Help! Can no longer get health insurance due to CPAP?!??!

I am self employed and used to get health insurance through my wife's job. While she was pregnant, she bacame a much lighter sleeper and started complaining about my snoring, which continued after the baby was born. Father and grandfather (lived to 98) snore like freight trains, which I apparently do as well. I'm in otherwise good shape, low BP, run 4-5 times a day and do a few half-marathon's each year, about 20 lbs overweight but 6'2" so not masively so. Until "apnea" I have had no health problems other than seasonal allergies (treated with OTC and nasonex).

Did a sleep stuy about 2 days before we moved to Europe (covered under old insurance) then canned our US insurance and got a travel policy. Sleep doc in the US said I had mild apnea, so on his advice I bought a S9 Auto out of personal funds since I no longer had US insurance. As an aside, I'm still struggling to get a good night's sleep, frequent noises coming from my mouth and wife still complaining. Not so happy with CPAP initially but try to stick with it.

Now, we're moving back to the states in a couple months so I wanted to get US and international insurance. Found a great company that met my US and International needs, and get denied at underwriting due to "CPAP use." Worst part is the form didn't specifically ask about CPAP, just about ever seeking treatment for snoring and dumb honest old me writes about the CPAP. Insurance agent says "Yeah, I see that all the time. Pretty much every company in the individual market will deny you for coverage due to CPAP."

So now apparenly this stupid $1200 machine is a scarlet letter that will prevent me from ever getting health insurance??? Anyone ever run into this? Am I now "marked for life" because I wanted my wife to not hear me snore? Even if it helps you sleep, what good is CPAP if you can't get health coverage and will be bankrupted if you ever need medical attention???

I asked the insurance company about their appeals process and they said there is none, and she said "as long as you're on the machine we will not cover you."

Sorry to vent and seem so negative, but at this point I wouldn't wish CPAP on my worst enemy.

So now apparenly this stupid $1200 machine is a scarlet letter that will prevent me from ever getting health insurance???

it is not the CPAP that prevents you from coverage, it is the corrupt insurance system that prevents you from coverage, the system that covers only the 100% healthy, not only CPAP, but insurance company now are having an equivalent to credit bureau, so whenever you apply for an insurance and they deny you, they report that to that bureau and the reason of denial, so now you can never change or deny CPAP in your application for any other company. now you are marked for life and your only option is high risk state insurance that cost 3 times more

A corrupt system that picks and chooses only healthy, (the basic violation of what the word insurance means), a system that Obama tried to overhaul but ignorant and/or selfish people attacked him for that.

A system that has one third of health care spending goes to the insurance companies as profits, one other third is considered over pricing of medical services and devices and medications , and only one third is real expenses

the second third (over pricing) is controlled in Europe and Canada for the same companies, as governments in these parts of the world compelled the same companies who sell here in USA by double the price to sell their products in Europe under controlled pricing system
considering medical devices/medications/services to be like controlled utility here in USA, that is why you can buy same medication from Canadaby half price , heart catheter half price is Europe ..etc
remember first third (insurance companies profits) doesn't exist because insurance is mainly governmental, so 2/3 of expenses are under control

A system that holds life saving treatment from some, like organ transplant, simply because the insured discovered that this treatment is not covered in their policies and those patients end up dying during appeal process, what would be considered a crime in Europe

Good bless lobbies, corruptions, and uncontrolled capitalism, and ignorance of voters and selfishness ,..

it is the corrupt insurance system that prevents you from coverage

I won't comment on the political stuff much beyond saying we have different political views. That's all an aside and I'd be more than happy to engage in a gentleman's (or woman's) debate about politics in a personal email.

What troubles me is why CPAP would add you to the "persona non grata" list at the insurance companies, and if anyone has had a smilar experience and what they've done to procure insurance coverage. Do the insurance companies just assume if you're on CPAP you're a 500kg couch potatoe and they should keep you at arms length?

It's not the "CPAP" they are worried about, but the OSA (Obstructive Sleep Apnea) which caused you to GET the CPAP.

OSA is forever (you treat it, not "cure" it). There are recurring expenses involved. And OSA often leads to more serious problems, including a higher chance of strokes and heart attacks. That's why insurance companies are hesitant.

