Apnea - Pre-existing condition?

[john_dozer]

Anyone have any experience with the "pre-existing condition" situation with apnea when you switch healthcare providers, change jobs, etc.? How badly were you hit?

Partly why I'm asking is that I can't hide my apnea so to speak. But I'm borderline diabetic and am wondering if I should officially cross that boarder and open up other forms of treatment or should I work on discipline alone (aka diet and exercise). The latter is currently feasible as a coarse of treatment for me but requires a relatively extreme commitment in terms of diet. My doctor was hesitant to have have me be officially diabetic and to took a little bit to dawn on me that in addition to wanting to find a non-drug solution he may have been trying help me avoid an official diabetes diagnosis too. He's even got me hooked up with some stuff which helps control blood sugar swings that is technically not a drug. It does work.

Anyway since I have apnea already it really worth it, aside from the medical implications, to avoid the diabetes diagnosis? Am I already damaged goods, from a medical bean counter perspective?

I also understand if I do this by diet and exercise alone long enough, I might experience some reversal too. And that's a consideration but not the point of my questions.

[elg5cats]

"john_dozer"Anyone have any experience with the "pre-existing condition" situation with apnea when you switch healthcare providers, change jobs, etc.? How badly were you hit? Partly why I'm asking is that I can't hide my apnea so to speak. But I'm borderline diabetic and am wondering if I should officially cross that boarder and open up other forms of treatment or should I work on discipline alone (aka diet and exercise). The latter is currently feasible as a coarse of treatment for me but requires a relatively extreme commitment in terms of diet. My doctor was hesitant to have have me be officially diabetic and to took a little bit to dawn on me that in addition to wanting to find a non-drug solution he may have been trying help me avoid an official diabetes diagnosis too. He's even got me hooked up with some stuff which helps control blood sugar swings that is technically not a drug. It does work. Anyway since I have apnea already it really worth it, aside from the medical implications, to avoid the diabetes diagnosis? Am I already damaged goods, from a medical bean counter perspective?I also understand if I do this by diet and exercise alone long enough, I might experience some reversal too. And that's a consideration but not the point of my questions.

Do you know what diagnosis your doctor gave you when considering diabetes? If labs were done that show elevated BG, documentation in your medical record documenting any abnormalities in BG including prediabetic references? If so, it's just as well as having the diagnosis when thinking of pre-existing illness. Any future insurance, life insurance, etc that considers pre existing illness will usually request/review documentation and not just diagnosis. Pre-existing for future health insurance coverage isn't as damning as it use to be. If you have maintained insurance, change jobs or insurance company, you can't be refused coverage for pre-existing conditions. The risky areas are if you are self insured or trying to purchase life insurance. In those situations, even pre-existing conditions even ones that cannot be repeated, such as having you gallbladder removed, still effects your eligibility or premiums. So if your MD has talked to you about entering the realm of diabetes, needing to monitory BG, needing to take action to prevent diagnosis, you're as good as diagnosed.

elg5cats

[Wulfman]

From an insurance standpoint, if there's a "diagnosis" (for anything) in your medical file, it's a pre-existing condition.
If you're in a "group" insurance plan, there are usually no exclusions for pre-existing conditions.
Once you HAVE diabetes, it's not necessarily "reversible"......only "controllable" (hopefully).

Good luck.

Den

[williamco]

although I hid sleep apnea from my medical records, I was denied coverage because of depression. how ironic!

imagine if they knew I had sleep apnea too, at least depression can be recovered from, but sleep apnea is for life with all the consequences and increased odds for other diseases with it

when they doubted that I had apnea (because I complained about being tired in my medical records so I can have Provagil) they hammered me with 12 questions inquiring about sleep apnea possibility

yes sleep apnea is a big deal with insurance companies

[leejgbt]

Pre-existing conditions are included if you go from an individual insurance plan to an individual insurance plan, go from no insurance to any plan and in many cases if you go from induvidual to a group. The only safe change is group to group as then there is no pre-existing condition. Insurance companies cannot rate you for something that is not diagnosed. If the insurance suspects a condition based on tests but no diagnosed has been made they can take you as is or deny you coverage. They cannot rate you based on something not diagnosed.

If you work for an entity that is self insuranced this is usually considered a group for rating purposes.

Hope this helps.

[PST]

Health insurance is regulated by the states with substantial differences in what companies are permitted to do with respect to pre-existing conditions. You cannot rely on anyone else's experience unless it is from your state and relatively recent. It looks increasingly likely that federal law will pass making it possible to move from one plan to another without worrying about denial because of or exclusion of coverage for a pre-existing condition. I would try to hang onto my current coverage if I could for the next month or so while we find out what's going to happen.

[Restless Dreamer]

Here is my experience with losing/changing jobs and insurance. I was uninsured for 2 months between jobs last fall. When I went for my sleep study, my insurance company required a "certificate of credible coverage", or there would be a waiting period of 2 years for coverage on cpap and the sleep study. They are looking for a lapse no longer than 62 days in insurance coverage. Ironically, my new insurance is with the very same insurance company! So, whenever you change insurance companies, immediately request a "certificate of credible coverage" and keep it with your important papers. Ask your new company what their policy is on coverage lapse, waiting periods, and pre-existing conditions. That is the only way you will know for sure!

