I am now under a COBRA plan. I was prescribed a CPAP machine becaue o

[Guest snapper]

COBRA CONTINUATION OF BENFITS

[KIP KRAUS]

I have no idea what a CPAP machine is, but if the insurance would cover it as an active employee it should cover it under COBRA. COBRA coverage must be the same as active coverage. You could check the SPD, but I would be surprised if that particular piece of equipment would be mentioned in it. In any event, follow the appeal procedures in the SPD.

[Guest Jim Hunzelman]

I'm familiar with a CPAP machine since I use one myself for a sleeping disorder. My insurance policy provides a lifetime maximum payment of $3,500 for testing, diagnosis, etc. for the sleeping disorder for which this machine if typically prescribed. Read your policy carefully to see if it also provides a lifetime maximum. If you have a lifetime maximum and have had a sleep study done, consultation with specialists, etc., you may well have hit the maximum before the purchase of the CPAP machine.

[Guest snapper]

I am sorry but I am new at talking about insurance but what does SPD mean?

[jeanine]

An SPD is a Summary Plan Description. You should have an SPD and a Benefits Summary, or a Certificate of Insurance if it is a true insurance plan. If you don't have these request them now. How were you told it was not covered? Send in a claim or pre-approval and you must be given a written denial of coverage with a stated reason. Once you have that you can determine your next step.

[Guest snapper]

I would like to take this time to thank everyone for answering my insurance questions.

I was sent a letter saying,"Since this plan is a Cobra Continuation of benfits, the purchase of the equipment is denied."

How would I start the SPD process?

[Guest Benefits Maven]

Interesting that COBRA was their stated reason for denial since that is blatantly illegal. Request the summary plan description (spd) from your benefits department. They are required to provide it. I would also calmly mention to them that they can't deny a claim BECAUSE you are on a COBRA plan. The COBRA plan has to, by definition, be identical coverage to the active plan. In the SPD you should find (usually toward the end) language describing how to file an appeal. FOllow the steps in the spd and appeal the decision - mention in the appeal that you are aware that COBRA coverage is supposed to be identical to active coverage. That should get their attention. Good luck!

[Guest snapper]

I faxed a letter to responsible person at the insurance company telling her that I wanted my case review.

Funny thing, I received a telephone call telling me that they had decided to pay for the CPAP machine.

Thanks to everone. Your were a big help.