insurance won't pay for the sleep test

[wiguy]

I have not received the bill for my study yet

I only had to pay 128 bucks out of pocket for my machine. After my 3 month compliance check the extend my Rx and after 10 months is considered a purchase and the machine is mine. I am not tryign to brag but I have some very nice health insurance for a great price through my employer.

When we had claire 4 years ago, we racked up 13k in bills with the C-section. I think we paid 250 out of pocket. There are definately good insurances and bad insurances. Claire also has a heart murmur and her 6 month EKG's are covered 100%

I also would shop around. My study never went for pre-approval, but I assume since its taking so long to get the bill, either its covered totally or goint hru insurance.

[deltadave]

There are definately good insurances and bad insurances.

That's kind of a broad generalization.

That said, "generally", one gets what they pay for. You can get away cheap if you're like 25, and all you need is catastrophe insurance. But if you're starting to get a little long in the tooth, trying to continue with an Economy Package becomes more and more of a gamble. Consequently, what happened to the OP should not have come as a surprise, since

• 8000 a year (depending on age, sex, risk factors, etc.) is kind of a cheap package. I'm thinking 12K would give a better coverage; and
• The package descriptions are usually readily availble to the consumer. For example, here's Horizon BC/BS of New Jersey:
  
  http://www.horizonblue.com/need-insuran ... mily-plans

[pats]

Well, I have friends who live in Canada. And, I've observed some of the trials and tribulations of forum members who have posted from Great Britain, Australia and other European countries who have tried to deal with the healthcare in their countries. I've also read many (horror) stories from those places in the last few years as our politicians were trying to pass "Obamacare".
One thing I've noticed in the area of Sleep Apnea treatment is that there are lots of people on both sides of the Atlantic and Pacific who order their machines from sellers in the U S.

I've never claimed that the healthcare system in the U S A was "perfect". We DO have many problems with it (mostly on the cost end)......which have been caused by the politicians, lawyers and a few "bad" doctors and hospitals (which has caused the liability/malpractice insurance rates for the others to go through the roof). We're also paying for the healthcare for many illegal immigrants and people who don't have insurance or don't/can't pay for their own treatments. But, if ours wasn't so good, why would so many people from Canada and other countries be coming HERE to get treatment?

Healthcare isn't "free" in any country. And, it's going to get more expensive and more difficult to get treated here in this country if "Obamacare" is allowed to stand.

Den
.

In any country, if you have money you can get good, prompt, medical care. If you have enough money, and you don't like the care where you live, you can always travel. The USA is one of the countries to which the very wealthy travel for major medical care. It is among the best in the world for money-no-object paid care.

I am most familiar with the systems for the rest of us in the USA, where I live, and in England where I grew up and have relatives I visit. In England, if you are on the NHS you may have to wait, and you may not get exactly what you want, but you will get care. Some of my relatives carry private medical insurance to get quick service for intermediate problems, but even those people would go with the NHS for anything really major.

Nobody claims the NHS is perfect, but the UK is typical among industrialized countries in achieving better whole-population medical outcomes than the USA, by the simple trick of proving essential medical care to its whole population, not just a series of arbitrary subsets of the population.

In the USA, there are people who have sleep apnea, but don't get any care. Not wait three months. Not get something that is not quite their first choice. Just no care. Remember, anyone posting here is somewhat computer savvy and has at least enough education to find out about sleep apnea. How many people are losing jobs because they fall asleep during the daytime, without understanding why, and have no possibility of seeing a primary care physician who might recognize possible sleep apnea and recommend a sleep study?

[TheLankyLefty]

Just curious what folks do think of The Affordable Care Act (Obama Care)? Most in healthcare are thrilled since we will no longer provide any free services. I know many who aren't real happy with their Medicare coverage, so I'm wondering how any exchange set up by the government will be any different or efficient enough to keep the costs down.

http://www.soapboxwar.com/viewtopic.php?f=9&t=13

[chunkyfrog]

No matter who is in office, the insurance companies and Big Pharma will be allowed to "assist" in writing whatever regulations are enacted, much to the detriment of patients and caregivers alike.
Once again, we are on the wrong end of the stick.

