The adverse health consequences of untreated OSA are severe and life-threatening:
Sleep apnea is a chronic condition that can cause more than just sleep deprivation. Sleep apnea can lead to memory problems, weight gain, impotency, and headaches, as well as may cause high blood pressure or other cardiovascular disease.People who suffer from severe breathing disorders during sleep, including sleep apnea, have been shown to have an increased risk of premature death. In fact, severe sleep apnea elevates the risk of an early death by 46 percent, according to a study done at Johns Hopkins University in Baltimore. The risk is most apparent among men between the ages of 40 to 70 years.
Findings revealed that experiencing as little as 11 minutes of severe, oxygen depriving, sleep apnea on a nightly basis nearly doubled the death rate among men, as severe sleep apnea episodes can cause the blood oxygen level to drop below 90 percent.
The current purchase price of my CPAP equipment is about $800.
My BCBS plan (“Preferred Blue, PPO Deductible”) provided by wife’s employer, is a typical high-deductible plan now offered by most Massachusetts employers.
My deductible is $1,000/year. The maximum that this plan authorizes for “medical equipment” is $1,500/year. The newest change is that BCBS will not cover the purchase of my CPAP equipment. Instead, they force me to rent it, at a cost of about $90/month.
The effect? This medically-necessary equipment will cost me, out-of-pocket, about $4,500 over its lifetime if I rely on my “insurance” coverage.
That’s right: BCBS will collect nearly six times the purchase price of the equipment over the course of its lifetime.
My wife and are, fortunately, able to simply purchase the equipment ourselves. A great many Massachusetts residents are not so fortunate.
The bottom line is that BCBS has, in essence, denied coverage for this equipment that literally saves my life, even though my wife’s employer pays ever-escalating premiums for this “coverage”.
The government forcibly stopped Bell from doing this with telephones decades ago. The government forcibly stopped internet suppliers from doing this with modems and set-top boxes. Yet the government encourages health insurers to continue this gouging.
BCBS/MA (a “non-profit”!) earned a net income of $13.4M in 2010. Our esteemed governor refuses to criticize the obscene $8.4 M compensation paid to outgoing CEO (and major Democratic donor) Cleve L. Killingsworth. This predatory company is funding these amounts by denying coverage while constantly raising the price of what’s left.
This gouging must be stopped. Public officials, like Governor Patrick, who encourage it need to be held accountable.
We (and I) are being robbed, folks. Not by the government, but by the very health insurance industry that our new Republican majority so successfully protected with their lies and distortions during 2010 (aided an abetted by our “Democratic” majority and president).
So much for President Obama’s much-vaunted health care “reform”. All it’s meant for me — life-long Democrat and fervent Barack Obama supporter — is a huge increase in my out-of-pocket medical expenses while Cleve L. Killingsworth walks away with more money in a year than I’ll see in the rest of my career.
I don’t know what happens next, but I do know that what we’re doing right now is not working.
could be a little more appalled by this. Has anyone heard any statement from him other than this:
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p>Remember now, we have to buy health insurance. It’s the law. I get that Governor Patrick is a proud free market capitalist, but we have a mandate to buy health insurance, not a mandate to pay out million dollar salaries.
if the cost/benefit analysis the insurance company runs is different than the one society would run for the same patient. STom clearly expects to live another 18 months in which case owning the machine is far cheaper than renting. However, if BCBS doesn’t expect to have STom as a customer long enough to recoup, then renting is a better deal for them.
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p>End result: artificially higher cost of medical care, because incentives have diverged. BCBS isn’t interested in reducing STom’s long term cost of care if they don’t expect to have STom as a customer in the long term. At that point, he’ll be Medicare’s problem.
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p>I wonder: how often are the interests unaligned, and what is the cost in dollars and medicine that we end up paying as a result?
If BCBS can persuade Tom to buy the equipment entirely out of his own pocket, that’s an even better deal for BCBS. Personally, I feel no need to wonder if the cost/benefit analysis the insurance company runs is different than the one society would run. It seems self-evident to me that it is different.
Consistent through MassHealth, Medicare and VA standard costing is that reimbursement for CPAP in order of preference is: 1) rent to own and 2) rent.
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p>Cost assumption being that rent to own is preferable in the event that CPAP is not effective, then you have a few months to try and return, and if it is effective, then you own it.
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p>Outright purchase is not reimburseable, because if CPAP is not effective, then there’s a blob of taxpayer paid plastic gathering dust in your house.
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p>At $80 per month, you are apparently quoting the rent to own cost, or if not, you are quoting the “I’ve been ripped off” price.
My insurer is BCBS/MA, not MassHealth, not Medicare, and not VA.
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p>You wrote:
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p>The quoted cost was $90/month, not $80. My plan does not allow me to purchase the gear. “Rent to buy” is not an option.
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p>The fact is, as I believe I made clear in the thread-starter, that my CPAP therapy has been effective for nearly fifteen years.
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p>There is ZERO risk of the equipment becoming “a blob of taxpayer paid plastic gathering dust”.
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p>Instead, the equipment is here, works great, and is used nightly.
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p>The problem we are discussing here is that it SHOULD have been covered by the enormously expensive health insurance policy my wife’s employer is mandated to provide. It was not.
Then allow me to express surprise.
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p>Surprise, because it seems odd that an large insurer wouldn’t have the same cost protocol as VA, Medicaid and Medicaid and permit a rent to own option.
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p>And surprise, because my insurer is also BC/BS and appears to mirror VA, Medicaid and Medicare. In fact, I just called my customer service, and they claim, contrary to your story, that they allow either rent or rent to own as options for cost reimbursement on a 10, 13, or 15 month term.