Are there any insurance companies that cover sleep apnea?

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Are there any insurance companies that cover sleep apnea?

Postby mrmojoe » Wed Feb 10, 2010 6:18 pm

I recently started my own business and applied for individual medical coverage. I was denied due to my history of obstructive sleep apnea. Does anyone here know of any insurance companies that will cover a person with sleep apnea on an individual (not part of a group) basis? Or, am I just out of luck?

Thanks in advance!
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Postby 74bravo » Wed Feb 10, 2010 7:29 pm

Have you tried Aflac? I'm thinking about picking them up for supplemental coverage...but I believe they also have plans that should fit your needs.
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Postby BODA » Wed Feb 10, 2010 7:52 pm

Well first you need your "Primary care physician" to diagnose you as having the symptoms of "Sleep Apnea," then he should refer you to a sleep study facility that will accept the same insurance you use for seeing your primary care physician.
The sleep study will determine what type of "Sleep Apnea" you suffer from.

If not, I know for a fact "Blue Cross" works, and through a local company here in California, called "Pacific Pulmiary" they deliver to my door all recommended parts on a monthly basis, free!

Hope this was helpful?
Good Luck! BODA
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Postby mrmojoe » Wed Feb 10, 2010 8:05 pm

BODA wrote:Well first you need your "Primary care physician" to diagnose you as having the symptoms of "Sleep Apnea," then he should refer you to a sleep study facility that will accept the same insurance you use for seeing your primary care physician.
The sleep study will determine what type of "Sleep Apnea" you suffer from.

If not, I know for a fact "Blue Cross" works, and through a local company here in California, called "Pacific Pulmiary" they deliver to my door all recommended parts on a monthly basis, free!

Hope this was helpful?
Good Luck! BODA


Thanks Boda, but my problem isn't finding an insurance company that will cover supplies related to my sleep apnea or for my sleep study; I've already got all of that. I currently have no medical insurance, and recently applied for coverage with a popular carrier; I was denied coverage because of my sleep apnea. I spoke with an insurance broker who represents many of the largest medical insurance companies, including Blue Cross/Blue Shield, Humana, United Healthcare, Golden Rule, and a few others; she said that obstructive sleep apnea was an "automatic decline" with all of those companies, and with all carriers that she knew of.

If I were an employee, covered by the company's group policy, it would not be a problem; but as a self-employed individual, I am subject to different, tighter underwriting criteria.
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Postby 74bravo » Wed Feb 10, 2010 8:20 pm

Just curious and you don't need to answer, but were there other factors in the denial? If so, you should be able to have an exclusion written into the policy to exclude coverage for your OSA and then go the route of supplemental coverage.
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Postby mrmojoe » Wed Feb 10, 2010 8:41 pm

74bravo wrote:Have you tried Aflac? I'm thinking about picking them up for supplemental coverage...but I believe they also have plans that should fit your needs.


Funny you should mention that, I am an Aflac agent! As an independent agent, I must provide my own individual health insurance. The problem is while Aflac offers many great products, it is not intended to replace major medical insurance, but rather to supplement and compliment it. I have several Aflac policies already, but still need major medical.
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Postby mrmojoe » Wed Feb 10, 2010 8:45 pm

74bravo wrote:Just curious and you don't need to answer, but were there other factors in the denial? If so, you should be able to have an exclusion written into the policy to exclude coverage for your OSA and then go the route of supplemental coverage.


No other factors; per their letter:

"We are unable to provide coverage for you because of: HISTORY OF OBSTRUCTIVE SLEEP APNEA"

The exclusion idea may be a possibility - thanks!
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Postby 74bravo » Wed Feb 10, 2010 8:47 pm

Hrmm..any chance you served in the Military, or had a Family member (I think it would have to have been a parent..but don't quote me on that) that served? If so, USAA may be a possibility....I used to have them years ago when I was paying out of pocket so I'm not even sure they still offer primary coverage...but a shot in the dark at the least.
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Postby apneafather » Wed Feb 10, 2010 9:53 pm

What you may need to do is find a group that aggregates companies that your company can join. I have two companies. One gets its insurance through a payroll processor along with many other small companies. The other employs only me and gets its insurance through the Massachusetts Business Association or something like that (initials are MBA) that is just a collection of small businesses. It could have gone through the payroll processor, but the HMO offered by the payroll processor didn't cover the oral/maxillofacial surgery that my son had for his sleep apnea. I don't think they look through the corporate structure to the employees. If you don't have a corporate structure, you can set up an LLC or a C-corp or an S-Corp. Done properly, there are ways to deduct medical insurance and medical expenses in a C-corp (it pays taxes whereas the others are pass-through entities for tax purposes.
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Postby SleepyToo » Thu Feb 11, 2010 1:33 pm

Depending on your age, try the AARP - they may be able to take you on as part of their group? Alternatively, try your local Chamber of Commerce. I am sure they have lots of people in your situation ...
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Re: Are there any insurance companies that cover sleep apnea

Postby ncshanes+ » Sat Jul 16, 2011 11:55 am

I am in NC and having the exact issues that you are having--denial only for sleep apnea. Did you find a solution to the issue? This is so frustrating...my group coverage ends in Sept.
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Re: Are there any insurance companies that cover sleep apnea

Postby Mike » Sat Jul 16, 2011 12:14 pm

I know in NC there are medical groups that offer care for low income and uninsured.

http://www.novanthealth.org/about_novan ... sitors.jsp
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Re: Are there any insurance companies that cover sleep apnea

Postby GoldLizard » Sat Jul 16, 2011 1:56 pm

I think it's a problem with most insurance companies. I have major medical through work, but tried to get signed up for short term disability when my employer began offering that. I was denied due to sleep apnea and being pregnant. I feel your pain, it's too expensive to go without it, yet no one will cover you. Good luck and let us all know if you're able to find someone to cover you.
Between a newborn, a 3 year old, and OSA, fatigue will be a part of my life for awhile I think. At least one of them is treatable :)
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Re: Are there any insurance companies that cover sleep apnea

Postby Bons » Sat Jul 16, 2011 5:25 pm

Is it sleep apnea or is it that you have a pre-existing condition? My daughter cannot get insurance because of asthma and polycystic ovary syndrome. The part of Obamacare that bans companies from rejecting people with pre-existing health problems has not gone into effect yet, unfortunately.
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Re: Are there any insurance companies that cover sleep apnea

Postby Janknitz » Sun Jul 17, 2011 4:14 pm

The only possibility for you may be your state's high risk pool. Be prepared to pay through the nose! It's very expensive. But until components of the new health care plan start kicking in in 2014, insurance companies can deny you for any pre-existing condition, including OSA.

The real irony here is that if you were never diagnosed and under treatment, you'd be a walking time bomb set to go off and cost the insurer a whole lot more for treating stroke, heart attack, diabetes, etc. But because you got diagnosed and are undergoing treatment to prevent these things, you are penalized.

This is the wonderful system people who oppose "Obama Care" want to preserve.
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