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How to Replace Your CPAP in Only 666 Days

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Re: How to Replace Your CPAP in Only 666 Days

#141

Post by appplication »

EdwardDiego wrote: post #51
jawngee wrote: post #39

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…

I feel like you were expected to pay a gratuity several times in that process and they were baffled you didn't.

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.

Re: How to Replace Your CPAP in Only 666 Days

#142

Post by RecycledEle »

ThrowawayTestr wrote: post #42
RecycledEle wrote: post #31

Earlier quoted context omitted.

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. I…

Is step 3 to eliminate the FDA? The idea of letting randos modify and sell medical devices is terrifying.

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.

Re: How to Replace Your CPAP in Only 666 Days

#143

Post by tylervigen »

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.

Re: How to Replace Your CPAP in Only 666 Days

#144

Post by aniforprez »

jawngee wrote: post #120
EdwardDiego wrote: post #51

Earlier quoted context omitted.

I feel like you were expected to pay a gratuity several times in that process and they were baffled you didn't.

I tried but they wouldn't accept it.

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

Re: How to Replace Your CPAP in Only 666 Days

#145

Post by bitwize »

stevekemp wrote: post #133
bitwize wrote: post #86

Earlier quoted context omitted.

Russians have a significant presence on the ZX Spectrum game and demo scene. There may be something to this.

There were several similar Z80-based systems made at the time, locally, such as the Hobbit: https://en.wikipedia.org/wiki/Hobbit_(computer)

But to clone the Speccy they first had to obtain one (or a few) :)

Re: How to Replace Your CPAP in Only 666 Days

#146

Post by positr0n »

methou wrote: post #101
jawngee wrote: post #39

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…

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 wee…

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.

Re: How to Replace Your CPAP in Only 666 Days

#147

Post by NelsonMinar »

"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.

Re: How to Replace Your CPAP in Only 666 Days

#148

Post by anjel »

eek2121 wrote: post #71
geekpondering wrote: post #25

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…

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 al…

Moats are gonna do what moats are designed to do.

Re: How to Replace Your CPAP in Only 666 Days

#149

Post by cabaalis »

hn_throwaway_99 wrote: post #121
RecycledEle wrote: post #31

Earlier quoted context omitted.

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. I…

> 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-rec…

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.

Re: How to Replace Your CPAP in Only 666 Days

#150

Post by from-nibly »

chrisandchris wrote: post #65
londons_explore wrote: post #33

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 ov…

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.

That's generally how it works in the US as well.
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