[HN Gopher] How to Replace Your CPAP in Only 666 Days
___________________________________________________________________
How to Replace Your CPAP in Only 666 Days
Author : tl
Score : 314 points
Date : 2024-02-04 08:36 UTC (14 hours ago)
(HTM) web link (aphyr.com)
(TXT) w3m dump (aphyr.com)
| ch33zer wrote:
| This 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 wrote:
| This feels like every health insurance endeavor I have ever
| attempted.
|
| In any other industry, this would be called "fraud."
| legutierr wrote:
| In any other industry he would have switched to a company that
| was better run.
| gotbeans wrote:
| Congrats 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 wrote:
| I 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 wrote:
| Another 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 wrote:
| 'don't buy anthem products, period, for any reason"
| spondylosaurus wrote:
| What'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 wrote:
| I'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 wrote:
| I 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 wrote:
| Indeed. The incentives are all in the wrong place in the
| American system.
| p_l wrote:
| An 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.
| hyperpape wrote:
| I believe insurers are required to spend 85% of premiums
| directly on medical care:
| https://news.ycombinator.com/item?id=37977842.
|
| (Not saying that's the right number, health care in the
| US is out of control).
| gorbachev wrote:
| These days I am screening potential employers with who they use
| for their medical insurance plan. There's absolutely no way I'm
| ever going with United Healthcare Group ever again.
| astura wrote:
| Problem is, insurance contracts are only for a few years then
| employers shop around and it's usually cheaper to switch than
| to renew.
| spondylosaurus wrote:
| LOL, I had a phone screener three days ago and did the exact
| same thing. Asked which health plan they offered with the
| explicit purpose of filtering out UHC. They're the lowest of
| the low and even doctors hate them. (At least one of mine
| audibly groaned when I mentioned being on a UHC plan and then
| he said "Guess there's no point in trying <drug>."
| spondylosaurus wrote:
| Ha, 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 wrote:
| Carelon 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 wrote:
| It'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.
| mdekkers wrote:
| After 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 wrote:
| At least people who don't have your means have another
| option.
| mdekkers wrote:
| I don't have much in the way of "Means", I just enjoy
| breathing and set my priorities accordingly. Also, where I
| live the most expensive CPAP costs like 1800 EUR. Mine
| costs 900 EUR
| waltwalther wrote:
| Sounds like you are in the US.
| mikigraf wrote:
| Haha, I'm in Germany
| dendrite9 wrote:
| Just in case you missed the news about the recall and issues
| with Philips CPAP machines. You might want to check if there is
| anything that you can or need to do. The disintegrating foam
| seems like an unpleasant flaw in production.
|
| https://www.fda.gov/medical-devices/safety-communications/up...
| mikigraf wrote:
| Thank you, I appreciate it. Luckily my machine is not under
| recall and was produced in March of 2023
| thih9 wrote:
| CPAP = 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_p...
| CaliforniaKarl wrote:
| Reading 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 wrote:
| Met 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 wrote:
| Bingo!
|
| 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 wrote:
| Is step 3 to eliminate the FDA? The idea of letting randos
| modify and sell medical devices is terrifying.
| RecycledEle wrote:
| A 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 wrote:
| Typical 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.
| elteto wrote:
| This is the typical libertarian insanity: "Regulations are
| bad, ergo there should be no regulations. And once we get
| rid of them everything will just work because somehow
| everyone will still abide by _some_ rules, although they
| are not required."
| GiorgioG wrote:
| The problem is most Americans don't have these types of
| chronic health issues, so it's not an issue for them. I have
| a type 1 diabetic son, the amount of money we have spent on
| health insurance and medical equipment/supples is criminal.
| wwilim wrote:
| I feel sorry for you, man. I have T1D as well, but pump
| supplies + CGM work out to something on the order of $200 a
| month in Poland. I am not even sure how much exactly,
| because I don't bother to count since it's not big money
| for me. Still a lot given the median pay, and you still
| have to buy the pump out of pocket, but nowhere near what's
| going on in the States.
