How to Replace Your CPAP in Only 666 Days
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aphyr.com
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.
You tell the person "I was told I had to pay this <X fee> to release my package but I don't know who or where I pay" while waving the cash around cluelessly. The person will 100% then offer to take it and "handle it from there" under the stupid guise of plausibility.
I tried giving a gift to some, as thanks for letting me sleep on their couch. They told me no no no. I asked my friends about it, they told me it's about face.
Omg, I get that honor is a big thing, but it makes normal interactions way more complicated.
"You'll have to pop in next time you're in the area!" does NOT mean "turn up at my house unannounced". Even if it sounds like it.
Or "How are you going?" is not a prompt to actually tell them how you're going.
I'm told that, in China, a way to greet someone is to say: "Have you eaten yet?" 你吃了吗
You are not supposed to provide a detailed answer such as: "Yes I ate a breakfast sandwich this morning at 8 am".
Instead you simply say "I ate" (吃了) or "Nope" (没呢)
Some areas may have it to a lesser extent (China were the cultural revolution steam rolled everything and only left superstition) but the concepts shared remain the same,the expression of the pattern varies widely.
Regarding money, you should start with cash. Have an amount you think is fair on your pocket. Tell them this is what you have and thank for their help. If they don’t look happy or they reject/ask for more, tell them it though, but that you need check if you have more in your car. If the difference is a lot, say you need to ask friend for help. Go back to your car, pretend to talk to someone and come back with more. If they really want a lot more, ask for they’re bank account and tell them you’ll need to transfer (throughout make sure to show them that they asking for a lot and this is very hard for you, you have kids, need to eat, get a cab, pay a loan, etc). Also if you tell them you’ll transfer from a different bank than theirs, they might settle on the cash because interbank transfers are not same day.
All this varies by country and what methods of payment are available.
Sounds like they thought they caught a reseller endangering somebodies sales friendship.
At least people in Vietnam don't kid themselves and call a bribe a bribe.
Paying a third party is just as illegal. However, unless you’re expecting to run for Congress, nobody is going to care that you bribed some low level foreign customs agent to get your ink cartridges released.
Grease payments are paid for the purpose of expediting a task that a low-level official is required to do anyway as part of their job, e.g. release a package from customs hell.
The FCPA prohibits bribes which are payments intended to influence high-level decision-makers to make a decision in your favor when they are not otherwise required to do so.
[0] https://en.m.wikipedia.org/wiki/Foreign_Corrupt_Practices_Ac...
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One of the major scandals associated with the Dole family is the overthrow of the Hawaiian monarchy. Sanford Ballard Dole used his government influence and self-appointed position in Hawaii to push the US toward taking over the islands in the late 1890s. The Dole fruit company in Hawaii rose out of the bloodless Hawaiian coup staged by the Dole and the US government in 1893. Another scandal involved the Dole Food Company, where a jury found that Dole should pay $2.5 million in punitive damages to five workers who claimed they were made sterile by use of a pesticide on Nicaraguan banana plantations in the 1970s.
Maybe if you are doing more serious stuff like business or real estate it makes sense.
Most of the time when you need to deal with a government agency you’d go through one of them. They don’t advertise that they’ll bribe people to get it done but that’s how it works.
Cousin Eddie: I'm real glad that things are going good for you, Clark.
Clark: Mm-hm.
Cousin Eddie: I got laid off when they closed that asbestos factory.
Clark: Ahem.
Cousin Eddie: And now, wouldn't you know it... ...the Army cut my disability pension... ...because they said the plate in my head wasn't big enough.
Clark: Shoo.
Catherine: Eddie, Clark and Ellen don't want to hear about our troubles.
Clark: No, no. It's very interesting.
Aunt Edna: Why don't you just ask him for the money, Eddie? He sure as hell can't take a hint.
I'm stuck in thinking that someone smart could break apart these CPAP machines and bring in necessary parts, then find other parts from China and hand carry those in. Then reassemble them inside Vietnam. A price differential of $1500 seems like an interesting arbitrage opportunity, maybe better than drug dealing. And there aren't chip sniffing dogs in the airport.
What a nightmare.
