getting new insurance, want to check for sleep apnea. tips?

[kdt15]

I lost insurance recently and am getting a new one, likely kaiser in los angeles.

Im not totally sure about how insurance works but they should be able to cover it, right? after the deductible, which is 6.5k or so

also, since im getting it soon (NOVEMBER) is it kind of dumb for me to use the insurance service, since ill have the last 2 months of 2017 wasted on deductible. should i just wait until 2018? i think this is how insurance works. also, how do i know if kaiser covers it? cant find it in the formulary anywhere.

anyone know the rough cost of sleep test + cpap supplies? i only really want to get the apnea checked and adhd taken care of, so im trying to gauge the annual costs to decide which plan to select.

thanks!

[Julie]

You really should call the insce. co. yourself to answer those questions... not all companies are the same and assuming (never mind asking us) anything about one or another and acting on it without confirmation would not be the best idea. And testing and 'supplies' (are you including the usually expensive machines in 'supplies'?) may or may not be included depending on the individual policy.

[Pugsy]

Which Kaiser plan?
Some will cover the sleep study but not the equipment at all.
Forum member Janknitz as the Platinum plan and it won't cover any cpap equipment...masks or machines.

If whatever you do choose has a high deductible I would go with a good quality home sleep study and buy my equipment privately. It will all add up to a lot less than a 5 K deductible unless you have some sort of special needs for a very special machine.

[nicholasjh1]

I'd second that, if you don't have the extra cash home sleep should be enough if you really suspect apnea (like a partner or someone said they noticed you stop breathing. ) if you just suspect it for some reason I'd record your sleeping etc to try to figure it out ahead of time.

[nicholasjh1]

In fact my doc kept on encouraging me to get the full sleep test over the home sleep test, so I kept on avoiding it due to the cost. ended up delaying my therapy 9+ months before I finally told her to shove it and give me the home sleep test. Worst mistake of my life to wait.

[kdt15]

In fact my doc kept on encouraging me to get the full sleep test over the home sleep test, so I kept on avoiding it due to the cost. ended up delaying my therapy 9+ months before I finally told her to shove it and give me the home sleep test. Worst mistake of my life to wait.

why was it the worst decision to wait?

youre suggesting the home one right? hpow much does that run and do i need insurance to order one? and from where?

[kdt15]

I lost insurance recently and am getting a new one, likely kaiser in los angeles.

Im not totally sure about how insurance works but they should be able to cover it, right? after the deductible, which is 6.5k or so

also, since im getting it soon (NOVEMBER) is it kind of dumb for me to use the insurance service, since ill have the last 2 months of 2017 wasted on deductible. should i just wait until 2018? i think this is how insurance works. also, how do i know if kaiser covers it? cant find it in the formulary anywhere.

anyone know the rough cost of sleep test + cpap supplies? i only really want to get the apnea checked and adhd taken care of, so im trying to gauge the annual costs to decide which plan to select.

thanks!

=========

you should get the details from them before you sign up

sleep labs are outrageously expensive
do an IHT to prove you have it
get the doctor to write the Rx
submit it to the insurance

if they insist on a sleep lab they should pay for that
less the copay which is still big

you could buy a cpap and supplies for less than the cost of a sleep lab test

thanks! confused on the process though. in order to get a doc, ill need to sign up first right?
isnt an IHT and sleep study the same? i dont really want to be spending a ton

is the doc writing the rx for the iht or for cpap/supplies? and would i have to submit it to insurnace myself or will the doctor do it?

and if i can get cpap/supplies online, i still need an rx to order them right?

thanks, insurance is still something im getting used to after not having it for years

[kdt15]

Which Kaiser plan?
Some will cover the sleep study but not the equipment at all.
Forum member Janknitz as the Platinum plan and it won't cover any cpap equipment...masks or machines.

If whatever you do choose has a high deductible I would go with a good quality home sleep study and buy my equipment privately. It will all add up to a lot less than a 5 K deductible unless you have some sort of special needs for a very special machine.

Not sure which plan yet but probably gold or silver in 2018? in 2017 right now i'm probably going to pick the the cheapest one (bronze/catastrophic) and not visit the docs since theres only 2 months left to hit my deductible, which seeems wasteful. Considering just getting my apnea and adhd stuff handled in january instead.

if high deductible, getting it privately - do i still need insurance ? I figure i need an IHT (300$?) and cpap stuff ($2000?) minimum for it, but can i just order that myself with no doctor/insurance/prescription? would love to know where if so! Would do this this month since waiting another 2 months to feel 'normal' sucks.

also, are you saying the sleep study is covered in some, but no plans cover the equipment? why get insurance then lol. how do i look it up? was browsing the different plans but didnt see anything about cpap or sleep in formularies.

[Pugsy]

I don't know all the ins and outs of Kaiser but with some plans the sleep study (an in home study is usually what they do) is covered but the actual equipment isn't covered.
Forum member Janknitz lives in California and knows a lot more about the ins and outs of the various plans.
I will send her a note and ask her to drop by your thread.

If it were me I would get the in home sleep study....and they vary in cost depending on how comprehensive the study is. Some are just basic oxygen level testing (I don't recommend that one because not everyone will have significant drops in oxygen) and some are pretty much as comprehensive as an in lab sleep study. Go here and read up on the different sleep studies.
http://freecpapadvice.com/home-sleep-tests
http://axgsleepdiagnostics.com/

You will need a doctor's order from someone somewhere though for any home study from anyone. There are some online websites that can help facilitate the getting of the order.

