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.

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.

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.

Seems like something you could have paid 500-1000k (20-40USD) and been done with.

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

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).

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...

Byzantine processes when dealing with medical issues should be punished with Byzantine punishments.

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.

Much more easier to fight than if you'll have to bring them to pay something you paid first.

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.

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.

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.

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 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.

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 question the "by stealth" part of this.

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.

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.

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.

my prescription was for a 30 day supply.

https://www.fda.gov/medical-devices/safety-communications/up...

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.

(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.)

That's why these are considered a prescription--the prescription is the settings on the machine.

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.

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.

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.