My CPAP machine was held by customs, they asked me to provide some extra paperwork from another department, which boiles down to a form and a "prescription". Fortunately they accept american prescriptions. I emailed all of the docs to the department, and they told me since I'm physically in Japan, I have to do what Japanese would do - send a physical mail in an envolope. A week later I got the approval mailed back to me, scanned them and emailed them back to the customs, they released my package.
Then, the shipper messed up with my address, they use a local partner for delivery, but failed to pass them my phone number and the second line in my address. Apparently the poor delivery guy attempted to deliver for a week, I found it out in the tracking page, called the customer service, they figured out and eventually have it delivered.
I thought it was terrible, but now.
Seems like something you could have paid 500-1000k (20-40USD) and been done with.
I've lived here for 12 years, I know how it works.
I had a business trying to get an institutional trading account, and all these compliance officers kept the application in limbo for a year
finally the exchange’s general counsel or someone maybe even the CFO said I needed to show my company’s AML/KYC policy.
I have my lawyer draft a comprehensive AML/KYC policy.
I told the financial institution that my legal counsel had prepared our "ANTI-MONEY LAUNDERING AND “KNOW YOUR CUSTOMER” PROCEDURES Which should fulfill all of your company’s compliance goals”
And apparently that contained the magic words because they approved the account instantly, after being in account creation limbo for an entire year, they never even asked for or looked at the document
I learned the hard way after a few experiences like yours to telegraph as little frustration or anger as humanly possible. Reasoning also only goes so far.
But if you appeal on some technicality, even a rule of your own invention..
Carol Beer presents differently across cultures (https://www.youtube.com/watch?v=1pw8m_NTJ_0).
With all the "free trade" agreements Vietnam is party to [1], you'd think this would be perfectly fine. Funny how that works, isn't it?
[1] https://en.wikipedia.org/wiki/Free_trade_agreements_of_Vietn...
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.
Byzantine processes when dealing with medical issues should be punished with Byzantine punishments.
Little late for the new year's stuff, but let's party like it's 499!
So I made a little personal mod that immediately castrated (if there was something to castrate) and blinded all characters of the Byzantine empire on game start, and it seemed to solve the problem.
Unfortunately sometimes you can't get back the court fees, and in situations like that, rather than spending $3000 on some new medical gear and battling insurance I would be very tempted to go to eBay, buy it 2nd hand from someone for $150, and just use that. Better time/effort/money/result tradeoff IMO.
https://www.ebay.com/itm/404778680293
They even have a category for "Medical equipment > ventilators". If they do have such a policy, they enforce it very poorly.
Policy: https://www.ebay.com/help/policies/prohibited-restricted-ite...
Guess which way we went…
I’m sorry the author had to deal with any of this. A lot of pandemic scarcity and multiple recalls made it hard to get supplies for a long time. My wife’s first CPAP is out of commission because the parts will simply never be made again. In between the pandemic start and the “well we all gave up” point three new models, recalls, and various mergers happened but not one replacement set of filters were delivered.
If it was any sort of other filter I’d just buy a replacement from Amazon and call it a day, but that doesn’t seem appropriate for this situation. Some people did and apparently (per doctors not my own research or anything I can verify) old OEM and new but improperly made third party filters can start flaking off while the machine runs due to how CPAPs work.
Now though? Apparently it’s easy to get a new model and all the components from a supplier… at least if you skip insurance.
Much more easier to fight than if you'll have to bring them to pay something you paid first.
Thinking about it, the only moderately difficult part would be compiling a list of small-claims courts and understanding the different paperwork each one requires.
After that, the whole thing could just be a single page with a few form fields (email, insurance company info, upload purchase receipt), a credit card form for the SaaS to collect its fee, and an API integration that uses one of those physical-mail APIs to send out the paperwork.
In reality the difficult part would actually be getting your service in front of people like OP at the right time. How do you imagine the guy in this post finds you and pays for your service? Have you ever looked for a similar service yourself when you faced similar issues?
my high school made sure I knew how to use both a band saw and a stand mixer; why not a courtroom? that's a systemic failure we could yet address
The very nature of having to be adversarial and “guard up” on everything is what exhausts people and sours a culture. It’s also inaccessible to many who are already exhausted and just don’t have another manual process and battle in them.
