So I snore pretty loudly. Sure lots of people do, but how many of their friends would liken their snore to the sounds of a whale? I have at least one. Over the past few years I’ve grown used to being the brunt of jokes about the volume of my snore, and I’m sure the number of nights my girlfriend wakes me up complaining “babe you’re snoring!” is vastly outnumbered by the nights she rolls over and tries to fall asleep. So a few years ago, after she noticed that not only was I keeping the dead from sleeping, but that I would often stop breathing- I decided to get checked out.
At first, I wasn’t even sure I could get it checked out- as a college student, with a college student health plan, I had learned first hand that medical insurance does not always equal medical coverage. But after a few calls, I was surprised to learn that Aetna would pay for me to visit the Windham Hospital Sleep Lab.
So I called them up and arranged for an overnight study. Basically, I went to the hospital late in the evening, had dozens of wires and electrodes stuck to my body with an unfriendly goo, and hopped into bed. Trying to fall asleep knowing that the technician in the room over whose voice was omnipresent via unseen speakers, was watching over my every toss, turn, and scratch was a tricky task. Finally , I managed to fall asleep, and 8 hours later awoke to a new morning, eager to run home and grab a couple more hours of sleep before the day began.
Shortly after, I returned to the hospital to meet with the doctor in charge of my case. Sizing me up with curiosity, he announced that I had severe obstructive type sleep disordered breathing (sleep apnea), despite the fact that I was about 20 years too young and 60 lbs too light. Then came the real shocker: I had severe heavy snoring disease. I had to chuckle inside a little at that one, and promptly noted the condition so that I could explain to my friends I was not being purposefully obnoxious when I slept.
But getting back to this sleep apnea business- what exactly did that mean? In a nutshell, during the 6.1 hours of sleep I was observed, “274 respiratory events were manifested”, i.e. I stopped breathing. That didn’t sound so great. So what did this mean for my body? Basically, every time I stopped breathing, extra stress was put on my heart as my brain kick-started things. I learned that over a period of time, untreated sleep apnea can lead to high blood pressure, heart disease, and a host of other undesirable side effects, including the “moderately severe reduction of REM sleep” I exhibited: read I miss out on the deep rejuvenating stage of sleep every night.
The answer supposedly was a CPAP machine- an awkward looking device (pictured above) that you hook up to your face before you sleep each night. It is supposed to generate a constant flow of air into your lungs to prevent the “respiratory events”. Dr. “X” told me the technicians would simply need to schedule a second night of observation during which the CPAP would be hooked up to me and calibrated specifically for my breathing. Then a order for a machine would be placed with a local supplier, who would then come to my house, set it up, and show me how it worked. Bada-bing! Problem solved.
Only not really. When the Dr. mentioned a second night at the hospital, I told him that probably wasn’t going to happen any time soon. The fact was, my student health insurance had a “per-condition, per-year” policy cap of $1500 or so. That meant spending on any one condition over $1500 came from my pocket. I told him that I would have to see how much the 1st night’s bill came to before scheduling a 2nd night. I called the billing department- and ouch! One night in the lab had not only wiped out my cap for the year- but had exceeded it.
So in the span of just a few weeks I incurred hundreds of dollars of medical debt payable by me, just to learn that I had a dangerous sleep disorder that I couldn’t schedule a follow up study for. So I grinned and beared it. I waited until my next policy year started, and contacted the hospital to set up the 2nd night of my study. It had taken a while, but at least now I could complete the process. It was a lovely idea, but the hospital thought otherwise. Apparently in waiting for my policy limit to reset, the first night of the study had become void- the data was too old to use for a 2nd night’s sleep.
By this point I was pretty ticked off. I explained my dilemma to the Dr. & staff, and they came up with a solution- they would schedule me for a split-night study. Instead of observing on night #1, and intervening on night #2, they would split one night into 2 parts, waking me up half-way through. And so I trudged back to the hospital, submitted to goo and electrodes, and fell asleep easier this time, not nearly as creeped out by the watchful eyes in the dark this time.
So finally the problem was just about taken care of- the split night study went well, my order went into the CPAP vendor, and I should be all set in a couple of weeks. Then came the best news of all: Aetna declined to pay for the CPAP machine. I must admit I was surprised. After all, before even embarking on this journey, I had done some homework and learned that CPAP would likely be the answer the sleep lab recommended. So when I asked Aetna if they would pay for the study, I also asked if CPAP would fall under “durable medical equipment”- which had its own cash limit. They informed me it would, and did not count towards the “per-condition” limit. So why did they turn down my medical treatment?
“It was not medically necessary”
I had to laugh. It was all too ridiculous. If Aetna denied me medical treatment now because it was not medically necessary, in 20 years, Aetna, or other insurers could deny me medical coverage for developing what they would then call a pre-existing condition: heart problems. Indeed, even if I tried to switch insurers then, I would run into problems: many insurance companies will not pay for conditions that a “reasonably prudent” person would have taken care of in the past.
I asked My Dr. appeal Aetna’s decision, which he did, but it was to no avail. I joined the ranks of the millions of American’s who fall into the no-man’s land of “underinsured”. Much talk is had of those without insurance, and those with insurance who pay too much- but little focus is placed on those ostensibly with insurance, who find their coverage exists only on paper.
After this experience I vowed when I moved on to grad school to drop Aetna and pick up a new carrier. However, when the time came, after weeks of research and inquiry I was chagrined to learn that my new grad school also used Aetna- and it was the only coverage I could afford with my now “prexisting condition”.
And so I have grudgingly been forced to enroll again with Aetna- a health insurance company that considers each one of my 274 nightly respiratory events of medical insignificance. It is in this way that 18,000 American’s die each year for want of adequate health care. My beautiful sister Holly was one of them 1.5 yrs ago, and it appears that Aetna is perfectly happy to add me to the count after they collect my premium.
With a new Health Czar, a new HHS secretary, increased money for Medicaid, funding for new health centers, and tomorrows health care reform summit, the temptation to mistake action for progress will be great. It is up to everyday Americans to make sure that Washington remembers health care reform is not just about policy options, but about people.
Obama’s Health Care Plan
Sustinet: Connecticut’s Current Universal Health Care Proposal
Pennsylvania’s Universal Health Care Efforts
United States Department of Health & Human Services
Health Care for America Now
Universal Health Care Action Network
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