Help understanding insurance
Help understanding insurance
Okay so after asking my dad's co-worker or supervisor the cost of adding a member to the insurance plan was around 700$ per month I was shocked and disappointed.
So I checked my school's insurance plan for part-time students and found that it cost 1720$ from January 15,2013 till August 14, 2013. Not bad
Anyways I checked the DME which stated
"Durable Medical Equipment, a written prescription
must accompany the claim when submitted. Benefits
are limited to the initial purchase or one replacement
purchase per Policy Year.
($1,000 maximum Per Policy Year) (Durable Medical
Equipment benefits payable under the $1,000
maximum are not included in the $1,000,000 Maximum
Benefit)
See also Benefits for Orthotic and Prosthetic
Appliances.
90% of PA 60% of U&"
Can anyone explain what all this means like I am five years old? Thanks. Is the coverage any good? Because I saw 1,000 maximum per policy year and I automatically thought this was the most in amount I would get (That does not even cover the cost of an ASV machine!) Anyone please explain
So I checked my school's insurance plan for part-time students and found that it cost 1720$ from January 15,2013 till August 14, 2013. Not bad
Anyways I checked the DME which stated
"Durable Medical Equipment, a written prescription
must accompany the claim when submitted. Benefits
are limited to the initial purchase or one replacement
purchase per Policy Year.
($1,000 maximum Per Policy Year) (Durable Medical
Equipment benefits payable under the $1,000
maximum are not included in the $1,000,000 Maximum
Benefit)
See also Benefits for Orthotic and Prosthetic
Appliances.
90% of PA 60% of U&"
Can anyone explain what all this means like I am five years old? Thanks. Is the coverage any good? Because I saw 1,000 maximum per policy year and I automatically thought this was the most in amount I would get (That does not even cover the cost of an ASV machine!) Anyone please explain
_________________
| Mask: Quattro™ FX Full Face CPAP Mask with Headgear |
| Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced |
System One Respironics Bipap AutoSV Advanced Quattro Fx
Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5
Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5
-
SleepyStar
- Posts: 88
- Joined: Mon Jan 06, 2014 9:24 pm
- Location: Pure Michigan
Re: Help understanding insurance
Yeah, that plan through the school I don't think will meet your needs if I'm understanding it right...which as someone new to this game I'm not sure I am, so hopefully someone more experienced will be by soon and take pity on us youngins. Are you sure that's not just the out-of-pocket cap though? This is confusing isn't it. There should be along with the insurance information a number to call for people who are looking to sign up. They can definitely try to explain things. I have called BCBS a few times to ask questions about coverage questions myself.
Have you looked at healthcare.gov (if you're in the US)? The plans I saw there were actually fairly decent, but the one through my work was better and offered an HSA that I'm trying to understand how that works currently. Since you're a student I'm guessing odds are decent for you to be able to get the subsidies too....my engineering paycheck is just a bit over the cutoff for those, but I think as a student I would've gotten a large subsidy. Although if you're still living with your parents you may not qualify as it goes by household income for the subsidies. It's worth a look to see though!
Have you looked at healthcare.gov (if you're in the US)? The plans I saw there were actually fairly decent, but the one through my work was better and offered an HSA that I'm trying to understand how that works currently. Since you're a student I'm guessing odds are decent for you to be able to get the subsidies too....my engineering paycheck is just a bit over the cutoff for those, but I think as a student I would've gotten a large subsidy. Although if you're still living with your parents you may not qualify as it goes by household income for the subsidies. It's worth a look to see though!
_________________
| Mask: Swift™ FX Bella Nasal Pillow CPAP Mask with Headgears |
| Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
| Additional Comments: I have a custom TMJ biteguard. Autoset 8-11 cmH20, EPR = 3, No ramp. Sleepyhead is awesome. |
Re: Help understanding insurance
Well I did try healthcare.gov and they wanted to give me medicaid. Isnt that the worst of them all. My parents make a low amount of money. My dad gets 13$ an hour for a full time job and my mom works under the books. I get 12$ at 24 hour work week. Isn't student aid better than medicaid. I do not mind paying more because my aunt whom I live with and who is retired has a pretty big backup amount of money
_________________
| Mask: Quattro™ FX Full Face CPAP Mask with Headgear |
| Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced |
System One Respironics Bipap AutoSV Advanced Quattro Fx
Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5
Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5
Re: Help understanding insurance
I forgot to mention I probably do not need a new ASV machine but I do need a titration study. Does titration study fall under DME
_________________
| Mask: Quattro™ FX Full Face CPAP Mask with Headgear |
| Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced |
System One Respironics Bipap AutoSV Advanced Quattro Fx
Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5
Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5
Re: Help understanding insurance
Nosleepinow wrote:I forgot to mention I probably do not need a new ASV machine but I do need a titration study. Does titration study fall
under DME
_________________
| Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
| Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion) |
| Additional Comments: Back up is a new AS10. |
Re: Help understanding insurance
Nothing wrong with looking at what Medicaid has to offer...it's there to help people with low incomes, so take advantage of it if you need to.
_________________
| Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier |
| Additional Comments: ResMed AirFit N30i mask |
Re: Help understanding insurance
+1RogerSC wrote:Nothing wrong with looking at what Medicaid has to offer...it's there to help people with low incomes, so take advantage of it if you need to.
_________________
| Machine: DreamStation BiPAP® Auto Machine |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: Settings are IPap 23 EPap 19 |
Re: Help understanding insurance
I would life the best for what I can afford and I know how to save money well. So would the student aid be better or should I go to medicaid. I want whichever one will cover more in terms of sleep apnea
_________________
| Mask: Quattro™ FX Full Face CPAP Mask with Headgear |
| Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced |
System One Respironics Bipap AutoSV Advanced Quattro Fx
Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5
Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5
Re: Help understanding insurance
You need to call both and ask. Every student health policy is different.
_________________
| Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
| Mask: DreamWear Nasal CPAP Mask with Headgear |
| Additional Comments: EPAP 8, IPAP 14, PS 3.6 |


