I snore. I mean, really bad. I’m certified — the doctors say I have sleep apnea, which means that I don’t get the kind of deep sleep that most people get. If left untreated, long term, this can cause all sorts of problems (in the worst case congestive heart failure — all from snoring? wow). But short term there’s a much more practical problem — my snoring means that my wife Pnina can’t sleep.
As far as I know, there’s no magic cure for sleep apnea. There is a surgery you can undergo, but from what I hear the chances that it will help are low. The best solution is something called CPAP, which is a machine that sits next to your bed and pumps air through a tube into your nose:
It’s not sexy, but it definitely works.
I started using my CPAP several years ago. I actually had to undergo a complete “sleep study”, which is where you stay in the clinic overnight and they hook up all kinds of wires to your body to check your vitals while you sleep – first without a cpap, then with a cpap, then with a different mask, then with another mask, etc. It’s not actually a very restful night.
I was really looking forward to getting the CPAP because I figured that for the first time in my life I would get to experience “real sleep”. I had this idea that one hour of my new cpap-powered super-sleep would be equivalent to two hours of old-sleep, or maybe even more. I imagined myself sleeping just 4 hours a night and feeling just as refreshed, and getting so much more done, or else sleeping a full 8 hours and feeling more refreshed than I ever had in my life. Maybe my expectations were a little too high because sleep with the cpap felt…pretty much the same. The machines tell me that I’m sleeping better with the cpap, but I don’t feel much of a difference. Anyhow, at least I don’t snore which means that Pnina sleeps better, so it’s a net gain regardless.
Last year when Pnina and I went off to travel the world, I actually took the cpap with me in my backpack (it wouldn’t surprise me if I was the first person ever to do a round-the-world trip with a cpap). Was it a pain to lug around? Absolutely. These cpap machines have been getting smaller over the years, but still the machine (plus mask, tube, power supply, etc.) took about 1/4 or 1/3 of my backpack. Also, it was complicated to figure out which transformer and/or converter I need to use from one country to another, and we were always a little nervous that a flaky electrical grid in some random 3rd world country would fry the machine. So, after about 4 months of traveling, when we met my parents in Israel, I gave up the cpap for the remainder of the trip (with Pnina’s blessing).
In October 2009 we returned from the trip, and I started using the cpap again. But then, only a couple of weeks after our return — disaster! My mask broke! The break was actually really tiny and stupid. There are these little plastic latches used to secure the straps to the mask, and one of them broke:
We tried to glue it together. We tried to tape it together. Nothing worked. And it’s silly but without this little plastic clasp the entire cpap apparatus is useless — the mask doesn’t stay flush against my face, so the air doesn’t blow into my nose.
I figured it should be relatively simple to replace my mask, but I was dead wrong. This was the beginning of my 2-month quest to get a new cpap mask, a quest that made me realize more than before how our American health care system is totally screwed up.
Start with this — Pnina found a website where we could order the same CPAP mask for $59: http://www.cpapfirst.com/reconamawihe3.html. The catch is that, by law, you cannot just order a cpap mask. First, you need to get a prescription. That’s right, cpap masks are in the same category as vicodin. How exactly a person can hurt themselves with a cpap mask is beyond me. You can’t exactly suffocate because it’s designed to let air through. Meanwhile, 50,000 people each year go to the emergency room with a Tylenol overdose. But what do I know? I’m just a software engineer.
OK, so I can’t just buy the mask on Amazon. Fine. I called my old cpap supply provider, Quest Healthcare of Redmond, WA (which is now owned by a parent company called Rotech). I explained the situation and asked if I could order a new mask. The said that I now need to call the national provider, a company called Sleep Central. OK. I called Sleep Central and tried to order the mask. They asked for my insurance information, and at this point it became clear that the insurance they had on record for me is no longer accurate — I used to work for Microsoft and now I work for Redfin, so my insurance has changed. Seems like a simple thing to fix, but Sleep Central explained that I must first call Quest Healthcare and have them update my insurance information. Why couldn’t the Sleep Central people just take my insurance info? That’s just how it’s done. Okaaaay.
I called Quest Healthcare again and gave them my insurance. They said that they’ll need to send it off to the Rotech billing department. How long will that take? Unknown. I didn’t hear from them for a week so I decided to call back. I discovered that my insurance info hasn’t reached the billing department yet, and more than that, they lost my new insurance info (!!!). I gave it to them again.
A week later I called again and learned that my insurance information has reached the billing department. Why didn’t they call to let me know? Unknown. I then called Sleep Central and learned that there’s a new problem. It turns out that these companies (Quest Healthcare / Sleep Central / Rotech) are not a “part of my network” as far as my insurance is concerned. What does that mean? How much would I need to pay? They couldn’t tell me (!!!).
