Insurance plan covers sleep study, please help

[bwexler]

It is clear that in May of 2010 Sebelius issued regulations that would cause/allow insurance companies to cancel most private health insurance policies. Those same regulations will have a similar effect on employer based policies, which is why Obama postponed that requirement for a year.

It is equally clear to me that Obama said he wanted single payer health coverage from the beginning. I believe ACA was intentionally sabotaged so it could destroy the existing health insurance system and allow the savior to usher in single payer as the only viable solution in an emergency situation.

I don't believe one size fits all government provided anything is the best solution. I was one of the millions of uninsured for forty years, by choice. In retrospect it was a wise financial decision for me. My total outlay for medical care was less than $50,000 over all those years. With a typical $1,000 deductible it is clear to me that there were only a couple years that I would have met the deductible. My dental bills for those years far outpaced my medical bills and it is unlikely the medical insurance would have covered any of them. So simple economics tells me I was tens of thousands ahead by self insuring.

Others may have different experiences which is why there is so much controversy over the individual mandate.

I think the first step in controlling medical costs is to have the consumer aware of and involved in the actual cost. Gee should I go to the emergency room for a $15 aspirin and a $1,000 visit which I don't have to pay for OR go to Walmart for a $2 bottle of 100 aspirin that I must pay for. When one is presented with the bill for both, even with only a 10% copayment the decision would be easy and total medical costs would plummet. Our current system hides the real cost from the consumer and provides no reason to even pay attention.

[49er]

Bwexler,

As you previously acknowledged, most people do not have the fortune of being in your position. I hate giving vague examples since I deplore it when the other side does it but what the heck. I read about a situation where someone was about to have a double mastectomy and her insurance company pulled the plug out from under her.

And by the way, all these folks who seemed to be concerned about insurance policies getting cancelled, didn't seem to be concerned when people like that woman were getting the plugged pulled out from under her. That happened to people constantly and there was no outcry in my opinion.

I couldn't disagree more that Obama wanted single payer coverage. He deliberately kept single payer advocates from the negotiating table. Heck, he even sabotaged a public option which according to the congressional budget office would have substantially lowered costs.

I agree with you that prices need to be published about what things cost. But that still doesn't solve the problem of the woman who needed the double mastectomy or people in similar situations who don't have health insurance through not fault of their own. Many people aren't a position to do comparison shopping and need health care yesterday that they can't get do to not having health insurance.

Finally, to paraphrase Black Spinner, the rest of the world doesn't seem to have a problem providing health insurance for its citizens but folks keep squawking in this county it can't be done. We're spending more and more for less care and we are not the leaders in any relevant statistics.

49er

It is clear that in May of 2010 Sebelius issued regulations that would cause/allow insurance companies to cancel most private health insurance policies. Those same regulations will have a similar effect on employer based policies, which is why Obama postponed that requirement for a year.

It is equally clear to me that Obama said he wanted single payer health coverage from the beginning. I believe ACA was intentionally sabotaged so it could destroy the existing health insurance system and allow the savior to usher in single payer as the only viable solution in an emergency situation.

I don't believe one size fits all government provided anything is the best solution. I was one of the millions of uninsured for forty years, by choice. In retrospect it was a wise financial decision for me. My total outlay for medical care was less than $50,000 over all those years. With a typical $1,000 deductible it is clear to me that there were only a couple years that I would have met the deductible. My dental bills for those years far outpaced my medical bills and it is unlikely the medical insurance would have covered any of them. So simple economics tells me I was tens of thousands ahead by self insuring.

Others may have different experiences which is why there is so much controversy over the individual mandate.

I think the first step in controlling medical costs is to have the consumer aware of and involved in the actual cost. Gee should I go to the emergency room for a $15 aspirin and a $1,000 visit which I don't have to pay for OR go to Walmart for a $2 bottle of 100 aspirin that I must pay for. When one is presented with the bill for both, even with only a 10% copayment the decision would be easy and total medical costs would plummet. Our current system hides the real cost from the consumer and provides no reason to even pay attention.

[bwexler]

There are several reasons why people are uninsured. One is people like me who choose to be uninsured or self insured.
Another is those who depend on employer provided plans and become unemployed and therefore uninsured "through no fault of their own".
Then there are the impoverished who have no job or ability to pay for insurance or health care.
And those like your example of those dropped from coverage because of their need for expensive care. I do not believe insurance companies should practice this. Today knowledge is power and Google et al give us all great access to that knowledge. If those desiring insurance researched the practices of the insurance companies it would become easy to avoid those who acted in this manner. Not all of them do.

