healthcare premiums with CPAP diagnosis

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
eflayer
Posts: 8
Joined: Tue Dec 06, 2011 10:21 am
Location: SF Bay Area, CA

healthcare premiums with CPAP diagnosis

Post by eflayer » Tue Dec 06, 2011 10:56 am

I am new here. I am 61, 5'11", and right around 190 lbs. I take no prescription medications and ride a bicycle around 100 miles a week. I have been diagnosed with apnea, but as you can read in another of my postings today, I am finally being "treated" correctly with my every night use of my CPAP machine, mask, and chin strap. So as a healthcare risk, I would say my profile is about as good as it can be at my age.

Drives me crazy and maybe to the poorhouse that my healthcare insurance premiums are jacked up due primarily to the apnea diagnosis. I believe I pay at least a 30-40% extra amount on my premium due to this alleged rediculous pre existing condition.

I understand the dangers of untreated apnea and why insurance would consider that an additional risk factor. But what if it is being treated properly and you are healthy in every other way???

Is anyone in the same boat. Has anyone found away around this with any sane insurance provider? Any info appreciated.

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xenablue
Posts: 1358
Joined: Tue Sep 07, 2010 12:52 pm
Location: Aussie living in balmy Wisconsin

Re: healthcare premiums with CPAP diagnosis

Post by xenablue » Tue Dec 06, 2011 11:01 am

I agree - it's ridiculous to penalise someone for looking after their health and being compliant with treatment - what about all the people who have apnea and don't use their machines, or don't bother getting diagnosed and suffer from other horrible side-effects (or death)?

I feel the same way about my diabetes - IMHO the insurance premiums should reflect compliance with treatment. My average glucose readings and 6-monthly A1C should confirm my compliance, just as stats from our XPAP machines do.

Cheers,
xena

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LSAT
Posts: 13316
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin

Re: healthcare premiums with CPAP diagnosis

Post by LSAT » Tue Dec 06, 2011 11:15 am

eflayer wrote:I am new here. I am 61, 5'11", and right around 190 lbs. I take no prescription medications and ride a bicycle around 100 miles a week. I have been diagnosed with apnea, but as you can read in another of my postings today, I am finally being "treated" correctly with my every night use of my CPAP machine, mask, and chin strap. So as a healthcare risk, I would say my profile is about as good as it can be at my age.

Drives me crazy and maybe to the poorhouse that my healthcare insurance premiums are jacked up due primarily to the apnea diagnosis. I believe I pay at least a 30-40% extra amount on my premium due to this alleged rediculous pre existing condition.

I understand the dangers of untreated apnea and why insurance would consider that an additional risk factor. But what if it is being treated properly and you are healthy in every other way???

Is anyone in the same boat. Has anyone found away around this with any sane insurance provider? Any info appreciated.
Have you tried appealing to the insurance company with a letter from your doctor indicating your treatment?

eflayer
Posts: 8
Joined: Tue Dec 06, 2011 10:21 am
Location: SF Bay Area, CA

Re: healthcare premiums with CPAP diagnosis

Post by eflayer » Tue Dec 06, 2011 11:31 am

maybe worth a try. but i don't think a note would suffice. i have the feeling if anything could happen, i would have to somehow prove the treatment was working. would that mean paying for another sleep study? and even if that proved that i was no longer at risk via the apnea, would the insurance company change my premium?

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Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Additional Comments: extra chin strap to keep mouth shut is essential. i started with a humidifier, but no longer need/use it

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So Well
Posts: 554
Joined: Wed Oct 07, 2009 5:20 pm
Location: Atherton

Re: healthcare premiums with CPAP diagnosis

Post by So Well » Tue Dec 06, 2011 12:52 pm

eflayer wrote:maybe worth a try. but i don't think a note would suffice. i have the feeling if anything could happen, i would have to somehow prove the treatment was working. would that mean paying for another sleep study? and even if that proved that i was no longer at risk via the apnea, would the insurance company change my premium?
I am near you in CA. Health insurance is heavily regulated by the state of CA. I had the insurance company send me the form and instructions for protesting my rate. The idea was the same as yours - show that my sleep apnea was well under control. I have the software and all the data showing a very low AHI and total compliance.

When I saw the instructions for protesting and what they consider a valid protest, it was clearly apparent that my situation would not qualify me for a "normal" rate.

We live among a population of very unhealthy people - extremely poor diet, sedentary lifestyle, substance abuse, morbid obesity, lack of sleep. Antibiotics and heart surgery keep the lifespan of these individuals long. So you have a lot of unhealthy people living a long time and needing a lot of medical care. We pay a big price for this in the form of insurance premiums including the cost of government programs.
So Well
"The two enemies of the people are criminals and the government, so let us tie the second down with the chains of the Constitution so the second will not become the legalized version of the first." - Thomas Jefferson


Janknitz
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Joined: Sat Mar 20, 2010 1:05 pm
Location: Northern California

Re: healthcare premiums with CPAP diagnosis

Post by Janknitz » Tue Dec 06, 2011 2:10 pm

Many insurers would refuse to insure you at all because of your "pre-existing" condition.

This makes little sense, They'd rather provide health insurance to the UNdiagnosed individual who is harming their health than one who is treating the condition to prevent long-term complications of untreated sleep apnea.

I heard yesterday of a mom of 4 year old twins. She had always been a stay-at-home mom and was insured through her husband's employer. Her husband died unexpectedly, and now she can't get private health insurance because her total cholesterol is over 200 (new research suggests that higher total cholesterol measurements may actually be HEALTHIER and prevent diseases like cancer!). The insurer completely turned her down for private insurance.
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