[TheLankyLefty]

Are you talking about lobbyists basically writing the law? If so, I agree with that.
I wondering if the exchanges will be so cheap through subsidies that they'll put all other insurances out of business.

My question/concern is, then what?

Doesn't matter what end of the stick we're on. We can still grab the stick and beat them with it!

[chunkyfrog]

But it's a pointy stick; and I think they greased it!

[zoocrewphoto]

I'm hoping that Obamacare gets repealed. For me, it will be a huge loss. I have good insurance right now. And with the new system, assuming I don't lose that insurance, it will be taxed - at 40%! Right now, I get more into my HRA account than my annual premiums, so it is basically free. I just have to pay my deductible ($250) and then 15%. If I have to pay a 40% tax, I will suddenly owe over $4,000 a year. My gross income is only about $25,000. I can't imagine how I would come up with that money.

Also, due to the new health care rules and how little they pay doctors for medicare, my mom's primary doctor has stopped accepting medicare patients. And her diabetes doctor is retiring at the end of the year. So much for getting to keep your doctors.

I don't understand why there isn't a way to help people who need help getting affordable insurance without ruining it for those who already have something good. I would never have stayed at my current job for 23 years if it weren't for the good insurance. Now, it would be really hard to find something new. I can't afford to lose my insurance, but I can't afford to pay a high tax on it either. My contract expires next May, and every year, something gets worse. Who knows what my insurance will be after that.

I have a small business that I do on the side. It was going really well until summer of 2009. Had 3 good months in 2010. Not so good in 2011, and horrible this year. These days, I consider it a good month if I break even on expenses. No wages. I'm just hoping to ride it out and still be able to keep going when/if the economy picks up. I do pet photography, so it is a luxury item, and my customers need to be able to afford it. Most of my business takes place at events such as horse shows and cat shows. So, I need my customers to be able to afford going to the events and still have money to afford the photos. These days, there are fewer events (many have lost money and cancelled future events) all of the remaining events have much fewer entries, and those who come, have spent more money to get there (gas and large vehicles), so they don't shop very much at the shows anymore. All the vendors are struggling. And of course, our expenses are higher too. It takes a gas guzzler to haul my equipment to the events.

I really hope next year is a better year.

[purple]

If OP is pretty well off, then he is really in a hard place, as he can not get anything for a lower cost. In some ways the ones who have the worst deal, are those whose income is above the bottom of middle class, as they do not really have much more money than the poor. In particular money that they do not need to spend, as the real poor simply do without some things one would think as necessary. Good insurance being prohibitively expensive, and then paying in cash for real health care is the same.

OP might try to find a teaching hospital, although some distance away, they might cut him a deal of some kind. Lower cost, payments.

Same might be true for you cousin. Although the cousin might have to relocate to a place near the teaching hospital.

Some of those who have long paid the most for health care are those with no insurance whatsoever. Insurance policies always negotiate with medical providers prices below the list price which providers have. Those list prices are really for the purpose of the ongoing negotiation between insurers and medical providers for the medical providers to be paid more.

I support the idea of public health care to keep workers, to be able to continue working.

Consider that an individual has undiagnosed diabetes. The individual knows that a single trip to a doctor, with complete blood tests would be more than they can skim out of their budget in a year. So they can not expect to afford treatment. They will try to soldier on until they lose their job for non-performance, and whatever little insurance they have.

LIkewise if the individuals had only the single problem of undiagnosed sleep apnea?

If health care insurances were like clothes, then a person would be arrested for indecent expose.

If Obamacare goes through, then the next big issue will be what is how to define what is reasonable coverage, and how to limit dollar costs to individuals.

Please keep in mind, that much of Obamacare were provisions supported by conservatives, who were not willing to vote for anything pro Obama. The Obamacare provision which conservatives, and individuals hate is the "individual Mandate." Obama gave up on the one thing that would most have contained costs, which is the single payer system, which is in effect price controls, as the single payer would set prices for all services.

The fine for an individual not obtaining insurance for themselves is quite small. A lot of small businesses, have few enough employees that they will not be required to obtain insurance for their employees. I can see that it gets dicey if the company size approaches the point where hiring one more person will require the employer to get health insurance for all.

