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.
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.