As for the impoverished provide a safety net that includes training in how to lift ones self out of poverty and an incentive to do so. I know someone who receives over $2,000 a month in assorted benefits. If she took a minimum wage job she would loose all the benefits and wind up with a 30% reduction in here standard of living and not have health coverage as she does now. Loosing all the benefits after the first pay check is a strong disincentive to change. A transition where net standard of living is improved would make more sense, even if the working poor continued to get ~50% of what they got when unemployed.

Finally I believe employer based policies should be phased out and replaced by individual policies that don't evaporate when you leave a job.

If you go back to the first American Thanksgiving it celebrates the successful transition from a socialized group who were literally starving to death while sharing the fruits of their collective labor to the capitalistic society that has built the strongest wealthiest nation on earth. Socialism has failed around the world every time it was tried. Look at USSR, Greece, Spain.

[mason.smith1975]

Call the Social Worker of the hospital you want to go to. They should have information that you need as well as applications for financial assistance. It is also possible to find the local Medical School Teaching hospital, and call their Social Worker for them to waive the cost of things. Might be you have to go to Galveston (one Teaching Hospital used to be there). Find the sleep clinic itself, call and explain your situation, impoverished student, they might have waivers as well.

It is the young who can get the big advantage from the Affordable Care Act. That is, I was once at the University of Houston. While we did not have Sleep Apnea treatment then, my difficulty sleeping was a big factor in my not being able to work (pay rent) and go to classes, study. That being work-study ninety hours a week. Thereby obtaining better paying employment. For my generation it was literally sink or swim. A minor health problem would limit us for the rest of our life. Whether the ACA really helps the younger generation is to be witnessed.

I go to University of Houston, too. I'll call the Medical School Teaching hospital in Galveston. I just found out UT Medical School in Houston also has sleep clinic. I will call them, too. Thanks.

If he moved to Texas just to be a student there, his legal state of residence would not change.

So, he may not even be a resident of Texas.

I'm a resident of Texas.

If you are college-aged (less that 26), you can still be on your parents plan under Obamacare.

My parents are not living here in US. I'm from South America


Thanks you all for answering me. Even though I still haven't had a clear path to go now, but I will do more research about this. As I'm going through the plans of BSCS of Texas, there are Bronze Plan, Silver plan, Gold plan. I know that the less premium we pay, the higher deductible will be. But anyone has any advice on which plan (Bronze, Silver, Gold) is good ? What type of plan do you guys have ?

[Janknitz]

I'm not going to get into the ACA debate--left my popcorn at home today, and it's NOT helping the OP who asked for advice.

I want the OP to know that you don't need to get all caught up in the POLITICAL argument. People are blowing a lot of smoke, but that's not at all helpful to you.

Just because Texas opted out of the Medicaid component doesn't mean that there may not be an affordable ACA alternative for you. None of us know your financial situation, so you need to do some research and find out what's up for you.

Go to the NATIONAL Affordable Care website to see if you qualify for an Affordable Care Act plan and whether or not you would qualify for a federal subsidy. If you can find some plans that work within your budget (with or without the subsidy), the next step is to check the plans out to see if they cover or exclude sleep testing AND Durable Medical Equipment (DME) so that if you are diagnosed with sleep apnea, you will know if that insurance will cover the treatment.

You may need to get more detail than just the advertising information from a prospective insurer. You might ask for the list of exclusions or you can request a copy of the "evidence of coverage" (EOC) for each plan you're interested in. That's the actual contract there will be between you and the insurer, and it will tell you what's covered and what's excluded. You never see the EOC unless you specifically ask for it. (I'm not 100% positive they will furnish a copy before you sign up for the insurance, but that doesn't make a lot of sense since otherwise you are being expected to buy a "pig in a poke".)

Secondly, there are ELEVEN hospitals and two medical schools on the same Medical Center Campus in Houston. If you can't get better insurance and Hermann Hospital doesn't have any financial assistance (ask about a discount for paying cash with no insurance), go over to Baylor, or Methodist or St. Lukes and find out if they will. And there are other hospitals and sleep centers all over the city. (I went to TWU on the Medical Center campus, about 1000 years ago).

Worst case scenario is the "empirical method" that some people have found--titrate yourself with a second-hand autopap and see if it makes you feel any better.

[archangle]

You can buy insurance through the "healthcare.gov" exhange even if you are in the "income too low" group and can't get a subsidy. The exchange gives you the choice of a number of different insurance companies and plans.