Note: some states do not allow forum selection clauses in insurance contracts, by statute or by case law. However, that will not stop a company from boilerplating it in. so, just because the policy might have the clause does not mean it’s necessarily enforceable.
On the other hand, I get the point that they may just pay the money rather than send it to legal to handle. YMMV.
In general, small claims courts aren't very strict on the correct procedure being followed - they are explicitly designed to be accessible to non-experts.
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.
Of course, someone is upcharging somewhere, but that's hardly the patient's fault.
They had me rent the machine for 30 or 60 days. The machine had a cell modem that reported data to medresair, the manufacturer, and my sleep clinic checked that. A nurse called me twice to check in, sent the something to the insurer and after 60 days submitted a new claim.
It was actually one of the most efficient processes I’ve ever had with my insurance.
Like everything in the US health system, experiences vary depending on provider and payer.
Fortunately I was able to just return it, but if I hadn't been able to, why should that mean insurance wouldn't cover it? I was prescribed this device and it didn't work for me.
I'm not saying the surveillance and payment-held-hostage model is the best, but it does at least attempt to provide some useful incentives.
So given all of that, I think it's better to work on trying different masks and other strategies for getting used to the mask before considering the implant.
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.
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)
If you work for a company that does this, be aware that the things you dislike about your insurance coverage may well have been designed that way by your employer, not the insurance company. Don't curse the insurance company when you don't like the benefits. Ask your manager and HR department why your employer chose that rule or limit.
isn't this simply a service that big corps can buy from these huge insurers? so they end up as the payers, they can manage their own plan(s), but of course they actually don't even have one single actuary on payroll, right?
They rarely have actuaries on payroll but there are several boutique actuarial consultant who serve these companies (e.g. "given the geographical distribution of your employees and the higher use of services X, Y, Z, you would save $xxx if you choose insurer A over insurer B").
I suffer from sleep apnea and I too had an issue with my CPAP machine. The NHS fixed it within a week.
I can’t imagine spending 2 years chasing different health providers to sort a simple repair.
There was probably some argument for requiring a prescription when someone needed to adjust the pressure, but now that the machines do that themselves, they should probably just be available at Wal-Mart next to the reading glasses.
Apropos of anything else, the newest CPAP machines are relatively sophisticated. They may not be worth the $1,100 they sell for, but definitely more than $150. $500, maybe.
> The sleep apnea world is kind of a weird racket; in order to buy $150 worth of electronics, you need to pay a doctor $5000 to interpret the results of a sleep test.
ENT too. I had a deviated septum. Most (all?) of my life. Finally did something about it when I was 40. Went to an ENT, who was great. "Yup, right nostril, 90% occluded". "Makes sense. So when do we schedule the surgery?"
He sighs, and with a roll of his eyes (at the process, not me), "Welllll.... first I'm going to prescribe you these two nasal sprays so that you can come back in 30 days and tell me that, to our mutual shock, they didn't realign the cartilage in your nasal septum. At that point, insurance will approve the surgery and I can have it done within 3 days of getting that approval back."
Thankfully, that went like clockwork. I saw him on day 30, and they had an approval and 34 days after seeing him for the first time, it was taken care of.
But what a fuckshow.
I guess my point is that as reassuring (as a Brit) as it is to know the NHS is there, private insurance isn’t necessarily bad if regulated well (and that matches my experience of having private insurance in the UK too), it’s just America’s seems incredibly poorly regulated.
Correlation isn’t causation of course. Not suggesting golf courses cause doctors. But in general in this thread I see people from heavily golfed areas saying ‘I found a doctor really quickly’ and people from golf deserts talking about long waits.
They have figured out the right time in the morning to call every day to try to grab a canceled appointment slot but it takes dedication.
- Dermatologist: 5 months
- Cardiologist: 3 months
- ENT: 8 months (turned out to be a useless appointment too sadly)
According to my PCP last week, endocrinologists have stopped taking in patients that do not have urgent issues and even then it's a 6+ month wait. He said 9/10 of his referrals to endocrinologists in the last year have been denied.
This sort of thing depends heavily on where you live, what your insurance coverage is, and the specific condition you're seeking care for.