| GiorgioG wrote:
| Yep, I have a cousin in France who is also a T1D, he pays
| effectively nothing for his supplies (he tried pump+CGM
| but he's been doing injections for so long he found the
| pump to be a hassle.)
| thfuran wrote:
| >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.
|
| 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.
| dangus wrote:
| Funnily enough, we have a constitutional amendment
| guaranteeing the right to own machines that are designed
| with the singular purpose of killing people. How could a
| "medical device second amendment" be worse?
| j16sdiz wrote:
| People owns and uses a gun know what can be done with it.
|
| People uses faulty medical device, however....
| dangus wrote:
| If you say so!
|
| https://www.independent.co.uk/news/world/americas/toddler
| -sh...
|
| https://apnews.com/article/toddler-shot-kenton-county-
| parent...
| thfuran wrote:
| The second amendment doesn't guarantee an unrestricted
| right to sell guns and isn't even really interpreted as
| an absolute and unlimited ability to own then these days.
| Furthermore, the abusive ways to use guns to the
| detriment of others are inherently illegal and don't
| scale. If the right to sell medicine were absolute,
| thalidomide couldn't have been barred from the US market
| or subsequently pulled and probably would've been laced
| with nicotine or heroin to make sure people keep buying
| it. But maybe that wouldn't have been a problem because
| it would be lost in a sea of snake oil.
| xboxnolifes wrote:
| The right to bear arms doesn't stipulate the right to buy
| any possible configuration of arms. The equal comparison
| is the right to _use_ medical equipment as seen fit, not
| the right to purchase.
| hn_throwaway_99 wrote:
| > 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.
|
| 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-...
| cabaalis wrote:
| I also have experienced various delays related to my cpap
| machine. I wonder how much of this debacle is because
| people in the know knew that this was coming, and therefore
| intentionally delayed anything to do with cpaps.
| Karunamon wrote:
| How does that not demonstrate the ineffectiveness of the
| regulations?
|
| Plain old consumer device safety stuff would apply here.
| snakeyjake wrote:
| >How does that not demonstrate the ineffectiveness of the
| regulations?
|
| 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?
| quickthrower2 wrote:
| They went too extreme. Maybe let people buy the device but
| it still needs to be manufactured to regulations.
|
| 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?
| thfuran wrote:
| If a CPAP just did nothing, the users would be harmed.
| That's why they're using a CPAP machine in the first
| place. Or do you mean can the wrong settings be _even
| more harmful_?
| verytrivial wrote:
| You can now understand why the UK is holding on the its NHS with
| white knuckles despite the Conservative push to dissolve it by
| stealth.
| vertis wrote:
| Yes, 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 wrote:
| Though 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 wrote:
| Depending 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 wrote:
| I 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.
| nvm0n2 wrote:
| You got lucky. My father went to a&e recently with
| breathing problems due to some non COVID respiratory
| virus. He was struggling to breathe. They had zero free
| beds and he stayed overnight on the chairs waiting to be
| admitted. Eventually they found him a recliner.
|
| 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.
| p_l wrote:
| Part of it is a Tory problem - when they changed how the
| funding gets distributed, so that overall bigger fund is
| divided now into smaller pieces that still have to cover
| the same population, but without the scaling benefits
| that previous allocation provided.
|
| 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.
| robmccoll wrote:
| I have terrible news about systems built on private health
| insurance (USA): it will still take 666 days to see a
| specialist, and you will need a referral from your PCP who
| may also decide they want to see you in person first. This
| may be its own scheduling nightmare. Then you may find out
| that your preferred specialist is out of network for your
| private insurance. The waits are a generally a supply and
| demand issue more than a beurocracies issue, but I can assure
| you that multiplying the number of beurocracies involved in
| getting healthcare doesn't speed anything up.
| dralley wrote:
| I've never had to wait more than a month to see a
| specialist in the US
| bentt wrote:
| LOLOLOL
|
| that is not typical
| coldtea wrote:
| LOLOLOL depends on the area.
| ceejayoz wrote:
| That'll depend heavily on location and specialty.
