How to Replace Your CPAP in Only 666 Days

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

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.

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.

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.

I don't know Vietnam, but to my South American sensibility, it looks like they were fishing for a bribe.

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

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).

I guess random bureaucracy is ok when the treatment in question isn’t urgent.

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

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...

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.

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.

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)

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.

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.

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.

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.

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.

despite the Conservative push to dissolve it by stealth

I'd question the "by stealth" part of this.

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.

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.

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.

That would be great if more than 0.2% of the population had a vague idea of how to access the legal system.

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.

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.

They'll pay and then drop you at the next anniversary. Can only use that trick a few times.

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.

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.

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.

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.

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.

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.

No, but, you see, the system is privatized, therefore it must be more efficient. /s

Clearly it leads to lower premiums (or higher profits) because many claims are abandoned.

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.

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....

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.

Sounds like you are in the US.

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...

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?

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.

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.

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.

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.

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.

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)

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.

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.

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.

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.)

In any other industry he would have switched to a company that was better run.

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.

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.