I started out with my company’s insurance coverage, at the time - Cigna.  In November 2009, after asking to be tested for a second year, my PCP referred me to a local sleep lab for an overnight PSG, split study.  The attempt at titration on the first study was unsuccessful, requiring a second overnight titration.  I think I had a $150 deductible fee for this, which resulted in a diagnosis of complex sleep apnea (low severe range).  My Rx included an O2 feed by an oxygen concentrator, into my CPAP tube.  The oxygen was delivered on Christmas eve, with back up tanks in case the electricity goes out, and the CPAP came the following week, just before New Year.  The O2 concentrator was a month to month rental, covered by the insurance, and the PR System One CPAP with heated humidifier was paid for outright by Cigna.  Too bad it was the type of machine that does not give efficacy data, and I didn’t know better until after all the research and guidance on SG in January.  This CPAP and accessories (mask, tubes) was all covered 100% by my insurance.  Lucky for me the RT picked a mask for me that worked right away without a lot of problems like some have.  My PCP wanted me to see a Pulmonologist to check for any underlying conditions with the central part of the complex diagnosis (nothing found).  

The end of that year, my company outsourced our division and closed our office, laying everyone off with a little severance, and I was now in COBRA land.  If it weren’t for Obama admin’s policy of helping pay for the COBRA, I would not have been able to afford this health coverage while on unemployment.  At least I owned the basic CPAP thanks to Cigna!

Meanwhile, my company switched insurance carriers to Aetna, which now had to pay for my pulmo specialist appointment.  I got the pulmo doc to Rx me an APAP with efficacy data card, as the CPAP was not going to tell us if my therapy was working or not with it’s compliance data only card.  Unfortunately, Aetna would not allow a purchase of the equipment, only a monthly rental for 15 months, until it was paid for.  I had the same DME - Apria, for all of this.  Aetna did cover the rental fees for the APAP and O2.  Not knowing how long I would be able to hang on to the COBRA, probably up to 9 months, I made sure  to get a new mask sooner than later.  I also asked for an overnight oximetry test 4 months in, to see if my APAP was keeping me breathing well enough to get the oxygen without the boost.  ( I didn’t like the noise, power use ($20/month) and trouble of using it and didn’t know if I could keep paying the monthly rental if I lost the COBRA.  This showed adequate O2 saturation, so we discontinued the O2 concentrator.  

Sure enough, taking some temp jobs at the end of summer caused me to lose my COBRA coverage, leaving me with the lamest coverage via the temp agency - Allied Health.  After sweating over my options, I figured out that Allied wouldn’t cover any of the SA equipment and appointments for this would require significant paperwork and hassles to prove I had continuous care (no more than 30 day lapse between insurance coverage) for preexisting condition.  I called my DME - Apria, spoke with the manager, and negotiated a deal to either pay the balance on the APAP outright, or pay it off myself, month to month for a higher fee.  Aetna had paid seven months toward the purchase and I chose to put the $450 balance on a credit card so I would own it, and not have to worry about that, just the credit card bills.  I knew I had the CPAP as a back up, but wanted the APAP with the variable pressure and efficacy data.  I later learned how bad Allied Health was when they wouldn’t even cover a basic lab blood test for a skin infection I got, nothing to do with anything I ever had before!  If I hadn’t purchased the APAP, I would have been with out it for about six months.  In the end- Allied was a complete waste of my money.  It’s only value to me would have been maintaining coverage to bridge me for preexisting conditions - SA and migraines. 

I was fortunate to find new employment with “real” health insurance - November 2010, but am still not sure how this will work out, since they use Kaiser Permanente, and I have not been able to get in to see their “sleep department” yet.  I am glad I had the overnight PSG at a lab, as I believe KP does the home studies, which would likely not have recognized my central apneas. 

So far, I like their “preventive” approach to healthcare, and the “electronic health record” standard that allows me to see lab reports online, e mail my doctor, make basic appointments and order Rx’s online.  They want me to pay a specialist copay to see an RT, so I can order new supplies.  I don’t know why this is necessary, as it is not even a doctor appointment. At least KP does not have any “preexisting conditions” disqualifications at all, so I can get sleep apnea appointments for the specialist copay and equipment for 20% copay, no deductible.  For now, the company covers a big chunk of the insurance premium, so I pay about $42 per month. 

 I’m counting myself lucky, with all the people I’ve read about who could not afford the insurance, or have preexisting condition disqualifications or continued unemployment.  Not having continual CPAP therapy would, no doubt make it much harder to get and keep a new job, with the continuing health deterioration, tiredness and brain cell loss.  

As usual, thanks to Sleep Guide forum members for helping me to know what is important in my SA therapy and what to ask for.  Without being a strong self advocate, I could be in much worse shape right now from all of this.