| Neurology and dermatology book 3-5 months out for new
| patient visits in my area, from personal experience.
| 15155 wrote:
| This is my experience as well.
| Brybry wrote:
| I don't know about 666 days but my senior citizen parents
| complain about specialists where the earliest (non-
| emergency) appointment is 6+ months out.
|
| 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.
| SamoyedFurFluff wrote:
| I think it heavily depends. I know a friend who can only
| see her neurologist with a 3 month wait. Rheumatologists
| and specialized cardiologists are about the same issues.
| As an adult, trying to speak to a neurologist for an
| autism, ADHD, or learning disability evaluation is also a
| nightmare time-wise.
| ericjmorey wrote:
| Last month, I tried to make an appointment with an
| endocrinologist. The first one I called had the earliest
| availability in July. The earliest one I could schedule
| was in March. and it's an hour and 15 minutes away from
| my home.
| gorbachev wrote:
| I couldn't find a single specialist who were taking new
| patients within 100 miles for my chronic condition when
| it was first diagnosed.
|
| This sort of thing depends heavily on where you live,
| what your insurance coverage is, and the specific
| condition you're seeking care for.
| y-c-o-m-b wrote:
| In the Pacific NW for me:
|
| - 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.
| diob wrote:
| When was the last time you went? Nearly everything, even
| non-specialist, are booked out a month or more.
| WarOnPrivacy wrote:
| Mine are booked out forever because usable health
| insurance is far out of reach.
| hnlmorg wrote:
| My sleep apnea went from initial visit to an NHS GP to a
| working CPAP machine in under 3 months.
|
| This includes multiple consultations with sleep specialists
| and zero chasing from me.
| hnlmorg wrote:
| I completely agree.
|
| 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.
| MrBuddyCasino wrote:
| The NHS is a failed system that absolutely nobody is envious
| of, except brits because for some weird reason, they seem to
| think that the alternative is poor people dying in the streets.
|
| 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.
| dhc02 wrote:
| "The NHS is a failed system that absolutely nobody is envious
| of"
|
| ...except people in the US.
| MrBuddyCasino wrote:
| If you think the problems of US healthcare are caused by
| too much ,,free market" and could be solved or even
| marginally improved by an NHS-style socialized replacement
| with even more government interference, you have never
| seriously investigated the issue.
| bigstrat2003 wrote:
| People in the US, by and large, aren't envious of the NHS.
| For most people, if they've even heard of the NHS they have
| a negative opinion of it.
| petesergeant wrote:
| I dunno, I've just spent 18 months in Dubai, where I had
| private insurance, and it was a breeze. See a UK-trained
| specialist for almost anything within a day or two, and
| hospital direct billing meant I almost never had to interact
| with the insurer directly.
|
| 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.
| jameshart wrote:
| A consistent theme in responses here is that how long you
| just wait for a doctor depends on location, and the
| preponderance of evidence suggests that the differentiating
| factor between locations where it is easy to see a doctor vs
| waiting a long time is _how many golf courses are around_.
|
| 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.
| eszed wrote:
| I think the critical element in the UK hasn't been
| regulation, so much as the NHS putting a hard price floor
| under everything that private providers offer. The two
| systems worked symbiotically. As / if the NHS is killed,
| private medicine will enshittify as well.
| humanrebar wrote:
| I'd rather go the other way and not require a prescription for
| a breathing machine. They're not habit forming and you won't OD
| on breathing.
| jrockway wrote:
| I agree with this. 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. Insurance companies require this because they don't
| want to waste money on electronics if there is no disease
| that needs to be treated. But of course, the testing costs
| them more than the devices. (And the devices aren't $150,
| because they aren't marketed directly to consumers, they're
| marketed towards insurance companies. That means you get to
| jack up the price because people aren't using real money to
| buy them.)
|
| 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.
| FireBeyond wrote:
| > And the devices aren't $150, because they aren't marketed
| directly to consumers, they're marketed towards insurance
| companies
|
| 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.