[CollegeGirl]

although I hid sleep apnea from my medical records, I was denied coverage because of depression. how ironic!

imagine if they knew I had sleep apnea too, at least depression can be recovered from, but sleep apnea is for life with all the consequences and increased odds for other diseases with it

when they doubted that I had apnea (because I complained about being tired in my medical records so I can have Provagil) they hammered me with 12 questions inquiring about sleep apnea possibility

yes sleep apnea is a big deal with insurance companies

Unfortunately, seemingly NOT from an insurance standpoint. I was "clinically depressed" for years until I found CPAP therapy. Doesn't matter that that depression is now gone - simply the fact that I had it at one point means higher rates on my insurance forever. They don't ask you "do you currently have depression" they ask "have you ever been diagnosed." It's been several years now, and I still get dinged when I try to apply for individual coverage.

[Autopapdude]

Sleep Apnea is a preexisting condition for any insurance company in ANY state. However, if you have group health insurance, you sign up during an open enrollment period, and underwriting is bypassed in most states. Individual health insurance definitely and unquestionably considers it a preexisting condition, and probably will not cover you at all.

[leejgbt]

While it is true that rules for insurance varies from state to state the feds have stepped out only because states have met certain minimum federal guidelines and this is one of them. Think about this, if the states had the final say then how could the feds impose the new health insurance reform and have it have any teeth? By the way I was a licensed agent in several states for over 7 years.

[Autopapdude]

While it is true that rules for insurance varies from state to state the feds have stepped out only because states have met certain minimum federal guidelines and this is one of them. Think about this, if the states had the final say then how could the feds impose the new health insurance reform and have it have any teeth? By the way I was a licensed agent in several states for over 7 years.

Insurance is privatized, and not regulated on a Federal level. That is the problem. Each state can set rates according to what the market can bear, and that is exactly what they do--provided that everyone in a particular rate class (that is, in a given age and heath status) is treated equally. In the case of non-group policies, almost no regulation exists---medical underwriting (read that, cherry-picking by insurance companies) is rampant. Sleep Apnea when disclosed on a health questionnaire (required by all new applicants for private non-group policies) is an automatic disqualification. On "open enrollment," it isn't the case, as companies have less option to cherry pick, and must ensure all employees in a group. Quite a system, isn't it?

[PST]

While it is true that rules for insurance varies from state to state the feds have stepped out only because states have met certain minimum federal guidelines and this is one of them. Think about this, if the states had the final say then how could the feds impose the new health insurance reform and have it have any teeth? By the way I was a licensed agent in several states for over 7 years.

I will grant that legislation like COBRA has introduced more uniformity than formerly existed. It still worries me, however, that someone might make an important insurance decision based in part on the experiences of others as reported here, since differences do exist from state to state, and most of us don't know where the others live. In addition, some group plans negotiate terms better than a state's minimum standards.

[Uncle_Bob]

Given that I work as a Software Engineer my condition forces me to remain a full time company employee (group health) and not to go out and work as a contractor

Slightly related, I wish i had gotten my term life insurance before i had my sleep study done. Sleep Apnea = High Risk = More $$$

I wish there was a way to show your data reports to the insurance company as proof that you are no longer at risk while on xPAP.

[leejgbt]

Autopapdude,

You are flat out wrong on this one. Every insurance has to be approved by each state's insurance commissioner (it is calling having been appointed). The feds set minimum standards that the states must follow. States can be more stringent but not less. Insurance being privatized has absolutely nothing to do with this issue. Call your state's insurance commissioner to find out any specifics but pre-existing condition rules are at a minimum of what I said earlier.

P.S. Just had a pre-existing condition issue where an employer made the employee wait past the 63 day window (waited 90)for the pre-existing condition so the employee was technically uninsured for 90 days. He stated we follow the federal minimum and by the way it starts when you apply not when it is actually placed.

[Autopapdude]

Autopapdude,

You are flat out wrong on this one. Every insurance has to be approved by each state's insurance commissioner (it is calling having been appointed). The feds set minimum standards that the states must follow. States can be more stringent but not less. Insurance being privatized has absolutely nothing to do with this issue. Call your state's insurance commissioner to find out any specifics but pre-existing condition rules are at a minimum of what I said earlier.

P.S. Just had a pre-existing condition issue where an employer made the employee wait past the 63 day window (waited 90)for the pre-existing condition so the employee was technically uninsured for 90 days. He stated we follow the federal minimum and by the way it starts when you apply not when it is actually placed.

Then you're misinformed as both a DME and an insurance practitioner. The insurance commissioner is a rubber stamp for insurance companies. THEY NEVER deny requests made by insurance companies. Deregulation has made that an accomplished fact, and if you deny that, YOU are misleading the folks on this board in two areas---DME practices and insurance. You're 0 for 2, baby!