The $1200 for the CPAP is the tip of the iceberg as far as the insurance company is concerned.

Without the CPAP, you could have gotten reasonable insurance coverage; (but you probably wouldn't need it for as long...)

I know it's frustrating, but don't blame the CPAP...it is saving your life.

With tongue firmly in cheek...

It's really simple. Now that you have OSA and use CPAP, they know you that one day you will get sick and die. Without the diagnosis, they wouldn't know this, see?

I'm glad I got my extra life insurance a couple of years ago, because something tells me that would be denied to me now. The "health credit" agency knows all about any diagnosis or prescriptions you've been given, not just when you've been rejected for coverage.

CPAP is about way more than just not waking up your wife with your snoring. It's about saving your life, as someone else said. Apnea can and will kill you, untreated (just ask Reggie White's widow). It's scary, but CPAP is the solution. If you want to keep living, you have to work at it until you get it right. I am lucky enough to have health insurance through my employer. As someone else said though - it's not really the CPAP that makes them not want to cover you, it's the apnea. The CPAP makes you LESS of a risk. But the fact you use it shows them you have apnea... which makes you MORE of a risk, since MOST people don't care enough about their health (or don't understand the consequences of untreated apnea) enough to stick with their machine.

TheBigHeavy wrote:I am self employed and used to get health insurance through my wife's job. While she was pregnant, she bacame a much lighter sleeper and started complaining about my snoring, which continued after the baby was born. Father and grandfather (lived to 98) snore like freight trains, which I apparently do as well. I'm in otherwise good shape, low BP, run 4-5 times a day and do a few half-marathon's each year, about 20 lbs overweight but 6'2" so not masively so. Until "apnea" I have had no health problems other than seasonal allergies (treated with OTC and nasonex).

Did a sleep stuy about 2 days before we moved to Europe (covered under old insurance) then canned our US insurance and got a travel policy. Sleep doc in the US said I had mild apnea, so on his advice I bought a S9 Auto out of personal funds since I no longer had US insurance. As an aside, I'm still struggling to get a good night's sleep, frequent noises coming from my mouth and wife still complaining. Not so happy with CPAP initially but try to stick with it.

Now, we're moving back to the states in a couple months so I wanted to get US and international insurance. Found a great company that met my US and International needs, and get denied at underwriting due to "CPAP use." Worst part is the form didn't specifically ask about CPAP, just about ever seeking treatment for snoring and dumb honest old me writes about the CPAP. Insurance agent says "Yeah, I see that all the time. Pretty much every company in the individual market will deny you for coverage due to CPAP."

So now apparenly this stupid $1200 machine is a scarlet letter that will prevent me from ever getting health insurance??? Anyone ever run into this? Am I now "marked for life" because I wanted my wife to not hear me snore? Even if it helps you sleep, what good is CPAP if you can't get health coverage and will be bankrupted if you ever need medical attention???

I asked the insurance company about their appeals process and they said there is none, and she said "as long as you're on the machine we will not cover you."

Sorry to vent and seem so negative, but at this point I wouldn't wish CPAP on my worst enemy.

I don't know all the ins and outs of it, but you are eligible for the new insurance plans each state has that cannot deny you for any medical condition. This is part of the health care reform package. This is a temporary measure until the part of the bill when all insurance must cover for pre-exiting conditions kicks in in a few years. The ones available to buy into now are not cheap, but they are way less than trying to buy insurance on your own. When you get stateside, check into this with your local authorities for information on your state's program.

TheBigHeavy wrote:Sorry to vent and seem so negative, but at this point I wouldn't wish CPAP on my worst enemy.

I agree with you, TheBigHeavy, this is an outrageous state of affairs! Not a good way to say welcome home at all. I hope you can get matters straightened out to your satisfaction soon.

Welcome to the world of "pre-existing conditions"! You now have one. And insurers susbscribe to a reporting service just like credit companies, so if you are refused from one insurer you can pretty much expect to be refused by all.

In case you were under a rock for a while or perhaps not paying attention because you thought your health was just fine, THIS is why this country needed (and continues to need) healthcare reform.