| FireBeyond wrote:
| > despite the Conservative push to dissolve it by stealth
|
| I'd question the "by stealth" part of this.
| thegrizzlyking wrote:
| Are 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 wrote:
| No, but, you see, the system is privatized, therefore it must
| be more efficient. /s
| eastbound wrote:
| The upside of inefficient privatized process is that you can
| replace them.
| genocidicbunny wrote:
| Well 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 wrote:
| LOL
|
| If only.
| hyperpape wrote:
| I 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-tim....
| kevincox wrote:
| Not 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.
| lolc wrote:
| Clearly it leads to lower premiums (or higher profits) because
| many claims are abandoned.
| geekpondering wrote:
| I 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 wrote:
| I 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 wrote:
| Moats are gonna do what moats are designed to do.
| RecycledEle wrote:
| This 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 wrote:
| From 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 wrote:
| This 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/
| londons_explore wrote:
| Please 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 wrote:
| Unfortunate 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 wrote:
| Byzantine punishments were more along the lines of castration
| and facial amputation.
| genocidicbunny wrote:
| Who'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 wrote:
| Anthem CEO here we come! lolol
| philwelch wrote:
| Reminds 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.
| londons_explore wrote:
| In most places you can at least get back the court fees
| (which are typically a few hundred bucks).
|
| 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.
| patja wrote:
| eBay is pretty good at enforcing their policy banning sales
| of medical equipment requiring a prescription. They yank
| any listing for a CPAP very quickly.
| londons_explore wrote:
| Took me literally 30 seconds to find one:
|
| 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.
| patja wrote:
| I guess it varies by country. In the US they pull CPAP
| listings very quickly.
|
| Policy: https://www.ebay.com/help/policies/prohibited-
| restricted-ite...
| genocidicbunny wrote:
| I don't want to get back just my court fees. If I could
| have it, heads would roll, but in lieu of that, I will take
| severe personal penalties to all those involved. Their
| tunes will change really frakking quick if the consequence
| is being put out on the street (or worse) for frakking
| around with people's medical coverage.
| q7xvh97o2pDhNrh wrote:
| Someone should start a SaaS that just automates this process.
|
| 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.
| jasonjayr wrote:
| A use of AI/LMM I could support: read the policy documents
| and produce (or execute) the exact steps to get the insurance
| company to honor their obligations.
| danuker wrote:
| Hell, even reading the policies and responding whether I'm
| covered (and where it says so/hints towards) would be a
| worthwhile service.
| ericjmorey wrote:
| The policy is largely written in code that will not be
| released to a policy holder.
| nojs wrote:
| > the only moderately difficult part would be compiling a
| list of small-claims courts and understanding the different
| paperwork each one requires.
|
| 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?
| lolc wrote:
| I think this is where search engine ads would work. The
| keyword is Anthem. The message is "File Anthem claims
| through us. Get paid in no more than 60 days or we waive
| your $10 fee."
| epgui wrote:
| That would be great if more than 0.2% of the population had a
| vague idea of how to access the legal system.
| silverlyra wrote:
| and this gets me wondering; what could we accomplish if we
| took 0.2% of the time we spent writing (let alone reading)
| internet comments, and instead used that time to engage in
| our state democratic processes, and help update our public
| school education standards to build a robust civil society!
|
| 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
| xrd wrote:
| Does small claims court work in some states and not other ones?
| I'm assuming you are us based? And my understanding was that
| small claims courts are very different in each state.
| londons_explore wrote:
| They are, but the basic idea works pretty much everywhere.
|
| 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.
| chrisandchris wrote:
| Thinking about that I really start to love the Swiss version of
| health insurance where (with most providers) you'll just
| provide your insurance card and they'll pay first and then
| decide whether to get reimbursement from you.
|
| Much more easier to fight than if you'll have to bring them to
| pay something you paid first.
| from-nibly wrote:
| That's generally how it works in the US as well.
| Waterluvian wrote:
| > and when they don't reimburse within 30 days file in small
| claims court
|
| 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.