As far as cost...you can get a really good full data apap machine (assuming plain jane vanilla OSA) for less than $600 new and less than that if you would accept used.
I would target the ResMed or Respironics brands for several reasons.
If you can swing it...narrow the target to the ResMed AutoSet either the S9 AutoSet (prior model) or the AirSense 10 AutoSet which is the latest model.
Mainly because we don't know what pressure you will end up needing and I personally think that at the higher pressures that the ResMed exhale relief is a little better.

Check out Amazon for machine and masks.. No RX required. I saw a ResMed AirSense 10 AutoSet on Amazon the other day for $525 and that included shipping.
or check out secondwindcpap.com for used or new open box specials.

[zoocrewphoto]

also, are you saying the sleep study is covered in some, but no plans cover the equipment? why get insurance then lol. how do i look it up? was browsing the different plans but didnt see anything about cpap or sleep in formularies.

If you have a really high deductible, none of it is going to be covered anyway. It may count toward a deductible that is never met, but you may be paying inflated amounts to earn credit that won't count. I don't see the purpose of high deductible insurance except for things like cancer or a car accident. My deductible isn't that bad, but it was bad enough that I did not go to the doctor for 3 years except for two urgent care clinic visits. I paid for cpap supplies out of pocket.

This year, I met my deductible, so I have been going to the doctor to work on my blood pressure. But I still owe over $1500. I might lose my insurance next year when my contract is up. I would rather go without than waste my money on a plan that costs 5 times my current premium and has a deductible 8 times my current deductible.

[Janknitz]

I can tell you what it is in NORTHERN California--it's a different region, so I cannot guarantee it's applicable to you in Southern CA.

First, you probably will have no problems getting a sleep study, but it's going to be a home study. That's not necessarily a bad thing. They use state of the art equipment that is very accurate unless you have more than the usual form of obstructive sleep apnea. And there may be very little or possibly NO out of pocket cost for the testing. I believe that sleep testing (at least the home test) is covered on all of Kaiser's plans.

DME is another issue. It is my understanding that there is NO CPAP coverage on any of the ACA plans. Yes, they do have DME coverage, but they don't seem to cover much more than a wheelchair or a walker. Depending on your point of view, it may be a blessing in disguise.

First, the only vendor Kaiser uses is Crapria. Crapria has earned it's nickname, they are a PITA to deal with. If Kaiser isn't covering your DME you don't have to use Crapria. That's a good thing. However, you may still want to use Crapria because in truth Kaiser is your DME and Crapria is merely the supplier. So if Kaiser prescribes a CPAP, hose, filter, and mask, even if they don't COVER it, they still have a contract with Crapria to provide it at a very discounted cost. So your out of pocket costs may be very reasonable.

But you also have the freedom to go elsewhere. You can buy a used CPAP from a couple of sources (some members here sell, Craigslist, or Secondwind.com are good options) for a very reasonable price. You can buy masks off eBay and even Amazon these days. And you don't have to put up with any of Crapria's crap. Priceless!

Now there are other private plans with Kaiser which may have other coverages. I don't know right now the ins and outs of other plans. You're going to have to ask.

I suggest for any plan you are considering you ask them to print out the "Evidence of Coverage" for you. That's the ACTUAL contract between you and your insurer, but you never see it unless you ask (and IMHO you should be able to see it BEFORE you purchase the coverage, but they may argue against that, claiming it's "proprietary"--how can you be expected to contract without full information, though???). Whatever the EOC says is GOD--if the EOC says they have to cover it, it's covered. If it's not in the EOC, or they are using cagey language, it's not covered.. They use really cagey language in the DME portion of ACA plans, let me tell you!

Be forewarned! My Kaiser silver plan insurance premiums are going up 27.9% this year thanks to the jerk in the whitehouse's little executive order games. More than $2500 to cover three people in 2018. It may be worse next year--if it is we will be joining the ranks of the uninsured. By then my youngest will be eligible for a college health plan, my husband will be on Medicare, and I will just go without healthcare until I am eligible for Medicare myself. If it's still there when I get there.

[SewTired]

First, you should check your coverage with your insurer. In addition, your insurance may cover the testing, but not the machine.

In general, with a high deductible, if you don't have a heart or lung problem and feel you have obvious symptoms of sleep apnea, then a home test is a better choice. Some folks here have even skipped the test via their doctor's office and had one done through an online supplier. When my cousin enquired about this, they did say that if the home study showed something really off, the doctor will contact you. An example of this would be someone who has very low oxygen, but no obvious apnea that could be causing this. In any case, even if you have the home sleep study sold by an online retailer, you can get a copy of the prescription and buy elsewhere.

[TASmart]

The amount of increase depends on the insurance type you have. The huge increases are in the ACA state pools, not private insurance. If xxyzx got insurance through one of the ACA mandated exchanges, I would fall out of my chair laughing at the irony of it. But he is correct it's not Trump causing the cost of insurance to rise, but once again, he is wrong, it's not Obama's fault either.

[zoocrewphoto]

you cant go without
or obama will have the irs coming after you for a big payment
unless trumps weenies finally do fix bamacare and kill that requirement to have insurance

The penalgty is lower than the cost of premiums that can't be used. Why would I spend thousands on premiums for a plan that has a $2000 deductible that I am unlikely to get past? I am already struggling to pay medical bills with my (currently) cheaper insurance as well as car repairs. I really won't have a choice. I just don't have that kind of money. I am praying they get rid of the Cadillac tax before my contract is up in the spring. It has been postponed a few times, but it is currently scheduled to start in 2020 which is during the next contract. That's an extra $4000+ per employee that my employer would have to pay. This is why they are trying to ditch our current plan.

"The Affordable Care Act's high-cost plan tax (HCPT), popularly known as the “Cadillac tax,” is a 40 percent excise tax on employer plans exceeding $10,200 in premiums per year for individuals and $27,500 for families. The tax is scheduled to take effect in 2020."