Diagnosed With Sleep Apnea: What Will Happen With My Health Insurance?

The doctor finally found the answer to your erratic slumber: sleep apnea. You’re grateful for knowing why you can’t rest well, but now you’re probably wondering about the next steps. What solutions are available? Can you afford the possible treatment plans? Will your insurance assist in paying for the best CPAP machine?

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According to the Affordable Care Act, an insurance company cannot drop a patient due to a preexisting condition, nor can the group deny the patient coverage. For apnea sufferers, this law offers reassurance, preventing providers from refusing to help or increasing payments. It’s not as much a question of whether they will help but what forms of assistance they provide.

Researching Insurance Companies Regarding Sleep Apnea

A fairly common disorder, sleep apnea is now on the radar for most providers for significant reasons. According to the American Sleep Apnea Association, approximately 22 million Americans struggle with the condition. Most providers find it in their best interest to work with the patients early on to avoid long-term complications such as diabetes and heart disease.

Begin your insurance search with a cursory look online to learn about various plans. The original Medicare policy, for instance, notes that the company usually allows for up to 20% of the initial CPAP machine costs if the doctor prescribing the unit and source is within the network. Other industry leaders also express interest in working with apnea patients. Viewing their insurance plans online could give you a glimpse at possible assistance.

Once you’ve read a bit, narrow your list to several services. Locate or call an agent. Write out a list of questions before you talk with the professionals. Various treatment options exist, including purchasing a full face mask CPAP device and having medical surgery.

Ask insurance agents how their organization approaches sleep apnea and whether they consider the surgery a viable solution. Many institutions are more likely to look for a breathing apparatus first.

Understanding Your Medical Coverage

Understanding Your Medical Coverage

Work with your physician and insurer to get the most out of your benefits to minimize your out-of-pocket expenses. Review your plan’s coverage through the online portal. Here you get specifics on deductibles, copayments and in-network carriers.

Speak with customer service about any particular concerns, especially your individual care. For instance, are you interested in the AirFit P10 mask? Ask about it. The service agent can walk you through the necessary process to obtain coverage. While on the phone, ask about any follow-up questions from your online research.

Often, companies compensate for the device but not for additional tubing or parts. That cost falls instead on the patient. If you find the price too high, meet with your doctor to discuss options. Be sure to get answers to the following questions:

  • Could you change some personal habits to alleviate apnea concerns?
  • What flexibility do you have in appointments and assessments?
  • What options minimize the need for surgery?
  • Which tests are mandatory, and which ones are likely to help?

Don’t put off doing something good for your well-being. Insurance companies typically lend support to sleep apnea patients. Check in with your insurer now to understand your policy’s benefits.

Read More: Effective Ways to Take Responsibility for Your Actions and Your Life

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