Romney said that required health insurance in Massachusetts would be cheaper for the state than a system of some covered by private insurance, and the system being required to provide health care for those who have no insurance.

Other than he wants to be President, he would want controls on public health insurance, not to get rid of the individual mandate. I can see his answer would be to let states set their own policies what insurance covers in their state, and set the prices charged for premiums.
A Federal program with states rights to control, set limits.

I would have thought the insurance industry would have been donating money all over the place to get Obamacare into place, as it is likely to make them a lot of money.

Hundreds of billions is to be taken out of Medicare for Obamacare, which supposedly is not needed by Medicare recipients. To which I wonder what is not needed?

Those of us who have Medicare, if we are truly ill, have now been priced out of being to get the health care we need by the current deductibles, and co pays. Not to mention they doctors and clinics are now so exasperated by years of no increase in Medicare reimbursement that a lot of doctors will not take new Medicare patients. In truth I need to improve my health, more money for a better diet, not to mention I do not need the stress and aggravation of not having enough money to do anything but to sit at home and post on the internet, while dodging bill collectors phone calls.

Let me put how Medicare is really constructed now, it is a policy of genocide to kill off all those who receive Social Security.

[Janknitz]

If OP is pretty well off, then he is really in a hard place, as he can not get anything for a lower cost. In some ways the ones who have the worst deal, are those whose income is above the bottom of middle class, as they do not really have much more money than the poor.

Not true. If OP is pretty well off, he has a lot of BARGAINING power. He can go to sleep centers and say "my insurance won't cover this, what kind of deal can you make for me." If none in his area is willing to negotiate, he can travel out of his area to get the care he needs at a reasonable rate (some people go as far as Singapore or India for elective surgeries at considerable cost savings).

The sleep center charging $6000 for a sleep test does NOT EVER get $6000 from an insurer. They get a rate probably around $1,200. They may CHARGE $6000, but that's not what they get. And there is a lot of hassle (more than you can imagine!) in insurance billing. So when a patient comes and says "I'll pay cash if you can give me a discount" many medical providers are more than happy to offer the same amount that they get paid from an insurer without the billing hassle. Some even charge LESS. When you have the financial resources, you have a good bargaining position.

It's those of us in less populated areas without the resources to travel very far or pay directly out of pocket who are going to pay the most.

[Guest]

I'm hoping that Obamacare gets repealed. For me, it will be a huge loss. I have good insurance right now. And with the new system, assuming I don't lose that insurance, it will be taxed - at 40%! Right now, I get more into my HRA account than my annual premiums, so it is basically free. I just have to pay my deductible ($250) and then 15%. If I have to pay a 40% tax, I will suddenly owe over $4,000 a year. My gross income is only about $25,000. I can't imagine how I would come up with that money.

Also, due to the new health care rules and how little they pay doctors for medicare, my mom's primary doctor has stopped accepting medicare patients. And her diabetes doctor is retiring at the end of the year. So much for getting to keep your doctors.

I don't understand why there isn't a way to help people who need help getting affordable insurance without ruining it for those who already have something good. I would never have stayed at my current job for 23 years if it weren't for the good insurance. Now, it would be really hard to find something new. I can't afford to lose my insurance, but I can't afford to pay a high tax on it either. My contract expires next May, and every year, something gets worse. Who knows what my insurance will be after that.

I have a small business that I do on the side. It was going really well until summer of 2009. Had 3 good months in 2010. Not so good in 2011, and horrible this year. These days, I consider it a good month if I break even on expenses. No wages. I'm just hoping to ride it out and still be able to keep going when/if the economy picks up. I do pet photography, so it is a luxury item, and my customers need to be able to afford it. Most of my business takes place at events such as horse shows and cat shows. So, I need my customers to be able to afford going to the events and still have money to afford the photos. These days, there are fewer events (many have lost money and cancelled future events) all of the remaining events have much fewer entries, and those who come, have spent more money to get there (gas and large vehicles), so they don't shop very much at the shows anymore. All the vendors are struggling. And of course, our expenses are higher too. It takes a gas guzzler to haul my equipment to the events.

I really hope next year is a better year.