The insurers pretty much have the upper hand in this. I've heard of people getting denied because they had a bout of bronchitis a few years ago or allergies. I've even heard of insurers refusing to underwrite women between the ages of 20 or 40 because they might get pregnant.

Every state has a "high risk pool" for people with pre-existing conditions who cannot purchase health insurance any other way. The problem is that it's so expensive, it's rarely affordable. It can be as much as a house payment. Some states are beginning to subsidize those high risk policies in anticipation of the new health care changes that will begin to be implemented starting in 2014. See http://www.nydailynews.com/ny_local/201 ... _here.html for example.

Good old U. S. of A

TheBigHeavy wrote:

it is the corrupt insurance system that prevents you from coverage

I won't comment on the political stuff much beyond saying we have different political views. That's all an aside and I'd be more than happy to engage in a gentleman's (or woman's) debate about politics in a personal email.

What troubles me is why CPAP would add you to the "persona non grata" list at the insurance companies, and if anyone has had a smilar experience and what they've done to procure insurance coverage. Do the insurance companies just assume if you're on CPAP you're a 500kg couch potatoe and they should keep you at arms length?

You need to shop around. I voluntarily changed insurance policies last year and easily found two companies that would cover me.

I found a policy on my own, but an insurance broker can also help and may save you some research time. Of course the choices will probably be narrowed down significantly due to your international requirements.

I haven’t written a political post in quite some time, and to tell the truth, no one has complained. However, the problem TheBigHeavy is facing is serious, common, and no longer insoluble, so I'm going to dive in, with apologies in advance to everyone who was already tired of the healthcare reform debate 12 months ago.

TheBigHeavy wrote:So now apparently this stupid $1200 machine is a scarlet letter that will prevent me from ever getting health insurance???

No. As of January 1, 2014, under the Affordable Care Act (ACA), health insurance carriers in the individual and small employer market will be required to offer their policies with (1) guaranteed issue and renewability, (2) no exclusion of pre-existing conditions, and (3) only limited variation in rates: region, age (within limits), family composition, and tobacco use. So there is a permanent solution on the horizon.

In addition, a transitional Pre-existing Condition Insurance Program (PCIP) went into effect this month for many people and will be available through the end of 2013. Some states are running their own programs, and the effective dates are not uniform. Some states already had high-risk pools that offered reasonable plans as good as or better than the federal program. For those states that opted into the federal program, applications began to be accepted in July for coverage beginning August 1. Applicants must be citizens or legal residents, must have been without insurance for at least six months, and must prove that they were denied coverage because of a pre-existing condition. There is information (including state-by-state details) at http://pcip.gov and at http://www.healthcare.gov/law/provisions/preexisting.

I have always thought that one of the strangest misunderstandings about the ACA was that it is a program for the poor. We've had Medicaid for a long time. I wouldn't want to be stuck with it, but it exists and it will continue to exist. There are some changes, but basically the program for the indigent goes on as before. So too the much better Medicare program for the elderly who worked and paid in.

It is the middle class, very broadly defined, who stand to benefit from the ACA. You can divide us into two groups, although many of us go back and forth over the course of a working lifetime. On one side are the nine-to-fivers with standard group health insurance. On the other side are the self-employed, the consultants, the free lancers, the part-timers, the entrepreneurs, the full-time investors, the just getting started, and everybody else who isn't receiving a full-time paycheck with standard benefits from an established employer. Not the least among these are the temporarily unemployed who have assets and prospects, and still feel middle class, but are out of a job at the moment. One way or another, those of us in the first group know we could find ourselves suddenly in second. Some of us may even aspire to cross the aisle -- to cut our ties with a big company and go out on our own -- but we are held back because we understand the consequences of our pre-existing medical problems.

These are the people who can find themselves completely out in the cold if they have a condition that renders them effectively uninsurable in the individual market. These are the ones who can lose everything they own if they get seriously ill and have no coverage. If you have no income and no assets, you have nothing to lose, but if you have a house and some savings, cancer or other severe illness can pauperize you (and your family, too, even if you die). It is the people who have always played by the rules, but now find themselves without coverage and unable to purchase coverage, who need the protection of an individual market with guaranteed issue and no exclusion for pre-existing conditions.

