Apnea - Pre-existing condition?

Are you really this paranoid? The insurance commissioners would vehemently disagree with your take as they are an advocate for the beneficiary. Are you now arguing just to argue (you a sophist maybe)? You do not need to believe me call your insurance commissioner. Of course your opinion is based on what????????? Not facts...........emotion maybe.

The advice is there, take it for what it is.

Are you really this paranoid? The insurance commissioners would vehemently disagree with your take as they are an advocate for the beneficiary. Are you now arguing just to argue (you a sophist maybe)? You do not need to believe me call your insurance commissioner. Of course your opinion is based on what????????? Not facts...........emotion maybe.

The advice is there, take it for what it is.

I take it the same way I took that it is unlawful for a cpap patient to change his/her own pressure. You are spouting nonsense, and you have been called out by several folks on the therapy aspects of your misstatements. Now, I am calling you out on your lack of insurance expertise. So, I am taking the advice for what it is---WRONG!

The insurance company sets state standards that are largely unregulated. There are Federal mandates, but they are minimally impacting upon insurance autonomy. Groups of "insurable" versus "uninsurable" individuals are created, and insurance commissioners don't set standards for who is "worthy of being insured." Companies make that decision exclusively.

Uncle_Bob wrote: .......
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.

I guess the insurance companies gladly accept the undiagnosed/untreated 90%.

But like you say, get diagnosed and treat it and you are rejected.

autocpapdude wrote:

The insurance company sets state standards that are largely unregulated. There are Federal mandates, but they are minimally impacting upon insurance autonomy. Groups of "insurable" versus "uninsurable" individuals are created, and insurance commissioners don't set standards for who is "worthy of being insured." Companies make that decision exclusively.

This statement has absolutely nothing to do with whether there is a Federal rule for pre-existing conditions. Do you really think you know insurance regulations? There are rules regarding who is "worthy of being insured". When an insurance plan is brought to the insurance commissioner for approval it has to pass these guidelines or it is not allowed to be sold.

Where do you get your info? Insurance companies DO NOT make the decision exclusively on the types of persons who can be insured. Show me your proof or shut up.

Rooster,

The definition of insurance is you are agreeing to a small CERTAIN loss is exchange for coverage for a large UNCERTAIN loss. Insurance is a game of risk. OSA carries many risks for insurance companies if left untreated or if the clincal outcomes are poor. However, most insurance will change their rating if a person is being treated effectively. Be cancer free for five years and most insurance companies consider you cancer free. I have OSA and asthma but both are being treated effectively and my rate, when I was insured by an individual plan, was the second best they offered in my age group.

Yes, it sucks to be diagnosed with anything as it effects your rates but if your treatment has positive clinical outcomes this rating can be removed. The usual waiting time is from one to five years depending on the diagnosis. Ask your agent to find out what the time period is for OSA.

Where do you get your info? Insurance companies DO NOT make the decision exclusively on the types of persons who can be insured. Show me your proof or shut up.

GOTCHA on this one, fake DME/ Insurance everyman! I was rejected for non-group individual insurance because I had OSA 10 years ago. The UNDERWRITING DEPARTMENT of the company made the decision, not the State. Get your facts straight when you make a statement. END OF STORY---you are a fake. Now I have group coverage and can't be rejected on preexistings, as I was enrolled during open enrollment.

Now, YOU show us where the "CPAP" police will come and drag us away for adjusting our own pressures---lolol.

leejgbt wrote:Rooster,

The definition of insurance is you are agreeing to a small CERTAIN loss is exchange for coverage for a large UNCERTAIN loss. ..........

I am aware of that cutesy definition of insurance and do not agree with it. A loss is the giving up of something and in return receiving less than the value given up. When you pay your insurance premium, you are receiving something in return equal to what you give up. That 'something' is an amelioration of risk. You get this whether or not you ever benefit from a claim.

A rational buyer will not purchase an insurance policy if he judges the premium to be more valuable than the benefit. My barber, for instance, let his health insurance policy expire. I will try to convince him that the value of a "catastrophic" policy is greater than the premium he would have to pay.

john_dozer wrote: ....... 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.

.........

Would you be so kind as to tell us what this non-drug is?

I've had a lot of experience with individual insurance in Virginia. Anthem is the "insurer of last resort," here, so to speak, in that they have to cover you if you're HIPAA eligible, even if no one else will. But, that said, they can, and do, put you at the highest level they can (based on your medical history) and therefore might make it impossible to afford it. If you're HIPAA eligible, they have to cover pre-existing conditions (one item in being HIPAA eligible is that you haven't had a break in coverage, either individual or group insurance, for more than 63 days; another is that you are not eligible to be covered by anything else such as a spouse's policy or Medicare, etc.).

