Changing Insurance Companies Mid-CPAP Rental

So...due to a possible job change, it is likely that I will be changing from my current Aetna based PPO style insurance to a HSA account based insurance (high deductible, etc).

Does the new insurance pick up the rental for my cpap (lincare, if it matters) for the remainder of the rental term? Am I going to be expected to just pay for the rest? What's gonna happen here?

Because you are switching to a high deductible plan, yes you are going to have to pay the remainder yourself and it will count toward that deductible. This would happen even if you stayed with your current company. Insurance companies are basically sanctioned thieves and they will do anything to pay less, including extending your rental period to hit the deductible twice.

Be careful because what we have seen is that some DME's want to treat it like a brand new rental and start the clock all over again--no credit for rental payments made by your first insurer.

You should talk this over with the DME immediately and see how they handle it. Find out how much it's going to cost you and decide if it's worthwhile just to dump them and buy your own machine. Remember that you probably own the humidifier and certainly own the hose, filter, and mask, so all you have to replace is the base machine--more than likely you can buy new or used online and save. Plus, if the DME hears that's what you are planning to do, they MAY be willing to cut you a deal on the one you already have, because they certainly can't sell it for new and are about to lose a customer (if they even care, most don't, it seems).

Worst mistake is to simple ASSUME the DME will pick up where it left off with the new insurer. That's almost certainly not going to happen, and it's going to cost you.

I just switched insurance companies.

BIG thing to consider... Will your new insurance company cover your OSA at all, because it is a preexisting condition? If you have to wait 6 months before they will pay anything, you're up a creek. So find that out first.

What I was told by my DME: The new insurance company will start paying on the machine (the DME wants to start over the rental period as a new rental, but the insurance company says that it will pick up where the old rental left off, and I sure as heck am not paying any more than 8 copays to meet the end of the 12-month rental period).

If my new insurance would not cover my CPAP, or if their negotiated price was significantly higher than my old insurance, my DME said that I would have the option of paying the balance of the cost of the machine as negotiated by my old insurance company, provided that I pay it in full before I lost the old insurance. So, the DME's retail price on my machine is over $1000. The old insurance's negotiated price was about $675. My old insurance company (and I, with my copay) paid 4 months, for a total of $225 toward the machine price. So I could have paid the remaining $450 out of pocket before I lost my old insurance to own the machine outright. If my new insurance company would not cover CPAP at all and I couldn't get a lower negotiated rate with the DME through them, then this would have been my best option (cheaper than quitting with the DME and buying online). If I had waiting until I lost my old insurance, then found out it wasn't covered under my new insurance, I would have had to pay the balance toward the DME's regular price, or $775, which is definitely not a good deal.

BIG thing to consider... Will your new insurance company cover your OSA at all, because it is a preexisting condition? If you have to wait 6 months before they will pay anything, you're up a creek. So find that out first.

Federal Law says they cannot deny coverage for a pre-existing health condition if you are moving from one employer covered plan to another without a gap in coverage. I'm not positive if a private insurer can refuse to cover a pre-existing condition if you haven't had a gap--if that's the case you should find out (try calling your state insurance regulator).

But Cowlypso brings up another good point. Sometimes your new insurer will not cover CPAP supplies and equipment without a new sleep study to confirm the diagnosis and severity--a catch 22 for you with so big a deductible. You can try appealing, or you can just go ahead and pay for your own machine. If you hit the deductible for other reasons, go ahead and have the sleep study so you can get help paying for supplies.

Employer insurance companies can not refuse for pre-existing conditions. If you already have private insurance, they can not refuse it as a pre-existing condition unless they can prove you knew about it and lied on the application. Due to the healthcare reform, Children with pre-existing conditions can not be denied insurance and adults with pre-existing conditions can buy into high risk insurance pools.

In a nutshell, keep in mind that pre-existing conditions affect whether you can get insurance, not whether they will pay for a specific treatment. Once you have it, they have to pay.