Speaking for myself, I do not see this situation as having come about because of evil or corruption in the health insurance industry. If health insurance is a contract freely entered into by two consenting parties, there is no reason to expect an insurer to issue a policy that it expects will lose money. Insurers sell group policies because they expect to end up with a reasonable cross-section of the population and can underwrite against the averages. But in selling individual policies they cannot rely on averages, and it is simply rational to avoid someone likely to have expenses well above the norm, or to establish a high rate that compensates for the risk. I also have faith in the ability of the companies to assess individual risks accurately. It is their business to do so. Since they earn a profit selling insurance, they have no reason to exclude arbitrarily. If they think that people with OSA are a poor risk, they're probably right. They have the data and the actuaries to know. So I don't blame them for not wanting to write coverage for people with OSA any more than for people with cancer or Parkinson's or congestive heart failure.

However, it creates a huge social problem when they don't want to, which is why we needed the ACA. The act is balanced, requiring guaranteed issue with no exclusions, which is disadvantageous to carriers, but also requiring substantially everyone who can to purchase insurance to do so, with financial assistance where necessary, which is good for them. The system resembles what has long been the rule in Switzerland, Germany, and (I think) the Netherlands: everyone must have health insurance, many private companies compete to provide it, and the government subsidizes the premium for low earners. I know plenty of Swiss and Germans who are very satisfied with how it works. Health insurers compete in every way except the ability to pick healthy people. They must take all comers, so in the long run, they all end up with their share of good and bad risks.

The one big difference between the Swiss and German systems and the ACA is that the ACA was designed to preserve the system of employer group coverage for all the nine-to-fivers. People with decent employer-based coverage are not eligible. Too many people here were against shaking up an employer-based system that works for them, so the system was designed only to affect those who lack employer coverage, or who may lack it some time in the future. It is going to be a lifesaver for people who otherwise would be marked with that scarlet letter. The dust has settled a little since passage. No one is shouting socialism! death panels! at the moment. For anyone facing a health insurance problem due to a pre-existing condition, this would be a good time to see if the ACA may answer a need, even for those who opposed it.

The "AFFORDABLE CARE ACT" brought to you by the people who stole all of the money out of Social Sercurity and Medicare. I just looked at the app on my iPhone called National debt. It's over 14 trillion going on 15 trillion dollars. That's $48,363.00 for every citizen in the country. We can not sustain this burden of debt.

If you think health care is going to become more affordable in the near future you have your head in the sand.

TheBigHeavy wrote:I asked the insurance company about their appeals process and they said there is none, and she said "as long as you're on the machine we will not cover you."

That's kind of interesting. If that's really what they meant, all you would need to do is voluntarily "quit" and get a policy.

I suspect what they meant was that as long as you have SDB requiring the use of a machine to treat it, whether you treat it or not, they won't cover you.


I think I would call around to other companies as someone suggested. And obviously, you can't hide the CPAP thing now, but I would ask about getting some kind of non-coverage rider....what's that called? Insurance companies sometimes will give you coverage for everything EXCEPT the pre-existing condition. Usually there is a time limit even on that. I don't think the little girls that answer the phone will be able to help you with this, so I suggest you politely ask to speak to managers after the first person tells you no.

Also, if you have BCBS in your state you might want to check with them. Someone else mentioned high-risk pools. Those can be expensive policies, so get a large deductible if it's offered.

Call the insurance commissioner's office in your state and ask them how you get health insurance with a pre-existing condition. Expect to hear answers that are not very appealing.

If all else fails, if your business is flexible enough, I think that if you work at least 20 hours a week for Starbucks you can get health insurance with them.


One of the problems with obtaining health insurance in this country started years ago when companies started offering health insurance as a benefit to employees. If no one were covered through their employer, we'd all be able to get private policies. 'Nuff politics from me.

The problem is that in the individual market insurance companies can easily discriminate so they will reject almost everybody that has any sort of condition. This allows them to increase their profit. With the group policies they find that they must accept all members of the group so their profit is slightly less.

