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General Discussion on any topic relating to CPAP and/or Sleep Apnea.
mustard23
 
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Denied insurance do to sleep apnea.

Postby mustard23 on Tue Aug 12, 2008 12:24 pm

So recently the company I worked for and was liquated and sold, so I am out of job. Not a big deal I’m working on setting up a consulting service so I wasn’t planning on getting a job that would offer me insurance, COBRA is $475 a month, and so I went to blue Shield to see if I could get on one of there catastrophic plans for less then $100. They told me sleep apnea was an automatic denial, unless I can be diagnosed as recovered for a year without surgery. So I plan on working for myself, and want insurance. Any one in California know of a good insurance company, that will cover me?

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Wulfman
 
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Postby Wulfman on Tue Aug 12, 2008 12:28 pm

If you're pretty sure you have sleep apnea and the machine in the following thread is still for sale, I would skip the sleep study and go directly for self-titrated treatment.

http://www.cpaptalk.com/viewtopic/t3385 ... MASKS.html


Den
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Postby Slinky on Tue Aug 12, 2008 12:29 pm

Ow! Sounds like you might by flying nude and solo once Cobra runs out until you've been on CPAP for a year! Scarey as heck! Is there any type of "high risk" insurance you'd have to auction your soul to pay for to get you thru those uncovered months? Good luck and God bless.


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mustard23
 
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Postby mustard23 on Tue Aug 12, 2008 12:41 pm

there say I have to be without the CPAP for a year and be "cured". I have a CPAP so I'm not worried about that. I thought be treaded reduced my risk for all sorts of stuff.


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Wulfman
 
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Postby Wulfman on Tue Aug 12, 2008 12:53 pm

mustard23 wrote:there say I have to be without the CPAP for a year and be "cured". I have a CPAP so I'm not worried about that. I thought be treaded reduced my risk for all sorts of stuff.


Oops.......I misunderstood......I thought you were looking for insurance to get a sleep study and treatment.

Well, there ain't no "cure" and you really don't want to be off of it for a year.
Did you admit to having sleep apnea on an application? As far as I'm concerned, I have successful therapy and do NOT have sleep apnea. I wouldn't put it on an application and I could prove the quality of my sleep (with nightly downloaded reports) if it would come to that.

Den

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hobbs
 
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Postby hobbs on Tue Aug 12, 2008 1:24 pm

Wulfman wrote:
Oops.......I misunderstood......I thought you were looking for insurance to get a sleep study and treatment.

Well, there ain't no "cure" and you really don't want to be off of it for a year.
Did you admit to having sleep apnea on an application? As far as I'm concerned, I have successful therapy and do NOT have sleep apnea. I wouldn't put it on an application and I could prove the quality of my sleep (with nightly downloaded reports) if it would come to that.

Den



Up until now I thought of you as one of the most astute posters on this board. Maybe the above was the result of a lack of sleep last night? :wink: You use a xpap to sleep=you HAVE apnea. Leave info out of a insurance application? Yeah, that will work well. Go to the hospital and have them see apnea during recovery from surgery of any type, and the insurance will drop you like a hot rock!
Just more proof that health care in this country sucks. :x

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Postby Wulfman on Tue Aug 12, 2008 2:04 pm

hobbs wrote:
Wulfman wrote:
Oops.......I misunderstood......I thought you were looking for insurance to get a sleep study and treatment.

Well, there ain't no "cure" and you really don't want to be off of it for a year.
Did you admit to having sleep apnea on an application? As far as I'm concerned, I have successful therapy and do NOT have sleep apnea. I wouldn't put it on an application and I could prove the quality of my sleep (with nightly downloaded reports) if it would come to that.

Den



Up until now I thought of you as one of the most astute posters on this board. Maybe the above was the result of a lack of sleep last night? :wink: You use a xpap to sleep=you HAVE apnea. Leave info out of a insurance application? Yeah, that will work well. Go to the hospital and have them see apnea during recovery from surgery of any type, and the insurance will drop you like a hot rock!
Just more proof that health care in this country sucks. :x


Nope.....not lack of sleep or apneas. This subject has come up MANY times and many of us have the same philosophy about volunteering (or not) certain types of information. There are obviously far more people with UN-treated apnea than those of us who have successful "therapy". The ones with the untreated apnea are far more dangerous on the highway and at a greater health risk than those of us who hose up every night. If push ever comes to shove, I can prove my sleep is better than even the "average" (< 5.0 AHI) person. I'd put the burden of proof on them to find out, rather than to volunteer unnecessary information.

I also have some background in the insurance business (long time ago).
And, the health care and insurance industries.....ummmmm.......YEAH......what you said (nicer than what I was thinking).