Although Anthem can't deny coverage, they will bump you to higher levels (more expensive premiums) for pre-existing conditions. One you haven't been treated for a particular pre-existing condition for a certain number of years, that drops off as being a reason for being at a higher level. For example, I'm marked up higher because I have a herniated disc that has not been operated on. (I have no intention of having surgery for something that doesn't bother me.) Once I've gone five years with no treatment for it, that drops off as being a cause for being rated at a higher level. (It's been 3 years so far.) Each "condition" requires a different number of years without treatment before it's not considered anymore. They also combine things. Like HBP alone or cholesterol alone may rate a level 3 for example, but both of them together will rate a 4, for example.

From what I've read here, each state appears to be different, so you need to find out what the story is in your state. Maybe find an agent. I did this and it was very helpful. The agents I've talked to in Virginia do not charge anything and the premiums are not any higher than if I didn't use one.

You were not rated for a pre-existing condition autocpapdunce the insurance chose not to insure you. Do you know the difference? I find this hilarious as it is probably because you treat yourself and have no proof your therapy is effective. Or is it because you do not know enough about insurance to prove effective therapy.......hmmmmm. Still no proof to back your "facts".

WearyOne you have a good understanding of the general rules. And yes each state is different and an agent can be extremely helpful. One downside for the agent is they are usually paid very little to write the types of policies you talk about. It is my experience most agents will still write it but you kind of have to prod them along.

You were not rated for a pre-existing condition autocpapdunce the insurance chose not to insure you. Do you know the difference? I find this hilarious as it is probably because you treat yourself and have no proof your therapy is effective. Or is it because you do not know enough about insurance to prove effective therapy.......hmmmmm. Still no proof to back your "facts".

You are the dunce, lee-phony-DME-insurance-agent-know-it-all. I said I APPLIED for insurance for a private policy, not a group one. I have diagnosed OSA (which was treated by sleep doctor and 2 sleep studies). It is now monitored by doctors of Internal Medicine. Obviously, I disclosed it, as I am not a fraud like you. I was denied coverage--what is so miraculous about that, you dingbat? Afterwards, I was covered by a group policy through an employer, under 'Open enrollment"--I hope you know what that is, or do you? Why do you continue to come here, and spout the "untreated" BS line. I just don't deal with fly-by-night DMEs like YOU. I have had medical supervision by a DOCTOR, not an equipment gouger like you. I then choose to buy my own equipment, rather than deal with shysters like you that come to shill for their pathetic businesses, while telling people they have NO right to make informed decisions in their own treatment. So, MR CONSULTANT, DME, INSURANCE AGENT, or whatever you want to be tomorrow (how about coach of the New England Patriots)?? Why do you keep coming here, when people obviously don't think much of DMEs, and don't think much of you in particular? I guess that makes you a troll?

rooster wrote:

john_dozer wrote: ....... 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.

.........

Would you be so kind as to tell us what this non-drug is?

http://www.metagenics.com/products/a-z- ... dical-Food

This is the specific food. The doctor actually had me consul with a nutritionist. This one has cholesterol lowering properties and something else. There are other variants but I forget which is only for the blood sugar level.

This does work from what I can tell, you have to be on it for a week or so to see results. Horribly messy powder that likes to go everywhere the second you open the jar, but ironically doesn't mix easily in water. If you're interested in cleaning a blender out a couple of times a day, that helps. I usually end up drinking clumpy mix I stirred by hand.

Its got a dose of sugar added to it for sweetening. It taste slighly better than cardboard with it. I would be unpalatable without it. So you have to consider it a component of your daily intake if you're watching carbs and calories.

They have a rice version which is just terrible. Avoid it.

Its expensive too. Probably $50/bottle at least. It actually cost prohibitive. I did it for a few months along with diet. I've since had much lower post meal blood sugar behavior without it because of weight loss and change of diet. So I've been going without it.

I ordered it through this site: http://insync.meta-ehealth.com

I should add that the effects are potentially additive to other medicines, so you could potentially overdose when combined with taking this stuff.

john_dozer wrote:

rooster wrote:

john_dozer wrote: ....... 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.

.........

Would you be so kind as to tell us what this non-drug is?

http://www.metagenics.com/products/a-z- ... dical-Food

This is the specific food. The doctor actually had me consul with a nutritionist. This one has cholesterol lowering properties and something else. There are other variants but I forget which is only for the blood sugar level.

This does work from what I can tell, you have to be on it for a week or so to see results. Horribly messy powder that likes to go everywhere the second you open the jar, but ironically doesn't mix easily in water. If you're interested in cleaning a blender out a couple of times a day, that helps. I usually end up drinking clumpy mix I stirred by hand.

Its got a dose of sugar added to it for sweetening. It taste slighly better than cardboard with it. I would be unpalatable without it. So you have to consider it a component of your daily intake if you're watching carbs and calories.

They have a rice version which is just terrible. Avoid it.