| Moto7451 wrote:
| We lost my wife's CPAP while traveling. Through insurance it
| would have been a month of paperwork, an exception made, and
| $600. Without insurance it was no wait and $650.
|
| 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.
| syndicatedjelly wrote:
| If you need repairs done in the future, see if the local
| university's biomedical engineering department has a student
| chapter of Project C.U.R.E. Students may volunteer to fix the
| device (off warranty of course). They work for free for needy
| families, and if you're not in the former category, consider
| donating to their organization
|
| https://projectcure.org/
| jedberg wrote:
| They'll pay and then drop you at the next anniversary. Can only
| use that trick a few times.
| dmvdoug wrote:
| However, your policy might also contain (more likely) an
| arbitration clause, requiring you to submit any dispute to
| arbitration or (sometimes) a form selection clause, requiring
| you to submit a dispute in a particular legal forum other than
| arbitration.
|
| 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.
| 867-5309 wrote:
| Continuous Positive Airway Pressure
| jawngee wrote:
| Yeah 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.
| forinti wrote:
| I don't know Vietnam, but to my South American sensibility, it
| looks like they were fishing for a bribe.
| lolc wrote:
| Fishing is not the phrase I'd used. Insisting on, maybe.
| bethekind wrote:
| I think "searching for a bribe" or "seeking a bribe" might
| be closer
| EdwardDiego wrote:
| I feel like you were expected to pay a gratuity several times
| in that process and they were baffled you didn't.
| samstave wrote:
| Who's an expat who knows sliding some cheese? Not this guy.
| Roritharr wrote:
| I learned recently that you want a fixer that knows and
| bribes people where it's customary and expected. Going
| through lengthy processes deaf to the trigger phrases will
| make your life, which could be incredibly easy, unbearably
| hard in many countries.
| nimos wrote:
| Honestly I don't think most people need a "fixer" - just
| any local friend. Either they will know the expected
| bribe amount or they can figure it out. Also you might be
| able to get them to do stuff for you where all of the
| sudden the bribe is 1/10 the amount because they are
| local.
|
| Maybe if you are doing more serious stuff like business
| or real estate it makes sense.
| mlinhares wrote:
| In specific countries, like Brazil, "fixer" is a real job
| (it's called "despachante" there) and it's supposedly
| someone that knows the bureaucracy and how to navigate
| it.
|
| 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.
| gwd wrote:
| It is worth pointing out that (at least according to the
| corporate training I have to take every year) this is
| considered illegal _by the US government_ for a US
| citizen to do even not on US soil; if the Feds get wind
| of it and feel like making a point they could throw you
| in jail, even with an intermediary "fixer".
| Roritharr wrote:
| That's why these services are usually provided by "expat
| services agencies" that do these things intransparently
| to your knowledge.
| brnt wrote:
| It's amazing how based on the label, people are fooled.
|
| At least people in Vietnam don't kid themselves and call
| a bribe a bribe.
| mcculley wrote:
| Other common terms are "broker" or "agent". I pay the
| agent. He deals with the local bureaucracy. He knows what
| things should cost.
| samstave wrote:
| AKA; _... 'eeeeyyyyy, IgottaGuy..."_
| mcculley wrote:
| In my experience, they are more professional. I engage
| with a firm who offers "customs brokerage" and "agent"
| services. They take care of any local payments necessary.
| I get a proper invoice that I pay with a wire transfer.
| 15155 wrote:
| The FCPA allows "grease payments" to officials performing
| their official duties.
| coredog64 wrote:
| As a consultant, I have to take FCPA training an average
| of 3 times a year. So although I'm not a lawyer, my take
| is that it's only allowed if you can point to official
| documentation that lays out an expedited action fee
| schedule.
|
| 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.
| EdwardDiego wrote:
| There were some massive bribery scandals in the late 70s
| where pretty much entire governments were coopted by US
| corporates that these laws arose in response to.
| jawngee wrote:
| I tried but they wouldn't accept it.
