:20 PM by Winterfrost.)
02-08-2016 03:12 PM
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justMongo Offline

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Post: #4
RE: My experience with Kaiser Permanente and their sleep study process
Winterfrost: Sounds like you had a positive experience; and now have a good machine and mask.
Only one thing in your narrative took me aback: Group education on the machine.
Seems like one gives up some privacy. I suppose it's no different that being seen in a doctor's waiting room.

Any chance you are using the KP facility in Walnut Creek. I know a vascular surgeon there.

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.
02-08-2016 03:29 PM
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ruach Offline

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Post: #5
RE: My experience with Kaiser Permanente and their sleep study process
My experience with Kaiser has been more similar to that of Winterfrost. When I told my Primary Care Physician regarding sleep, and how some people had recently suggested that I check into Sleep Apnea, she immediately referred me to the sleep clinic. Initially with the group meeting and home test and titration. They sent me out to get an overnight sleep study because the initial titration did not resolve my apneas. Six months later they rewrote my prescription so that I could get a bilevel auto pap device. And, now, 3 years later, we are looking into potentially an ASV.

mrkdilkington, sorry to hear you had such a negative experience with Kaiser. I think it must depend on the type of coverage you have. Mine covers all DME for Sleep Apnea, and I have no Co-pays for my appointments regarding Sleep Apnea. Also, I do have periodic individual appointments with a Respiratory Therapist, and phone appointments with the Sleep Doctor after overnight sleep studies (had 3 so far).
02-08-2016 04:02 PM
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Winterfrost Offline

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Post: #6
RE: My experience with Kaiser Permanente and their sleep study process
(02-08-2016 03:29 PM)justMongo Wrote:  Only one thing in your narrative took me aback: Group education on the machine.
Seems like one gives up some privacy. I suppose it's no different that being seen in a doctor's waiting room.

Any chance you are using the KP facility in Walnut Creek. I know a vascular surgeon there.

The group thing was a little weird, but I was ok with it. Our individual results were not mentioned aloud, just general information. This was at the Santa Clara facility.
02-08-2016 05:29 PM
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Winterfrost Offline

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Post: #7
RE: My experience with Kaiser Permanente and their sleep study process
Quote:mrkdilkington, sorry to hear you had such a negative experience with Kaiser. I think it must depend on the type of coverage you have. Mine covers all DME for Sleep Apnea, and I have no Co-pays for my appointments regarding Sleep Apnea. Also, I do have periodic individual appointments with a Respiratory Therapist, and phone appointments with the Sleep Doctor after overnight sleep studies (had 3 so far).

I expect it was more that his PCP wouldn't make the referral, and then that he went outside of Kaiser's network to get a study done. I totally understand why he did so (I would too if my doctor had refused to refer), but frankly I'm amazed that he was able to get Kaiser to reimburse at all. They are very sticky about paying for any service out-of-network.
02-08-2016 05:33 PM
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ruach Offline

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Post: #8
RE: My experience with Kaiser Permanente and their sleep study process
(02-08-2016 05:33 PM)Winterfrost Wrote:  
Quote:mrkdilkington, sorry to hear you had such a negative experience with Kaiser. I think it must depend on the type of coverage you have. Mine covers all DME for Sleep Apnea, and I have no Co-pays for my appointments regarding Sleep Apnea. Also, I do have periodic individual appointments with a Respiratory Therapist, and phone appointments with the Sleep Doctor after overnight sleep studies (had 3 so far).

I expect it was more that his PCP wouldn't make the referral, and then that he went outside of Kaiser's network to get a study done. I totally understand why he did so (I would too if my doctor had refused to refer), but frankly I'm amazed that he was able to get Kaiser to reimburse at all. They are very sticky about paying for any service out-of-network.

Yes, I agree with you Winterfrost - it is quite unfortunate his Primary Care Physician would not refer, it is also totally amazing he was finally able to get reimbursed.

I am grateful for the Kaiser PCP and coverage that I have.
02-08-2016 06:18 PM
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DariaVader Offline
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Post: #9
RE: My experience with Kaiser Permanente and their sleep study process
(02-08-2016 03:29 PM)justMongo Wrote:  Only one thing in your narrative took me aback: Group education on the machine.
Seems like one gives up some privacy. I suppose it's no different that being seen in a doctor's waiting room.

I am not with Kaiser, but my DME did it this way also, except there were 6 of us not 15, and they handed us the new apap and not a loaner in the first visit. We also got sheets that said what our copays were, but they did not actually do their homework, mine, at least was wrong.

everyone who was in the DME group had either had a home or lab study, tho and not just some oximetry! Kaiser truly does things their own way.

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
(This post was last modified: 02-08-2016 07:53 PM by DariaVader.)
02-08-2016 07:51 PM
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bwexler Offline

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Post: #10
RE: My experience with Kaiser Permanente and their sleep study process
My brother in law had Kaiser and he loved it. Unfortunately he seldom paid any attention to what anyone said about his health.
I started monitoring it for him and accompanied him to his PCP appointments when I could. It took me about 2 years to convince his doc to order the sleep test and almost 2 more to convince him to use his APAP. Unfortunately at 80 years old and 50 years of smoking, when I finally moved in with him and took charge, it was too little too late and he passed last Thanksgiving. If KP had been more responsive and he had been more compliant maybe things would have turned out differently.
02-08-2016 11:07 PM
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