I decided to take a different approach. I called my insurance company (Great West) and spoke with a very nice lady who told my which CPAP supplier to contact in a straight-to-the-point, no-bullshit manner. She’s pretty much the only hero in this sorry tale, and I wish I knew her name so I could give her credit.
I called this new supplier, Care Centrix. As I suspected, they said that they can’t send me a cpap mask without first getting a prescription.
I made an appointment with my primary care physician, Dr. James Taki of the downtown Swedish Clinic. He was nice enough, except for the fact that he would not write the prescription himself. He said I must see a sleep specialist. Seriously?? Yeah, seriously. Incidentally, my doctor friend, Neville, says that primary care physicians actually make more money when they bill a referral-appointment than they do with a regular (no-referral) appointment. That makes absolutely no sense to me. It’s like giving someone extra credit for sending you elsewhere instead of just getting the job done.
There was a small glimmer of hope when I called Dr. Taki’s assistant, Cathy, who actually writes all the referrals for him. I explained my situation to her and asked if there’s a way for me to get the mask without spending (wasting) all the time and money it would take for me to first see a sleep specialist. It turns out that Cathy is a CPAP user herself, so she was empathetic to my situation and she said she’ll see what she could do. She said she might be able to give me a prescription if I simply gave her my CPAP “setting”, which is how hard my CPAP machine blows air. I can’t imagine why that’s necessary to get a prescription for a mask — the mask remains the same regardless of how hard you pump air through it — but whatever. I called her back with this info, but by this point she’d changed her mind. I’m not sure what happened. Maybe the man paid her a visit and set her straight. Anyhow, she didn’t give me a prescription, but she did give me the referral.
I made an appointment to see the sleep specialist, Dr. David Chang of the Polyclinic. He was a very fast-talkin’ kind of guy. He asked me a rapid-fire series of questions about how well I’m sleeping, and I replied that basically everything is OK and, really, I just need a prescription to get a new mask. He gave me the prescription (wow!), but he also recommended for me to undergo a new sleep study. Why? Because he suspects that my original sleep study didn’t focus on how well the CPAP works when I sleep on my side.
Well, I took the prescription and ran. I ordered my CPAP from Care Centrix who, it turns out, is also a middle man. My actual mask came from a local company called Apria. It arrived today and I will use it tonight when I go to sleep. Pnina will get a good night’s rest for the first time in way too long.
How much did the mask cost? I have no idea. Sometime soon I will get a bill in the mail and then I’ll find out. At one point Care Centrix was planning to send me not just the mask but a whole package (including new tubing, filters, etc.) and they said that this would cost $127. But I caught this and reduced the order to just the mask, and I couldn’t find anyone to tell me how much this will cost.
Considering all the runaround I experienced, I would have gladly paid the $59 out-of-pocket to just buy the mask from the website mentioned at the top of this article. But, again, I can’t do that because I’m just a lowly consumer.
Meanwhile, I also asked around to find out how much the sleep study would cost if I went ahead with it. My health insurance couldn’t tell me because they negotiate different prices with different care givers. I finally found the price from Dr. Chang’s office directly, and I have to say that I’m a little surprised they (of all people) gave up this information. Anyhow, here it is: $1843. And the funny thing is that while I need to pay for the mask myself (it’s under my yearly deductible), the sleep study would be covered in full. What do I have to lose?
But I’m not going to do this sleep study. Now that I have the mask, I’m going to call Dr. Chang’s office and cancel. Why? Because while this sleep study may feel free, it’s not really free. The $1843 it costs to pay for this sleep study is covered by the health insurance premiums paid by all the people who, like me, use Great West health insurance. Similarly, the premiums I pay (or, rather, the premiums my company pays on my behalf), are used, in part, to cover all the random procedures that other people get. If everyone took the attitude of “it’s free to me, what do I care?” then Great West would have more to pay, and they would deal with that situation by turning around and raising health insurance premiums. This is exactly why the cost of health care keeps rising in America. So I’m going to take a stand and skip this sleep study because I really don’t think I need it. Dr. Chang will just have to make his money from people who truly need care.
Glenn Kelman, the CEO of my company (Redfin), has said on several occasions that real estate is the most screwed up industry in America (and gotten flamed for it). While I agree that real estate could use a serious overhawl, I have to respectfully disagree. There is no industry quite so screwed up as health care. I can’t think of another industry where it’s so difficult to answer the question “how much will it cost?”