| aniforprez wrote:
| I've dealt with this many times as a South Asian person and
| it is very possible they still do actually want money. Most
| people will not ask in a straightforward manner for money
| and when you offer to pay them, they act all offended. This
| is a stupid game that I have no idea how it started where
| they will pretend to not want the money but will still very
| obviously want it. This has stumped me, being mildly
| autistic, for the decades of my existence and also stumps
| foreigners a lot. I cannot proffer a solution. Sometimes
| asking works, most of the time it doesn't and the other
| party feels unhappy about it and then when you decide
| enough is enough and want to pay, another guessing game
| begins where you need to gauge what amount satisfies them.
| It's incredibly goddamn annoying and I wish they just told
| you they want a bribe or money instead of engaging with
| these weird, obtuse, coy behaviours and then I have to
| obsess over whether I made a faux pas by paying/not paying
| them
| Solvency wrote:
| It's their culture of saving face. The solution is
| extremely simple.
|
| 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.
| aniforprez wrote:
| I will try this next time. Thanks for the tip
| bethekind wrote:
| Asian culture never ceases to confuse me. Nothing is ever
| straightforward.
|
| 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.
| EdwardDiego wrote:
| Every culture has things like this.
|
| "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.
| appplication wrote:
| My friend does export/import into SEA. You don't just have to
| know who/when to bribe, you have to have an insider set up
| already. They used to have a guy in customs who would take a
| monthly payment to forward all her packages through without a
| second look. He disappeared and then trying to find the next
| one took months. Nothing was getting through customs, and
| showing up at the office they would deny any attempts to
| bribe. It is definitely a very coded art finding the right
| person, price, and parameters to get something set up like
| that.
| Solvency wrote:
| It's always a guy with a gun. Fact of life. Border
| crossings? Find the guy with the biggest gun and bribe him.
| South America, Eastern Europe, etc. Import/exports have
| armed security too.
| failingslowly wrote:
| I love this tip, but I sincerely hope I never have to use
| it.
| BossingAround wrote:
| "Gratuity" is an amazing euphemism for corruption in a system
| :))
| EdwardDiego wrote:
| Haha, yeah, I was thinking air-quotes when I typed it.
| xrd wrote:
| I recently read the book "Gaming Behind the Iron Curtain." It's
| about the former Soviet satellite states trying to play video
| games inside the Czech Republicb in the late 80s. They had to
| smuggle in computers hidden inside suitcases from England. This
| feels almost like the same thing.
|
| 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.
| stuaxo wrote:
| Sounds like the zx spectrum was almost built perfectly for
| that.
| bitwize wrote:
| Russians have a significant presence on the ZX Spectrum
| game and demo scene. There may be something to this.
| stevekemp wrote:
| There were several similar Z80-based systems made at the
| time, locally, such as the Hobbit:
|
| https://en.wikipedia.org/wiki/Hobbit_(computer)
| bitwize wrote:
| But to clone the Speccy they first had to obtain one (or
| a few) :)
| nimos wrote:
| Did you not try to pay some coffee money? Do you have local
| Vietnamese connections?
|
| Seems like something you could have paid 500-1000k (20-40USD)
| and been done with.
| jawngee wrote:
| Yes they wouldn't accept it.
| natch wrote:
| You aren't telling us how it was offered. Openly in front
| of multiple people, discretely, etc.
| petesergeant wrote:
| If 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
| methou wrote:
| I had a similar experience but in Japan.
|
| 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.
| positr0n wrote:
| Back in the day I remember reading patio11 posts on
| navigating the Japanese bureaucracy and he described this as
| "doing SQL JOINs" across different departments by filling out
| forms and visiting each one.
| codewench wrote:
| Japanese customs is a special thing. I had a plastic
| Christmas tree held in quarantine for 9 months because the
| box said "tree", and all attempts to point out that the tree
| was in fact fake, and probably not of serious biological
| concern feel on deaf ears.
| coldtea wrote:
| > _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._
|
| 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.
| yieldcrv wrote:
| lol I felt that last part
|
| 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
| verticalscaler wrote:
| It isn't good to argue that way in this part of the world, I
| hope you didn't raise your voice - not 100% sure about Vietnam
| but in any of its surrounding countries - they would lose face
| and become uncooperative.
