insurance won't pay for the sleep test

[larry89445]

You know I like my Insurance the way it is. My employer pays 100% of my premiums for myself and my family, my insurance pay's 100% of all cpap supplies and sleep studies, 80/20 on every thing else until I hit a maximum of 6000 out of pocket. I DO NOT want Obama care... And for the people looking for work move to Northern Nevada the gold mining company I work for is putting on 100 new employees from now to the 1st of the year.

[pats]

You know I like my Insurance the way it is. My employer pays 100% of my premiums for myself and my family, my insurance pay's 100% of all cpap supplies and sleep studies, 80/20 on every thing else until I hit a maximum of 6000 out of pocket. I DO NOT want Obama care... And for the people looking for work move to Northern Nevada the gold mining company I work for is putting on 100 new employees from now to the 1st of the year.

I also like my insurance the way it is - although I pay 100%, more than $10,000 p.a., because I retired early. However, I am also deeply troubled by the number of people around me who are not getting proper medical care because of lack of insurance, or who are one serious illness away from bankruptcy. I don't know what I would have done if I had been born in the USA, and had not had the education and skills to hold jobs with good benefits.

I don't think Obamacare is perfect. It is likely to have a lot more money siphoned off, and more patients being denied treatment, due to insurance company profits and supplier inefficiencies than would happen with a single payer system. The USA might have done better making a random choice among the countries that get better overall medical outcomes than the USA at less total cost, and adopting that country's health care laws and regulations. A health care system does not have to be perfect to be significantly more effective and cheaper than the current USA non-system.

I do think Obamacare is a significant step towards everyone in the USA getting the standard of health care that people living in other industrialized countries get.

[larry89445]

The problem is that once the federal government gets involved with any thing never going to be cheaper or better it can only get worse. I think it would be better at the state level, what works in one state might not work in all states.

[pats]

The problem is that once the federal government gets involved with any thing never going to be cheaper or better it can only get worse. I think it would be better at the state level, what works in one state might not work in all states.

I don't understand why the US federal government is expected to be particularly inefficient, compared to both the US state governments and the national governments of most industrialized countries.

Remember, the USA health care non-system leads the world in costs, but not in health care outcomes. If private enterprise and competition were more efficient than government action in this field, one would expect the USA to at least have outstandingly low total health care cost, even if the lack of non-emergency care for much of its population guarantees poor performance.

[49er]

It is time for single payer

http://www.acepnews.com/index.php?id=49 ... news]=1564

Please note that this article is on the website of the American College of Emergency Physicians' website and not from a leftist organization:)

http://www.opensecrets.org/pacs/lookup2 ... =C00140061

2012 PAC Contribution Data
Contributions from this PAC to federal candidates (list recipients)
(39% to Democrats, 61% to Republicans) $947,500
Contributions to this PAC from individual donors of $200 or more ( list donors)

[Wulfman...]

It is time for single payer

2012 PAC Contribution Data
Contributions from this PAC to federal candidates (list recipients)
(39% to Democrats, 61% to Republicans) $947,500
Contributions to this PAC from individual donors of $200 or more ( list donors)

I'm confused.......
You advocate for "single payer", but then list reasons why it would NOT work.

Don't get me wrong, part of me wishes we COULD have a single payer system. Way back in my past, I was a licensed insurance agent for a few years till I changed jobs. But, in that short time and since, I've come to really dislike (understatement) the insurance business/industry.

But, who's going to run this single-payer system......the federal government? They can't "run" ANYTHING, except into the ground. Their track record is proof of that.
Those political contributions have been upheld and deemed legitimate by the Supreme Court. We've found out just in the area of Sleep Apnea that these companies can restrict free trade (whatever happened to NAFTA?), fix prices and can get away with just about anything they want to. They just twist the arms of the FDA (and whatever other agencies) and get their way. Most of this "medical equipment" could be sold over-the-counter......and in some countries don't even require a prescription.

I'm afraid we're doomed.

Den

.

[49er]

Hi Wulfman,

Sorry for the confusion.

Actually, the article responds to the typical concerns such as a Canadian style health care system wouldn't work.

By the way, I just realized the link I posted isn't working. Here is another one:

http://pnhp.org/blog/2012/11/02/dr-mitc ... all-of-us/

Hmm, while medicare certainly isn't perfect, it hasn't been run into the ground which is what a single payer system would be based on.

Sorry, due to sleep deprivation, I am losing steam in taking this discussion further. But you make some good points about industry influence on the FDA. Don't even get me started with drugs company trials.

49er






I'm confused.......
You advocate for "single payer", but then list reasons why it would NOT work.

Don't get me wrong, part of me wishes we COULD have a single payer system. Way back in my past, I was a licensed insurance agent for a few years till I changed jobs. But, in that short time and since, I've come to really dislike (understatement) the insurance business/industry.