You'll have to look at the info on the site to figure out the "gotchas" on each plan. It's mind numbing, but that has always been true with insurance of any kind. There are tons of tradeoffs and benefits.

If your income is below about $11,500 a year, you can't get a subsidy. If you're above that and less than $40,000 or so, you get a reduced limit on out of pocket expenses and deductibles if you get a "silver" plan. You have to go through the exchange to get subsidies and limits.

Be sure and run through the exchange. You may find better costs there after the subsidy.

However, if your current insurance is adequate otherwise, it may not make sense to pay for a better policy just for CPAP. Your premium costs plus deductibles may not pay for the cost. Do be careful when scheduling sleep tests, though. Many providers will charge you several times the "insured" cost for medical procedures if you don't have insurance.

Get a prescription and buy your CPAP online. You'll save a lot of money that way.

[49er]

Call the Social Worker of the hospital you want to go to. They should have information that you need as well as applications for financial assistance. It is also possible to find the local Medical School Teaching hospital, and call their Social Worker for them to waive the cost of things. Might be you have to go to Galveston (one Teaching Hospital used to be there). Find the sleep clinic itself, call and explain your situation, impoverished student, they might have waivers as well.

It is the young who can get the big advantage from the Affordable Care Act. That is, I was once at the University of Houston. While we did not have Sleep Apnea treatment then, my difficulty sleeping was a big factor in my not being able to work (pay rent) and go to classes, study. That being work-study ninety hours a week. Thereby obtaining better paying employment. For my generation it was literally sink or swim. A minor health problem would limit us for the rest of our life. Whether the ACA really helps the younger generation is to be witnessed.

I go to University of Houston, too. I'll call the Medical School Teaching hospital in Galveston. I just found out UT Medical School in Houston also has sleep clinic. I will call them, too. Thanks.

If he moved to Texas just to be a student there, his legal state of residence would not change.

So, he may not even be a resident of Texas.

I'm a resident of Texas.

If you are college-aged (less that 26), you can still be on your parents plan under Obamacare.

My parents are not living here in US. I'm from South America


Thanks you all for answering me. Even though I still haven't had a clear path to go now, but I will do more research about this. As I'm going through the plans of BSCS of Texas, there are Bronze Plan, Silver plan, Gold plan. I know that the less premium we pay, the higher deductible will be. But anyone has any advice on which plan (Bronze, Silver, Gold) is good ? What type of plan do you guys have ?

Hi Mason,

First of all, my apologies for derailing your thread as I agree the discussion about the politics of the ACA was not helpful to your concerns.

Regarding which plan is the best, that is a tough call. Essentially, you have to anticipate what your expenses will be next year and then do the math with the different plans to see if you would be better off with a higher deductible plan vs. a lower one. That is hard to do.

Unfortunately, it seems that the only states in which it is easy to access help are the ones that set up their own exchanges. But you might still see if you could find some assistance maybe by calling one of the hospitals to see if they can direct you to the right place.

Again, my apologies.

49er

[purple]

IF you have not heard yet.

You can get any doctor to write a script for a sleep machine, even a Primary Care Physician . While I do not like the method. It is possible to acquire an auto machine, and try to self titrate with the machine set to like 4-20 on auto. This is very frustrating, but it is doable.

Like someone said, it is possible to forget the sleep study. Just get an APAP with full data. Be very determined, and it might work out for you. If your problem is simple OSA, which odds are it is.

If you did not know, our forum host, CPAP.com is in Metro Houston. While I do not ever see them offering used machines. I would guess if you had a script for a machine, you could speak with them, and see if they could offer you a deal on a machine which had been returned to them.

Another option. http://www.secondwindcpap.com/

While one can acquire a machine from Craigs List without a script, one can be sure the machine was not well cleaned inside, as that technology is not available to the public. And the machine might have had water spilled back into it. My DME rep insisted that machines, when they fail, they fail catastrophically. That is, if it blows, it is likely working correctly. While everyone says that DME's lie, it is in their best interest to find fault with a machine, so they can sell us another one. Likely in this case, "machines fail catastrophically" is an accurate statement.

A description of DME's and such, http://maskarrayed.wordpress.com/what-y ... me-part-i/

Notice the discussion of what is a full data machine. A machine which provides information beyond just proving how many hours a day you are using the machine. This detailed information from a machine you are going to need to download and analyze, especially if you are going to self titrate.

You have not described if you might have some other kind of health problems, which might be a cue that trying to titrate yourself at home with a machine on auto is not a good idea.