Well I guess I have now met a Low Information Voter.

Where in the world do you get such ridiculous nonsense? Fox and Friends? You make minimum wage and have convinced yourself that you will pay 40% tax on private insurance? Absolute, complete falsehood. Are you putting this out there intentionally to frighten people on Halloween, or do you literally believe this?

Because if you do believe this foolishness, go to healthcare [dot] gov and inform yourself. Otherwise, please don't vote.

If you only make $25,000 you will likely qualify for heavily subsidized insurance plans under the new Insurance Exchanges, far cheaper than what you now pay on coverage, -- if not outright qualify for full Medicaid Benefits.
And even today, under the ACA, single person small businesses like yours can finally deduct health care premiums from individual federal taxes. How's that for a benefit.

These outright distortions and lies about what is and is not inside the ACA and other laws is just amazing. But then again when a man will lie about moving all Jeep production to China, he's bound to get surrogates to lie for him on just about anything else.....

[purple]

Janknitz, I meant to about a different economic group than I think what you refer to. It is good you required me to be more specific. You are correct in saying some who have cash, can have a strong hand in negotiating prices. I have never had the money to exercise the option of trying to negotiate. and some places may not negotiate a price much less than what someone some where else is likely to charge, plus the costs of traveling there. Usually Sleep Centers can run at full capacity. The institution, and I am guessing here, has little incentive to negotiate other than to be fair.

I did not mean to refer to the group which Obama calls the upper three percent, or many others in the uppermost tiers of the middle class. I believe that for those who are above the bottom of middle class, can have a really hard time if one of their family members has a continuing medical problem, in that they get no public help. Some of this group, I suspect, are the self employed, who work hard, and - if one of their family members have a serious continuing health problem, end up with less money to enjoy than those who earn less. As they are busy working, it is time consuming to get a deal on nearly anything.

[zoocrewphoto]

The sleep center charging $6000 for a sleep test does NOT EVER get $6000 from an insurer. They get a rate probably around $1,200. They may CHARGE $6000, but that's not what they get. And there is a lot of hassle (more than you can imagine!) in insurance billing. So when a patient comes and says "I'll pay cash if you can give me a discount" many medical providers are more than happy to offer the same amount that they get paid from an insurer without the billing hassle. Some even charge LESS. When you have the financial resources, you have a good bargaining position.

Actually, my sleep study charged $6000 and got over $4000 of that.

[zoocrewphoto]

Well I guess I have now met a Low Information Voter.

Where in the world do you get such ridiculous nonsense? Fox and Friends? You make minimum wage and have convinced yourself that you will pay 40% tax on private insurance? Absolute, complete falsehood. Are you putting this out there intentionally to frighten people on Halloween, or do you literally believe this?

Because if you do believe this foolishness, go to healthcare [dot] gov and inform yourself. Otherwise, please don't vote.

If you only make $25,000 you will likely qualify for heavily subsidized insurance plans under the new Insurance Exchanges, far cheaper than what you now pay on coverage, -- if not outright qualify for full Medicaid Benefits.
And even today, under the ACA, single person small businesses like yours can finally deduct health care premiums from individual federal taxes. How's that for a benefit.

These outright distortions and lies about what is and is not inside the ACA and other laws is just amazing. But then again when a man will lie about moving all Jeep production to China, he's bound to get surrogates to lie for him on just about anything else.....

Wow! Pretty insulting aren't you.

Let's see. First of all, I am not minimum wage. I said I work in a grocery store, and I do not have a high annual salary. Grocery stores usually don't give full time hours to everybody as their needs go up and down. Sometimes, I get full hours, and sometimes I do not. I also have a small business that used to do well before the economy tanked, so I liked having time off for that. The nice thing about grocery stores is that typically give FULL insurance benefits for part time hours. An individual plan requires 60 hours per month, which means a weekly average of 15. So, while the job isn't the best paying, the benefits are really good (and worth more than you might think).

