CPAPtalk.com

Ah yes -- I was able to pull up the plan and saw the reference to the CPAP limitation.

I am not sure exactly what type of plan this college plan is considered. I did see that the plan has a $3 million lifetime cap on benefits.

That says to me that this plan is NOT compliant with the Affordable Care Act, which outlawed such a limit last year. So, therefore, either the plan has not updated its online information to show its compliance with the ACA, or the plan is so limited, as a self-insured plan limited to students at a university, they may have a waiver to be able to limit benefits a standard private plan or employer group plan now cannot.

So, perhaps the plan has since changed its policy to include CPAP equipment and the person you spoke with was unaware?

Or, in the worst case, yes, the restriction will stand as is per the policy.

I would argue and appeal it == that the provision directly conflicts with the other terms in the policy, i.e. that medically necessary DME would be covered.

This is a good example of how haphazard, confusing, and backwards our current private healthcare 'insurance' system is and has always been. That minimum benefits can vary so wildly policy to policy, and how things like glucose monitors and wheelchairs will be covered by a policy, while CPAP machines will not.

I have yet to read anything yet regarding the 2014 changes coming under the ACA regarding CPAP specifically -- that is when the mandatory 'essential health benefits' will be required for insurance policies. (http://www.healthcare.gov/news/factshee ... 2011a.html) The changes include mandatory coverage for things including "7.Rehabilitative and habilitative services and devices" which I hope will include CPAP equipment. Hopefully the CPAP manufacturers will be lobbying for their equipment to be included in the minimum benefit packages which must be offered for all new policies sold under the healthcare insurance exchanges. I would assume that as prescription items, CPAP coverage would be mandated, no different than other items like ventilators, or wheelchairs.

This points out one of the obvious perverse incentives of our health care system - as a society we should be doing everything possible to get people to get things like sleep apnea treated when they are young so that they will not develop the incredibly expensive diseases it will lead to if untreated - the problem is that the savings down the line will not go to the insurance company that is paying for the young NOW but we -as a society - will get stuck with a much more unhealthy population when they hit 65 and medicare

Its as if I have to cover your car repairs up to 10,000 miles but someone else gets stuck with the costs after that - there wouldn't be much incentive to me to cover any preventative maintenance since no matter what i do, not much will go wrong in the first 10,000 miles ( but a lack of maintenance during those miles sure will pile the costs on later)

From reading all the replies there are defiantly some very different BCBS plans out there. Mine is through BCBS of South Carolina through the company I work for. I'm paying $18 a month for a new S9 auto set and humidifier and after 13 months I own it. They are also covering 80% of the supplies I need with no limits of what how much I order as long as I order through the DME supplier I use. I could literally buy a new mask every month and they cover it at 80%. I haven't done that, of course, but I do get a new cushion every month.

Heavylids wrote:From reading all the replies there are defiantly some very different BCBS plans out there. Mine is through BCBS of South Carolina through the company I work for. I'm paying $18 a month for a new S9 auto set and humidifier and after 13 months I own it. They are also covering 80% of the supplies I need with no limits of what how much I order as long as I order through the DME supplier I use. I could literally buy a new mask every month and they cover it at 80%. I haven't done that, of course, but I do get a new cushion every month.

Yeah there is not one 'BCBS' like there is one IBM or Ford. Dozens of individual BCBS licensees across the country, basically different companies that use the BCBS name for marketing purposes. And those companies offer dozens and dozens of policies. Or they simply administer self insured plans for companies like the Univ. of Minn. with their own policy. Here in Illinois the BCBS name is marketed by: "A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. © Copyright 2013 Health Care Service Corporation. All Rights Reserved." Try that one on for size.....

Like how AARP prostitutes its name out for sale to every company under the sun.

Another way to look at is is how much is your time worth to fight a probably losing battle versus the cost of supplies. I can keep my costs to a little over $100. a year. Most replacement schedules are way too generous and there are a wide range of less expensive options. And finally, how much would it add to the cost of the insurance policy to cover every little thing in the way of DME supplies and how many people would that force to go without insurance entirely.