I couldn't find a PT within 30 miles that could see me within "12-14 weeks".
that is not typical
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)
This was on a three-day business trip to the UK, which was extremely unlucky, but the NHS was fantastic.
And then of course you have the constant strikes and inability to even see a doctor at all unless you win the game of phone lottery.
The NHS may have a simple user interface, but it doesn't actually work when you need it so that's not very helpful. And the idea this is a Tory problem is propaganda. The NHS budget only ever goes higher yet service gets worse. Dumping ever more money into this third world system is never going to work.
It's visible in other systems too, where for example you end up with local government politicians fighting for "prestige" or even perceived need to have a specific kind of hospital in their area, but they don't have a way to bring enough patients to support it, so you get a system too fragmented to sustain despite spending more and more money.
A system that can't even provide dental slots without needing police to break up fights is a catastrophically failed system and it is a huge problem of the UK that people have loyalty to this dying corpse of a department.
Suddenly there's less money for smaller, cheaper things.
And what is the alternative? For-profit systems?
This includes multiple consultations with sleep specialists and zero chasing from me.
I'd question the "by stealth" part of this.
Similar systems as the NHS have been introduced and subsequently canned in favor of more sane approaches in other European countries, which now have better (but still socialized) healthcare as a consequence.
There is no central european country with a similar amount of health care horror stories than the UK, and none where it plays a similarly important role in its identity. It boggles the mind.
...except people in the US.
People in the US would like a system that works. That means not waiting 666 days for a CPAP. It also means not having the government strongly nudge you to off yourself with its assistance, as in Canada. And it means not having an ever-increasing number of deaths by waiting, as with the NHS, which typically don't happen here for most kinds of care.
https://www.theguardian.com/society/2023/aug/30/national-tra...
Sadly, healthcare is expensive to provide regardless of who's paying. The NHS is able to provide even that troubled level of care because it pays its medical staff poorly by American standards, which it is able to do because it relies heavily on immigrants, which it is able to do in large part because those immigrants can't come to America and make 3x the salary since we make it incredibly difficult for foreign medical credentials to be recognized here. If we quit doing that tomorrow, the NHS would collapse by Friday.
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.
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.
I refuse to do business with Apria. They’re the worst company I’ve ever dealt with.
In any other industry, this would be called "fraud."
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.)
Makes me wonder if in the US a trip to mexico or canada or somewhere could make this easier.
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.
The ironically terrifying evidence about what a horrible idea this is is that it was just in the news that the FDA said that recalled CPAP machines made by Philips killed 561 people: https://www.cbsnews.com/news/fda-sleep-apnea-philips-recall-...
Plain old consumer device safety stuff would apply here.
The only reason there was a recall was because of the regulations and the gargantuan and slow bureaucratic apparatus surrounding Philips.
Philips tried, and would have succeeded without the regulations, to brush this off. They stalled, delated, cajoled, and lied.
Consumer protection laws (i.e. just sue after someone dies) are almost worthless in this case. No amount of rationally acting rational actor's next of kins bringing individual actions after the death of a loved one would have gotten Philips to move. Those wouldn't have even occurred because the only reason the link was made was because of a medical device monitoring system put in place by the FDA and government medical researchers looking into anomalous death statistics whose only common factor was Philips CPAP machines and the ensuing technical evaluation. Numerous deaths occurred, were attributed by some other cause because dissecting a deceased person and examining their alveoli for microscopic particles isn't an action typically performed after someone dies of what appears to be a stroke in their sleep.
Indeed, when this whole mess first started Philips deflected and delayed for years and their teams of lawyers would have annihilated each individually rationally acting rational actor's lawyers one by one to protect their bottom line drowning each litigant in delays, appeals, and litigation by financial attrition as the cases popped up one-by-one.
"Duh gubmint" is slow and often ineffective, but in this case the only reason anything happened at all and Philips CPAP machines aren't still out there literally and actually killing people is because of "a fat cat gubmint parasite" enforcing "onerous and burdensome" laws.
Of course I could be wrong. We all remember how magnanimous and ethical corporations were prior to all of these systems being put into place, don't we?
Wait. We don't?
Second, this comment would have been better without the final three paragraphs, which amounted to flame bait.