But, who's going to run this single-payer system......the federal government? They can't "run" ANYTHING, except into the ground. Their track record is proof of that.
Those political contributions have been upheld and deemed legitimate by the Supreme Court. We've found out just in the area of Sleep Apnea that these companies can restrict free trade (whatever happened to NAFTA?), fix prices and can get away with just about anything they want to. They just twist the arms of the FDA (and whatever other agencies) and get their way. Most of this "medical equipment" could be sold over-the-counter......and in some countries don't even require a prescription.

I'm afraid we're doomed.

Den

.[/quote]

[macsnjets]

Check again with your insurance to see if they will pay for a home sleep test. They're sort of new to some insurance companies that they don't know much about them. My insurance covered the home test but couldn't even tell me where to go to for the test box. Google told me more than their own reps could. I'm now making progress towards a cpap.
Good luck.

[mnfe]

My insurance would not cover the sleep study until I did a home test. It was set up by my sleep doc and his sleep lab. I just had to go in and pick up the gear and they showed me how to hook it all up, then return it the next day. After that my insurance paid for a split study (the O2 readings didn't get picked up) where they verified the apnea then did a titration all in one night.

My sleep study was about $5000, my negotiated insurance price (that they pay) was $2300 or so, just for some comparison. I don't know how much the home test was, I didn't look it up.

Don't get me started on ObamaCare, my insurance plan is going away/changing drastically to avoid the "cadillac" plan tax. I am essentially taking a pay cut that is more than the raise I got last year.

[gomer]

I am a vet and have medicare.

I have a good gen med Dr & MS neurologist (specialist) at the VA , but beyond that the VA has not been very good. I am diabetic and diabetes care thru the VA went sour decades ago. I did better on my own & buying my insulin OTC instead of using the VA. If I had to depend on the VA as my only care, I would have been planted decades ago.

I have kidney disease, had to go to local ER 3 times in Jan ending up spending a few days in the hospital. The VA's kidney doc position is when/if my kidney fail (need dialysis) THEN they will consider WHY they are failing. Of course there would be not point in test then. (my diabetes is in great control, civilian endo thinks something other than diabetes might be the cause).

The VA urology clinic is also a total waste of time and MONEY (my co-pay $50) twice this year refused to even check on problems for which my good VA docs sent em to them for. They had no clue if I even had a pulse, fever or weighed more than 16oz! I told my gen med doc it was a wast of time when she sent me back to both after another kidney function drop this summer.

About a week later, urgent problem, I was at a non-VA urology office, for THE same exact problems the VA refused to even consider checking on. (the urologist office even called 911 and wanted me to go to ER, I refused) They did proper testing the VA would not & I just had surgery 3 weeks ago for the stricture and hope things will be a little better.

While I do get good MS medical care at the VA, ALL my mobility aids are either out of pocket or covered by medicare. My non-VA fam doc order a P/T evaluation and the therapist noted I was overdue for a p/c and doing more harm than good. Now nearly 3 yrs later my limited walking is a lot better thanks to the P/C tho still limited. I had to sell off personal property to afford a cheap scooter (via web) so I could get out (of the house) and about.

You will find good bad and ugly docs everywhere, VA and non-VA, good VA docs have to deal with the same bureaucracy vets do. VA medical center vary as well, some better than others.

There is NO simple answer to our health care system. A lot depends on balance between excess greed and conscience.

[NeNeen]

Until August 1 Medicare was my primary insurance and United Health Care was my secondary insurance (provided by my employee since I am LTD). In June they informed all the retirees and LTD personnel that they would not be providing UHC to us any longer. They would however continue to provide us a cash benefit to help with medical premiums. They also provided us with a company that would assist us with managing our medical coverage and claims.

I started to doing lot of research and found out that since I am not 65 the only insurance plan that I was eligable for was Humana Gap. Fortunately the one I chose has a great prescription plan but most everything else either has a co-pay dr visits or 20% of labs, xrays, etc.or

So my pulmonuolgist who had been seeing me since January said that I needed a sleep study. I rushed the test before I was swithed to Humana. I have to drive 150 miles round trip to see my pulmonolgist and almost 200 miles round trip for the sleep study. By the way, the person that does my taxes, says that ALL mileage used for anything to do with your health (dr visits, picking up meds, etc) are tax deductible.


Anyways, I just pulled out my EOB and I was billed $5050.42 for the sleep study. The plan discounts $4309.59. Medicare paid $480.59. UHC paid $200.26. It says my co-payment was suppose to be $50.07, which I have never received a bill for.

So I am glad that I was covered by my insurance companies because without insurance they would have expected me to pay the whole amount.

I had the best possible experience during my sleep study. The room was very plush, the tech was very caring and explained everything that was going to happen. Half way thru the the diagnostic part of the study she came in put me on the CPAP. The mask fitted perfectly and I went right back to sleep.

I am coming up on my third month on CPAP and doing fine. The only problem I have is sometimes the area between my nasal septum is sore in the morning. Any suggestions how I can stop this?