I feel that part of my job as a healthcare writer is to cover issues that will affect you life. Your choice of insurance is a big choice you are making during this time of year. I was talking to someone who was saying how few of the people at her workplace choose to have health insurance, especially for their children. This is a huge issue that affects a person’s budget as well as their health.
Most people believe that insurance is essential. I do not necessarily believe that. I believe HSAs, health savings accounts, are a great way to plan for the future that may be option. I also think that people do not take advantage of the states children’s health care programs that provide low cost HMOs, health maintenance organization programs, in Florida it is called Healthy Kids. These coverages are designed to take care of emergencies but provide minimal coverage for wellness care. You can negotiate cash prices for visits or testing you may need. For someone who does not have a chronic problem this could be a compromise between cost and coverage.
If you have a chronic problem this may not be the solution. Sleep apnea may be the one chronic problem that this rule does not pertain to. I will say this for several reasons. Sleep studies are usually done once every three to five years. If you are a cash paying patient you might be able to negotiate a lower price for the test. Since the company does not have to wait for payment they might lower the price. The one exception is that they cannot charge less than the reimbursement that Medicare due to the laws surrounding Medicare. So it might benefit you to know the Medicare reimbursement.
When you need PAP equipment or supplies I will be honest you can get them a lot cheaper than the insurance company’s negotiated price. When pricing masks research the online sites and the sites that do drop shipping of supplies, this little bit of research could save you a significant amount of money. They also tend to buy in bulk and have fewer employees so they have less overhead. They then share the savings with those purchasing the equipment.
As to whether sleep apnea will end up costing you more as a pre-existing condition or less because you are treating a health issues actually varies from insurance company to insurance company. If you have been diagnosed with sleep apnea and you choose not to treat it than you will be treated as having a pre-existing condition and they could not cover other issues such as high blood pressure or diabetes as they are associated with the sleep apnea. However if you are using your PAP than many of the insurance companies may ask for proof of use and will treat you as if you do not have a pre-existing condition. You will have to shop around and ask questions about that particular plan’s policy.
When it comes to our children many of them do have sleep apnea and it can look like many things such as ADD, fatigue, hyperactivity, anger and learning disabilities. If we looked at their sleep and have a sleep study they are usually treated initially with a tonsillectomy and if still needed PAP therapy or an oral appliance. It is important that we need to help our children to be able to achieve their best and taking care of sleep problems is worth the cost of insurance. If you can not afford your children’s coverage you need to ask your state what programs they have to help you cover them. It is worth it in the end and will help them to behave better and be more successful in school
When you are looking at insurance you must take many things into consideration including the cost to you and the ability to balance your budget while paying the premiums. But when choosing not to have coverage or you are choosing minimal coverage you must consider the effects it will have on chronic issues and your ability to pay for care.
The last two years have seen a great deal of change in health insurance and this has affected the care of people with sleep apnea. It is part of the job of a sleep lab manager to keep up with these changes so we can make sure that the patient receives the best service possible. The biggest problem we face is that many times the patient does not understand the changes that have taken place. If you are able to explain these changes effectively you might avoid a patient’s negative experience.
One big issue seems to be the most difficult with those patients who need a replacement machine. People who have older machines many no longer qualify for CPAP simply because the qualifications have changed. Respiratory events have a different definition today than they did 10 years ago. Documentation was also different 5 or more years ago. You need to make sure you have documentation that meets current standards when going to order a new machine.
The other issue that is becoming more influential on sleep patients is riders and deductibles. Today many patients have significantly higher deductibles they have to meet. This can cause financial hardships in having tests done and getting their CPAP equipment. Many people do not know the nuts and bolts of their insurance policy. If we can be of help in explaining what is going on and why we bill the way we do they will leave with a positive experience even if they do not end up having a test due to the cost. But if all you say is that “your insurance company says that your test will cost you x dollars,” the patient will only leave with a feeling of being short changed by your facility. Instead if we understand that the patient has a large deductible and that although when you visit the doctor you pay a copay if does not cover deductibles, instead the deductible applies only to everything that happens outside the doctor’s office, they will get a clearer picture.
It also helps to reduce the non pays for the lab. In our lab we rarely get an insurance company denial. The ones we do get usually get paid when we submit additional paperwork. This reduction in denials helps us make more cash flow overall and allows us to grow. It gives everyone in the lab job security.
In the end it is important to be a strong resource for our community. Knowledge about how insurance works is a great way to start. If you are an avid reader or you have access to the people in the billing department of the practice you can gain the knowledge you need.