I have what is considered a Cadillac plan, provided by my employer, and it is worth more than $10,000. My insurance currently gives me $500 a year in my HRA account. My premiums all year add up to $468. This means my plan is virtually free to me. There are NO plans that the govement can offer me that would be cheaper than I what I already have, except being on welfare (medicaid). I have a job. I don't need or want welfare. I have a great plan with an HRA account and a $250 deductible. This means that each year, my HRA is used first. Once it is depleted, I have the $250 deductible. After that, everything is covered 85%, and I pay the remaining 15%. I don't have to worry about networks or traveling. Dental is 100% free up to a limit (I think $2500) if I go to one of a few dentists in my area. 85% covered everywhere else. I have vision too, but no need for it so far, so I am not familiar with how that coverage works.

If I do not use the full HRA (as in years past, probably never again), then it rolls over. Last year, I had $1400 in my HRA account, before my two trips to the ER in less than a week. This year, I finished it off before my sleep study. Now that I have multiple doctor appointments each year and medical equipment to deal with, I will probably use it fully every year.


From the website YOU suggested (healthcare dot com):

"Beginning in 2018, a new federal excise tax will be assessed on insurance companies for health plans that are extremely expensive (in excess of $10,200 for self-only coverage, $27,500 for families)."

Either that cost will be passed to the consumer, or the insurance will be cancelled. You saw how nice my current insurance is. Do you really think I want to lose that (with no increase in wages) and go pay for a plan that isn't as nice? And Medicaid? You have got to be kidding. My current doctor does not accept medicaid or medicare. Those don't pay enough to cover the cost of ding business. I would lose the ability to go to my current doctors. No thanks.

Here are some quotes from different websites.

From the Forbes website:
"The key to understanding the long-term deficit impact of Obamacare, from the CBO’s point of view, is to understand the “Cadillac tax.” As a reminder, the Obamacare “Cadillac tax” imposes a 40% excise tax on the relevant premiums charged by any insurer that, beginning in 2018, offers a health insurance policy whose value is in excess of $10,200 for individual coverage and $27,500 for family coverage."

From npr.org

"The Cadillac tax isn't intended as a way to generate a lot of income for the government. Instead, it's designed to hold down health costs by making people more aware of the costs of medical care. It taxes high-cost insurance policies provided by employers, with the idea that employers will instead buy lower-cost, nontaxed plans.

Many of the high-cost Cadillac plans have no copayments and no deductibles — that is, no $10 or $20 for each doctor visit, no $300 or $600 for each hospital visit. Lower-cost plans do have deductibles and premiums, and the idea is that paying that will make people more price-conscious: Doctors will think twice before ordering tests that may not be really necessary; and patients will ask their doctors if they really need this procedure or that hospitalization. "

The idea of this tax is to get our employers to drop our current insurance plan. They say it is to save money and make more people aware of the costs of test, etc, but my insurance already does that since I have to use my HRA account first, and then pay the deductible first. It's my money, so I already have incentive to not use it unless I really need to. In reality, they need more people using the government exchanges. Why? Because they can't give free or cheap insurance to millions more people without having lots of people paying into the same program. If those of us with good insurance now keep our insurance, we won't be paying into the system. SO, Obamacare solves this program by taxing those who keep their old insurance and pushing most of us into the new insurance. It's like social security. You need to have enough people paying in, so that you have enough money to pay out. This whole Obamacare system simply won't work without enough people paying in.


If Obamacare goes forward, I will either lose my really good employer based insurance plan, or it will be taxed to the extreme. Either way, I lose.

[Wulfman...]

These outright distortions and lies about what is and is not inside the ACA and other laws is just amazing. But then again when a man will lie about moving all Jeep production to China, he's bound to get surrogates to lie for him on just about anything else.....

Dear foul-mouthed jerk,

You're the one who's repeating the "lie" being told by the liberal leftist media.
Romney never said in the ad that Jeep production was being "moved" to China!

The quote was:

"Obama took GM and Chrysler into bankruptcy, and sold Chrysler to Italians who are going to build Jeeps in China."

Everything in that statement is factually correct.

By the way, I took the quote from an article by the liberal-leftist ABC News.

The original article about Jeep production in China was from Bloomberg News. (Not exactly a bastion of conservatism.)
"Fiat Says Jeep Output May Return to China as Demand Rises"

I'm glad to see "zoocrewphoto" came back to reply and defend herself.


Den

.