Den

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dreamchick
 
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Postby dreamchick on Tue Aug 12, 2008 2:23 pm

First, I apologize for the length of the post but here is what you need to know if you have sleep apnea, which is a pre-existing condition.

Be careful when making a choice not to take the cobra. In many states if you are eligible for cobra they will issue an individual policy until your eligibility runs out. Most companies state you must not be eligible for or covered under…. Cobra is one of the choices.

You are experiencing the pre-existing condition limitation clauses. You are not covered by insurance for your pre-existing conditions unless you can prove you have been covered prior to this and that you have not been without coverage for a period of 31 days. If you obtain a proof of coverage certificate from your last insurance company and give it to the new one they will (usually, depending on the company and the state) cover you for the pre-existing problem.

As the laws exist today, you can never be without insurance again or they can exclude coverage for your sleep apnea for the next 12 months.

Pre-existing condition limitation: For the first 12 months following the enrollment date of your coverage, they will not pay for: Conditions for which medical advice, diagnosis, care or treatment was recommended or received during the six months before enrollment. As well as, conditions for which during the last six months there are symptoms, which would cause a prudent person to seek medical advice, care or treatment.

My advice is to take the cobra coverage until it runs out then, sign up for an individual plan. Make sure that you get a proof of prior coverage certificate from the insurance company you have now and give it to the new insurance company, when it is time to get new insurance and you shouldn't have a problem.

I am playing this game myself right now my cobra runs out the end of November (mine is 539 a month so yours is a bargain). Just yesterday, I started shopping for insurance. I am hoping I don’t have to close my business and get a job just so I can afford insurance but that is a real possibility.

Good luck and email me if you need any help. I am an expert at this game. I have a heart condition, asthma and now seep apnea!

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Postby Guest on Tue Aug 12, 2008 2:34 pm

awesome thanks for all the info, I think I'm going to do the cobera option, for now, I realy don;t want to go back to work a 9 to 5 and would much rather work for myself.

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Postby Guest on Tue Aug 12, 2008 2:36 pm

as far as not telling them, it's hard to not tell them when both the applacation have the question have you been dignoised with sleep apnea in the last 5 years.

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Wulfman
 
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Postby Wulfman on Tue Aug 12, 2008 2:40 pm

Anonymous wrote:as far as not telling them, it's hard to not tell them when both the applacation have the question have you been dignoised with sleep apnea in the last 5 years.


That's the problem with the idiots in the insurance industry......they don't know the difference between "treated" and "un-treated" sleep apnea.

Den
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dreamchick
 
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Postby dreamchick on Tue Aug 12, 2008 2:54 pm

The insurance industry in this country is the worst!

They look for any excuse not to pay a claim. Did you know that if you have to go to the hospital and you don't get a pre-certification they can deny payment? That really bites. You are so sick you can't function, that is why you are going to the hospital duh. But you have to get a pre-certification. Jeeze.

They just tried to bill me for 8,000.00 for three days. Lucky for me I was admitted through the ER and that put the burden on the hospital to obtain the pre-certification. They also make you prove you need to be there every two or three days. Some bobble head has to decide if you are sick enough to stay there every three days and send letters to you, the hospital and the Droctor.

They are just hoping you are too sick to keep track of it all. Now the hospital has to spend probably more in administrative costs then they will get paid to fight with the insurance company to get their money. No wonder the costs are so high!

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roster
 
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Postby roster on Tue Aug 12, 2008 3:05 pm

dreamchick wrote:....... I am an expert at this game. ...


Dreamie,

I am far from an expert and have been very lucky to have continuous health insurance coverage for 35 years. Let me ask you a question which comes from my ignorance. Is health insurance not regulated by the individual states so things are different from state to state?

Thanks,

Rooster

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Postby Guest on Tue Aug 12, 2008 3:09 pm

I was tring to explain that I'm treated I'm healther now then I have been in years, and the agent asked "well what happens ifyou CPAP brakes or the power gose out and you have to go to the hospital" I'm liek I went un treated for years, and the power has gone out when I have been useing worst case is I get a crap night sleep. They also asked what side efect of it was.. I'm like I feel well rested.. I get regulated good sleep. the only negative side effect I can think of is, it's hard for me to go back packign now, and I have the energy no to want to go do it.. Any one know of good cpap that runs on batteries?


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Postby Wulfman on Tue Aug 12, 2008 3:12 pm

My insurance provider required a copy of my sleep study.......sleep doctor's office hadn't yet sent one when I was in the process of ordering my equipment through CPAP.COM........then they supposedly faxed a copy.......didn't get there......then they faxed another (which finally DID get there). That FUBAR delayed the start of my getting my equipment by another 10 days.


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