Dunking on libertarians is the moral, ethical, and honorable duty of all sentient beings.
However I don’t know enough about CPAP to judge whether you should need a doctors cert or some kind of training cert on the device. Can a CPAP harm you if you incorrectly use it / use incorrect settings?
I'm pretty sure I've never heard of a worse idea for a law. Removing any possibility of regulating the quality or efficacy of medicines and medical devices will injure and kill far more people than any resulting improved access would help.
People uses faulty medical device, however....
The idea that the law prevents me from pulling defective foam out of a device I own is terrifying.
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.
But no communication from the insurance company told me that.
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.
my prescription was for a 30 day supply.
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.
Tell me why this is not fraud. Tell me why insurance company employees are not facing prison time.
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.
https://www.fda.gov/medical-devices/safety-communications/up...
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.
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.
If only.
I doubt he has a list if his doctors that his insurance companies or doctors would agree with.
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.
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.
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!
(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.)
https://en.m.wikipedia.org/wiki/Continuous_positive_airway_p...
(Disclaimer: I’ve never had to exercise this personally.)
That's why these are considered a prescription--the prescription is the settings on the machine.
I'm the US with health insurance but I bet it'll be more expensive to go the legit way.
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.
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
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.
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.
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.
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.
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.
This is a great example of why.
Every healthcare system has issues, but universal healthcare beats the pants off the US system any day of the week.
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.
(Not saying that's the right number, health care in the US is out of control).
Asinine.
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.
Edit: to downvoters - why the closed mind?
Unsolicited medical advice is not appropriate. It suggests that the people suffering from the condition in question have put literally zero effort into solving their problem, when in reality they likely have already heard about and tried every "trick" or "alternative treatment" you're going to suggest.
Other common scenarios:
* Telling a chronic pain sufferer to "just try cannabis, it works better than pharmaceutical pain killers!"
* Suggesting [common behavioral quirk] is a very obvious sign of ADHD, and encouraging them to take Adderall.
* A whole host of "x supplement fixes y chronic condition" suggestions.
If you can fix a problem by changing your diet, is it really a medical problem? Just because it relates to your health or body doesn't mean it's medical.
I know people who have made this diet change and it has changed their lives. They don't snore anymore. They don't need cpap.
If you're curious, look into it. If you're not, you're not.
Yes, without doubt.
Scurvy is a medical problem (very often) fixed by changing your diet to include vitamin C.
Beriberi is a medical problem (very often) fixed by changing your diet to include more thiamine.
Quite a few people have allergic reactions to the content of their food, like celiac disease due to an allergic reaction to gluten, which is resolved by switching to a diet without that component.
Some young children got lead poisoning because they would eat paint chips which tasted sweet due to the lead content. Their medical problem is helped by switching to a non-lead paint diet, often by removing the old paint from where they live and repainting, or by moving somewhere without lead paint.
> I know people who have made this diet change and it has changed their lives. They don't snore anymore. They don't need cpap.
Snoring does not mean someone needs a CPAP machine. How were they diagnosed? How severe was it?
Was the food actually low in histamines? How low was it? Did it affect histamine levels in the blood? As I pointed out elsewhere here, the histamine variability in foods is quite high, and hard even for nutrition professionals to get right.
Is there a response curve between the amount of histamine and the amount of obstructive sleep apnea?
How do you know the cause was due to low histamine vs some other dietary change? For example, it seems excluding citrus fruits is part of a low histamine diet even though they do not contain histamine because they are thought to "trigger the release of endogenous histamine" (quoting that paper). But perhaps there is something else in the citrus - the acid content, for example - which causes the problem.
How does an low histamine diet compare to taking anti-histamines? Why should we expect the former to work if the latter does not? What is the proposed method of action?
We have only to look at the history of scurvy and vitamin C treatment to learn how important it is to understand the details of why a treatment works!
How long does it take for the change in diet to affect people? 1 day? 1 month? 1 year?
Does it work for everyone with obstructive sleep apena or only a sub-population?
> If you're curious, look into it. If you're not, you're not.
I was curious. I looked into it. There appears to be no substance behind the idea.
No diet is fixing that cartilage.
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.2013.27.39... 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 , 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.