If you’ve been diagnosed with sleep apnea and are now looking for health care insurance, you’re likely to find that there are few companies willing to provide you coverage. If your employer offers group coverage, you may be in a better position, but if you have to purchase insurance on your own, you’ll probably have a tough time finding a policy.
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The difficulty with searching for health insurance after a sleep apnea diagnosis is the fact that your sleep apnea is considered a pre-existing condition. Health insurance companies have the legal right to refuse coverage for anyone suffering from certain pre-existing conditions. According to California’s Department of Managed Health Care, sleep apnea is joined by other things considered as pre-existing conditions that can cause a denial of coverage including:
- Heart disease
- Renal failure
- Cancers currently under treatment
- Multiple sclerosis
Why would insurance companies deny me for a pre-existing condition?
It’s easy to blame health insurance companies and accuse them of being uncaring and indifferent toward those with pre-existing health conditions. However, remember that health insurance is a business like any other; it needs to control its costs in order to keep its doors open. When you purchase health insurance, the provider is relying on the fact that you will pay into the system more than you will take out or, at the very least, pay enough into the system to allow their investments to earn enough to make payments on all your claims.
If they accept you with a pre-existing condition, you will most likely begin making health insurance claims almost immediately without paying significantly into the system. That will result in potentially severe losses on their part. If they continue to accept individuals with pre-existing conditions on a large scale, it will only be a matter of time before their business collapses and they go under. Then no one has health insurance coveragebecause no one can afford it.
What are my other options?
If your financial resources are limited, you might possibly be eligible for Medicaid coverage. Medicaid is health care insurance designed for people whose limited income does not make it possible for them to purchase insurance, yet still have medical bills that need to be paid. Typically, you don’t apply for Medicaid until you have specific health care needs; that would mean waiting until a hospital stay or some other condition that would prompt your application.
If you aren’t eligible for Medicaid because you make too much money or have too many assets, you may still be eligible to enter one of your state’s high-risk insurance pools. These pools provide government subsidized health insurance through private companies. By subsidizing these health care plans, a state government mitigates the potential losses a health insurance company may experience by taking on someone with your condition.
The biggest downside to purchasing insurance this way is the fact that it is very expensive. Even though the government is subsidizing it through a high-risk pool, they’re still expecting you to pay significant amounts into the system to help cover some of the costs of your sleep apnea. Exactly how much these risk pools cost depends on your state and the qualifications for entering the pool. You should check with your state insurance department for specific details.
Why wouldn’t I have this trouble with the group plan?
When you enroll in a group insurance plan through your employer the plan is designed to spread the total cost of care for all members across the entire group. Therefore, being diagnosed with sleep apnea, although it is a pre-existing condition, is something that can be shared among your fellow employees. Furthermore, many employer groups belong to larger groups within their local community, giving the insurance company potentially thousands of subscribers who can share the burden of health care costs.
This is one of the main reasons why group health insurance rates continue to rise. Right or wrong, the healthier members of any health insurance group are helping to subsidize the cost of less healthy members through their insurance premiums. The more costly medical care is for the entire group, the higher everyone’s premiums are.
If you’ve been diagnosed with sleep apnea, you certainly have some challenges ahead of you. Whatever you do, just don’t give up looking for help. Resources are available even if it takes you longer than you expected to find them. When you do find the hope you’re looking for, consider posting your story on one of the many sleep apnea related websites as a help for others with the same condition.
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