Its expensive too. Probably $50/bottle at least. It actually cost prohibitive. I did it for a few months along with diet. I've since had much lower post meal blood sugar behavior without it because of weight loss and change of diet. So I've been going without it.

I ordered it through this site: http://insync.meta-ehealth.com

I should add that the effects are potentially additive to other medicines, so you could potentially overdose when combined with taking this stuff.

Thanks John.

One serving has 15 grams of protein and 23 grams of carbs. That is a good ratio for helping to stabilize blood sugar (The Zone – Dr. Barry Sears). Very little fat in the formulation, but there are other healthy ways to get fat.

The protein is soy protein isolate and that is a very healthy protein. One serving also contains 2000 mg plant sterols and that has been clinically proven to reduce cholesterol. These are the main reasons you are having success with the product.

I use plain soy protein isolate to make shakes. I am sure it is much cheaper than this product and doesn’t have the sugars this product has. We like vegetarian meals, which are mostly carbohydrates, so I will use the shake to get a considerable amount of protein into the meal. I use a lot of oils, mainly olive oil, to get a good fat intake.

I use some products containing plant sterols but this reminded me that I still want to find a cheap source so I can get my minimum daily intake up to 2000 mg.

If you like women, go to a Tupperware party. Buy a couple of their shakers, http://www.google.com/imgres?imgurl=htt ... CBYQ9QEwBA . I use the shaker to mix soy protein isolate shakes and it would work for the product you are using plus they are much easier to clean as compared to a blender. Put the liquid in the shaker first and then add the powder. Stir well with a long-handled teaspoon and then assemble the shaker and mix by shaking vigoursly. Soy protein powder is hard to dissolve and I usually end up drinking a few lumps as you indicated.

I like doctors who do good things that are not in the AMA guidelines.

One last lesson for autodupe:

If you knew anything about insurance, which you obviously do not, you would know that you cannot be turned down for group insurance. So, of course I knew you were denied individual coverage. Do you know open enrollment rules? As you have proven to me over and over the meager limits of your knowledge I no longer will waste time on you.

Rooster:

The definition of insurance is part of any agent's testing for his license. The reason I quoted it is because the perception of the public, including me before I studied for my insurance licensing test, was that somehow you should at least break even with insurance. The reality is simply that this is rarely true. This definition says that you need to realize that you are making small payments (losses) that you have little chance of getting back. In return the insurance company takes on all the large risks including your potential large risk. How large a risk the insurance is taking depends on your health and any diagnosed problems you may have.

States have recognized that insurance companies will be unwilling to insure certain types of diagnoses. That is why each state has an insurance offered for those who have a certain diagnosis or has been denied coverage. While this insurance is not cheap it is better than going uninsured. The reason it is expensive is due to the cost of treatment for those covered. It is supplemented usually by taxpayer money or it would not be affordable at all. I am very concerned about Congress denying insurance companies the ability to exclude certain pre-existing conditions from a consurmer standpoint. What will this do to my already high insurance premiums?

As to OSA as a pre-existing condition I have argued before my state's insurance commission that effective treatment should negate ALL ratings for this diagnosis. I advocated for one year of compliance to treatment to eliminate this as a cause for rating. We had a change of commissioners and as of today do not know if this will be implemented or if the new insurance commissioner will leave this decision to each appointed insurance in the state. The insurance I have does allow for the rating to go away with effective treatment.

As this is a relatively new diagnosis, and as experienced by many on this site, and not always treated with expertise I have experienced hesitation from legislators about this issue at the state level. Medicare March of 2008 recognized that the majority of people with OSA are going untreated and now allow home sleep testing in an effort to get treatment for those who need it. However, in Medicare's often illogical way the reimbursement is too low so very few companies are doing it. There is hope as some of the larger self insured groups have decided to allow home sleep testing at an amount that is encouraging.

Autodupe will be happy to know that this is the busiest time for me so I will not have as much time to torture him with sound advice. But I will on occasion visit this site as time allows. You are as a group an interesting bunch. Godspeed.

Don't let the door hit you on the way out, Lee=phoney-baloney. Now, he's an advocate for OSA in his state? Talk about all things to all people---isn't that a conflict of interest being an agent for an insurance company, and being an advocate against their decisions? This guy is definitely a troll.

States have recognized that insurance companies will be unwilling to insure certain types of diagnoses. That is why each state has an insurance offered for those who have a certain diagnosis or has been denied coverage. While this insurance is not cheap it is better than going uninsured. The reason it is expensive is due to the cost of treatment for those covered. It is supplemented usually by taxpayer money or it would not be affordable at all. I am very concerned about Congress denying insurance companies the ability to exclude certain pre-existing conditions from a consurmer standpoint. What will this do to my already high insurance premiums?

Oh, now he's against health care? An "advocate" who is against health care?