Insurance companies find individual policies inconvenient and thus adopt policies to discriminate against them. The interesting thing is that when I become 65 they will be glad to have my business but until then they really could not care less.

It was suggested that they have no reason to exclude arbitrarily. If that was true then an individual whose blood pressure was controlled through the use of medicine would not be penalized. OSA is a risk if it is not under control otherwise it should not be a reason by itself to deny coverage.

When I recently applied for an individual policy it was clear that the individual vetting my application was working from a checklist and was not exercising any medical judgment. In the interest of full disclosure I noted that I had a prescription foot orthotic and had a prescription for high fluoride toothpaste both of which were listed as reasons for rejection. I was not buying dental coverage and you can now get a similar orthotic from the drugstore without a prescription.

The facts speak for themselves. The policies of the insurance companies are arbitrary. This is not just my opinion but is supported by the opinions of my GP and specialists.

What I find interesting is that they discriminate against individuals who are proactive in taking care of their health and in favor of these who don’t see doctors or get problems diagnosed.. The reality is that as doctors perform more testing they find more problems. If you performed enough tests almost everybody over the age of 30 would probably have a pre-existing condition. Thus the individuals who have individual policies just have not had enough tests performed.

The argument that with individual policies they cannot rely on averages is BS. You simply look at all of the individuals with individual policy and you have averages. This is done with automobile insurance. If they have a significant number of individual policies the averages will remain fairly consistent from year to year.

The insurance companies just do not want to take the time to evaluate individual applicants and do not want to bother with individual applicants. This is supported by discussions with a doctor at an HMO who is aware of company marketing policy.

The high insurance pools often require that you be without insurance for 6 months and may limit how long you can be in the pool. The immediate effects of the ACA for the most part deal with the young but those who are older but have not reached 65 are screwed.

For those that complain about the cost of medical care for everybody consider the cost of our wars and the long term medical costs for the military personnel. I am not begrudging the veterans medical benefits but why should the rest of us have second rate coverage? Why do elected officials and public employees who we pay for by our taxes get better coverage? We could control medical costs if we were willing to make common sense decisions.

There was a recent article in a California newspaper about the fact that Sutter Health’s charges at its hospitals were considerably higher than their competition. Because they have a significant market share they are able to dictate higher reimbursement costs from the insurance providers because people do not want to drive 30 minutes for elective treatments. Look at the billing practices of some DMEs.

Let us be clear that the current policies are arbitrary, not rational, unfair, and discriminatory!!!

I have coverage at work and when I changed jobs, I was careful to buy the Cobra coverage and remain with the same carrier to eliminate consideration of pre-existing conditions. But I remember the moment I realized (reading on this forum) that my OSA would make me ineligible for health insurance. Total panic. Of course then I realized that my weight, blood pressure and high cholesterol also probably had already made me ineligible, I just hadn't thought about it. It's scary--makes me all the more nervous about potentially losing my job.

There was an article in our local paper recently about people not paying their hospital bills and the hospital getting stuck. I work at an inner city hospital serving the poor and I know how difficult it is to manage our finances. This article referred to the many people who are buying very high deductible policies and pointed out the fact that those deductibles on a practical basis are out of reach for most people. So while they sound good, they may not be. I make what I consider to be a really good salary and yet if I was faced with a $5K bill for health care, I wouldn't be in a position to easily pay that. Even $1K would hurt like heck.

I recently had a checkup with my doctor. I inquired about a hearing test. My hearing seems fine at work, but I often find myself asking my kids to repeat themselves. My sister had an ear surgery not long ago because of a condition that can be genetic. So I thought I should get checked out. I was surprised to learn that gone are the days when the doctor's office has a hearing test machine. You know, the kind they have in every pediatrician's office. Put the ear phones on. Raise your hand when you hear the sounds in each ear. Instead, she gave me a referral to an ENT. And in big bold letters, she wrote HEARING LOSS. I was like what? We don't know that I have hearing loss...yet. Maybe I do. Maybe my kids just mumble. Those two words were like flashing letters in my mind on my medical record that anybody and everybody could see. So I just decided to forget it. Wish things could be simpler.