Excerpt from my new insurance policy D:

[eargos]

I made a post yesterday talking about a long struggle I had with my physician and former insurance company trying to get a repair or replacement for my broken cpap machine. In the end I lost the battle, primarily because I ran out of time as my company was in the middle of transitioning to a new insurance provider. When I finally gave up on the old provider I figured all was not lost as I would get another chance to work things out under the new policy.

Boy was I wrong here's an excerpt from the fine-print portion of the policy:



So I have 3 things to say about this...

First: WTF!?
Second: read any new insurance policy carefully!
Third: has anyone had any success petitioning their insurance company to change a really idiotic policy such as this one?

[ameriken]

Despite the new health care law that is supposed to be a good thing for insurance (ha ha), insurance premiums are shooting up. If this is company provided health care, your company may have had to get a 'streamlined' plan to be able to provide at least some kind of major med at a premium they could handle. Sadly, this may be the way of the future under the new health care law. At least, that's my best guess as to what is going on.

[eargos]

Despite the new health care law that is supposed to be a good thing for insurance (ha ha), insurance premiums are shooting up. If this is company provided health care, your company may have had to get a 'streamlined' plan to be able to provide at least some kind of major med at a premium they could handle. Sadly, this may be the way of the future under the new health care law. At least, that's my best guess as to what is going on.

This is more or less what's happening. By my estimation the new plan will cost 30% more in premiums and cost my family 60% more in out-of-pocket medical expenses. It's a pretty devastating shift in coverage, but I never imagined they would outright deny all coverage for OSA. It's unconscionable!

[Otter]

It's a pretty devastating shift in coverage, but I never imagined they would outright deny all coverage for OSA. It's unconscionable!

It's also stupid, unless they also don't cover strokes, heart attacks, diabetes, etc. Treatment for the things that will happen to you if you don't treat your OSA could be far more expensive than CPAP.

[MikeS]

Why is everyone so pessimistic? They just announced on our local news that the local government now covers "Gender Identity Disorder" for all of our government employees and their families including all appropriate operations, injections and doctors visits.

It is not like everyone is not able to get decent health care. And I certainly no longer feel like I am not paying for decent health care... its just not for me or my family.

[Otter]

Why is everyone so pessimistic? They just announced on our local news that the local government now covers "Gender Identity Disorder" for all of our government employees and their families including all appropriate operations, injections and doctors visits.

Hmmmmm. Voluntary sterilization for bureaucrats. That's a good idea.

[Lizistired]

Sounds like Sleep Apnea will soon be reclassed as a "Breathing Disorder". And that would seem more appropriate. I would talk to your sleep doc about it. Medical billing is their bread and butter.

[Janknitz]

It might be worth submitting a bill for some less expensive item to see what happens--on the theory that OSA is a RESPIRATORY disorder, rather than a "sleep" disorder. Just see what happens, understanding you may get stuck paying oop in the end. If you get a denial, try an appeal.

Be sure to double check that evidence of coverage.

And consider buying your own machine online to end all this frustration.

[ameriken]

Kudos to the last two posts. At the VA, the sleep clinic is located in the respiratory unit, which initially confused me at first (why is the sleep lab next to the pulmonary function test room?). Of course, now I understand why, as has been said sleep apnea is more of a breathing disorder than it is a sleep disorder. If someone breathed during the day the way we do during the night, there would be no problem covering it.

The medical terminology of our 'disorder' needs to be corrected.

[BlackSpinner]

Kudos to the last two posts. At the VA, the sleep clinic is located in the respiratory unit, which initially confused me at first (why is the sleep lab next to the pulmonary function test room?). Of course, now I understand why, as has been said sleep apnea is more of a breathing disorder than it is a sleep disorder. If someone breathed during the day the way we do during the night, there would be no problem covering it.

The medical terminology of our 'disorder' needs to be corrected.

Yes here it is also part of the respiratory clinics - after all it is about not breathing - the sleep part is just one of the symptoms.

[gailandartie]

If you don't mind, can you tell us which state this policy is written in.

Reason I ask, is because different states have different rules.

[kempo]

Despite the new health care law that is supposed to be a good thing for insurance (ha ha), insurance premiums are shooting up. If this is company provided health care, your company may have had to get a 'streamlined' plan to be able to provide at least some kind of major med at a premium they could handle. Sadly, this may be the way of the future under the new health care law. At least, that's my best guess as to what is going on.

This is the reason Congress opted out of Obama Care.

[goldfinch]

The new heath care law has nothing to do with this issue. And the new law is for the most part not in effect yet.

Anyway, currently whether an insurance policy can have exclusions such as this depends on state law. State laws have differed on this issue for years, long predating "Obamacare. For example, some states allow policies to exclude mental health treatment. Other states allow policies to put dollar limits on different types of claims. So, to blame the new health care law for this change is wrong and misleading. One of the reasons for the new federal health care law was this constant chewing away at benefits and the rising cost of insurance and care.

So, what state is the policy written in?

[someone else]

Most insurance companies are making $$$$ changes in anticipation of Obama care. My copays just doubles and tripled and much more ER and hospital.

[Janknitz]

Most insurance companies are making $$$$ changes in anticipation of Obama care.

Most companies are making $$$$ changes because they CAN. Whether the new health care law was imminent or not they'd be doing this. They are multi-billion dollar profit making companies and they will continue to make these profits regardless.