Help understanding insurance

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
sleepinow
Posts: 464
Joined: Thu Apr 25, 2013 9:40 am

Help understanding insurance

Post by sleepinow » Fri Jan 10, 2014 8:20 pm

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

_________________
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

SleepyStar
Posts: 88
Joined: Mon Jan 06, 2014 9:24 pm
Location: Pure Michigan

Re: Help understanding insurance

Post by SleepyStar » Fri Jan 10, 2014 8:30 pm

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!

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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.

sleepinow
Posts: 464
Joined: Thu Apr 25, 2013 9:40 am

Re: Help understanding insurance

Post by sleepinow » Fri Jan 10, 2014 8:37 pm

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

sleepinow
Posts: 464
Joined: Thu Apr 25, 2013 9:40 am

Re: Help understanding insurance

Post by sleepinow » Fri Jan 10, 2014 8:42 pm

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

User avatar
LSAT
Posts: 13405
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin

Re: Help understanding insurance

Post by LSAT » Fri Jan 10, 2014 9:11 pm

sleepinow 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
No

User avatar
RogerSC
Posts: 1917
Joined: Sat Jul 21, 2012 1:11 pm

Re: Help understanding insurance

Post by RogerSC » Fri Jan 10, 2014 9:16 pm

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.

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Bill44133
Posts: 1087
Joined: Tue Jul 09, 2013 8:34 pm
Location: North Royalton, OH

Re: Help understanding insurance

Post by Bill44133 » Fri Jan 10, 2014 9:21 pm

RogerSC 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.
+1

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sleepinow
Posts: 464
Joined: Thu Apr 25, 2013 9:40 am

Re: Help understanding insurance

Post by sleepinow » Fri Jan 10, 2014 10:18 pm

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

User avatar
Jeannh
Posts: 296
Joined: Sun Aug 18, 2013 12:08 pm
Location: CA

Re: Help understanding insurance

Post by Jeannh » Sat Jan 11, 2014 4:57 pm

You need to call both and ask. Every student health policy is different.

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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