|
| 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).
| bugbuddy wrote:
| Your mistake was not bringing an envelope full of USD as
| evidence to be submitted to the relevant authority to expedite
| the service. Guess why it costs over $2k? Additional
| administrative taxes included. Also, you are supposed to do
| this through somebody that knows somebody that works somewhere.
| jevoten wrote:
| > Next week you can't have it because they think I'm importing
| to resell it.
|
| 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...
| genocidicbunny wrote:
| Medical, 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.
| HumblyTossed wrote:
| Health 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 wrote:
| Alternatively, 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 wrote:
| I 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.2013.27.39...
| 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.
| seattle_spring wrote:
| > 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.
| r2vcap wrote:
| It 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 Lowenstein's CPAP, and it works great without any
| problems.
| mattmaroon wrote:
| But we can't have public health insurance because the lines will
| be too long.
| ergonaught wrote:
| Have been trying to replace my (recalled) machine for about a
| year, now, myself.
|
| Asinine.
| Havoc wrote:
| Making sick people jump through a million hoops takes a special
| kind of evil.
| bhoops wrote:
| Why 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 wrote:
| You 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 wrote:
| Not 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 wrote:
| I'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 wrote:
| Buying/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.
| bytearray wrote:
| Insurance 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 wrote:
| I 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 wrote:
| Have 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
| tshirttime wrote:
| Forget the CPAP. If you're having trouble sleeping, just read
| this longwindedness.
| wsintra2022 wrote:
| I read how to replace your Crap and was interested briefly.. I
| got a lot of crap laying around that needs replacing
| sanarothe wrote:
| Reimbursement 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 wrote:
| I'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 wrote:
| > 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)
| jffry wrote:
| Yeah companies directly running insurance is a thing:
| https://en.wikipedia.org/wiki/Self-funded_health_care
| patja wrote:
| This is how a lot of big companies work. They self-insure.
| They set the rules, pay all the bills, and the insurance
| company just administers things.
|
| 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.
| NelsonMinar wrote:
| "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.
| _qua wrote:
| As 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 wrote:
| I don't know. I feel like the compliance checks are more
| expensive than the machines at this point. They retail for
| around $/EUR 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 wrote:
| I went through this with my provider and insurer, Aetna.
|
| 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.
| logbiscuitswave wrote:
| How do you feel about the new surgical options like Inspire
| Sleep as an alternative for people who can't tolerate CPAP?
| _qua wrote:
| It's a lot more involved than CPAP. You need to have a low
| enough BMI to qualify which excludes a not insignificant
| proportion of apnea patients. You need to have
| predominately obstructive sleep apnea since the device
| can't treat central apneas (where you just stop attempting
| to breathe). You need to be fit enough to tolerate surgery.
| You usually need to have an induced sleep study where you
| get put to sleep with propofol while someone uses a nasal
| endoscope to watch what part of your airway becomes
| occluded when you sleep to see if it's even something that
| can be treated with the device. And then even after all
| that the device essentially zaps your tongue to make it
| move and open your airway and for some people they find
| this intolerable, and the device needs to be turned off.
| After all that I think it's effective in about 50% of
| people.
|
| 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.
| yegle wrote:
| I 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 wrote:
| I 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 wrote:
| I 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 wrote:
| Got rid of mine by going on keto/16-8 fasting by dropping 80lbs
| over about 9 months.
| Glyptodon wrote:
| The 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 wrote:
| 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 wrote:
| 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 wrote:
| 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 wrote:
| 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 wrote:
| 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 wrote:
| 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.
| lepus wrote:
| 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.
| pgraf wrote:
| Might 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-r...
| dramm wrote:
| Anthem Insurance staff just following their Claims Manual,
| Section U.
| steve-atx-7600 wrote:
| I'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 wrote:
| I 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 wrote:
| Having 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 wrote:
| I 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 wrote:
| I 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 wrote:
| God, 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 wrote:
| For 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-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
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