Insurance rejects Dr's Sleep Study referral

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metsfan302
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Re: Insurance rejects Dr's Sleep Study referral

Post by metsfan302 » Thu Nov 19, 2015 7:37 pm

three years ago, he had no issue getting it approved from the same insurance.... but guess insurance is looking at it i dunno

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SleepyEyes21
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Re: Insurance rejects Dr's Sleep Study referral

Post by SleepyEyes21 » Thu Nov 19, 2015 10:38 pm

metsfan302 wrote:three years ago, he had no issue getting it approved from the same insurance.... but guess insurance is looking at it i dunno
Hi Eric - I think you're running into the same thing I experienced today when I went to my first appointment with a sleep doc/ pulmonologist, to assess the need for me to have a second sleep study, but this time to have it in a lab. My first apnea test was last year and in-home. The doc I saw today told me the primary reason that an in-home test is less reliable than a lab test is because an in-home test does not measure for centrals; in-home tests generally do not have the equipment to measure brain activity during the test.

The in-home test I had last year was also a SNAP Diagnostics test; I had the pulse ox monitor, a cannula, and the chest strap. I received NO DATA from SNAP Diagnostics on whether or not I had central apneas occurring, and I would caution you to do your homework here if you do decide to use SNAP Diagnostics for home testing for this reason, and also because of the cost which is most likely NOT covered by your insurance. SNAP will take your credit card info before you take the test, and tell you they take your insurance, but if your insurance doesn't have a contract with them, you will have to pay the total $300.00 out of pocket (that's the part SNAP doesn't tell you prior.)

The sleep doc I saw today is going to try to get authorization from my insurance company for me to have a split-night/titration study. He's not sure if insurance will authorize this since they obviously will know (from my medical records) that I already have OSA. (You are in the same situation; your insurance knows you've had an apnea test and you have at least OSA.) My doc said insurances are trying to save money, of course! So these days, unless a patient is showing significant signs/ symptoms of cardiac disease/failure or has a diagnosis of restless leg syndrome or a limb movement disorder of some kind, insurances usually are only approving in-home tests for patients. However, it could be different for FL and DE, so keep that in mind too.

I would suggest that you NOT waste your money and have the in-home test. Your insurance will fight against you more if they see you've had two tests, and I would be real cautious that you would actually get accurate data of your centrals from an-in home test. I am sending you a PM with some more ideas to think about.

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metsfan302
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Re: Insurance rejects Dr's Sleep Study referral

Post by metsfan302 » Fri Nov 20, 2015 5:40 am

SimbaLion wrote:I'm actually a bit lost in your story. Aren't you the same person in another thread who just started ASV? How did you start on ASV without an ASV lab titration?

Yes someone did purchase one for me to use.....

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Cardsfan
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Re: Insurance rejects Dr's Sleep Study referral

Post by Cardsfan » Fri Nov 20, 2015 8:39 am

I agree with sleepy eyes about Snap charging the $300. I was extra vigilant and got everything in writing from my ins. co and a specific written approval that Snap would be covered at In-network prices. (that part took about 2 months to negotiate). So whatever you do, make sure you get your approvals from the ins. co in writing. Snap told me they "take my insurance".
If I had taken their word for it, I would have been surprised with a $300 bill, because they are out of my network.

Good luck Metsfan - you just have to keep fighting with the ins. co. Plus, they will drag it out till the new year, when most people have deductibes. That's what UHC tried to do to me. I actually got my machine at the very end of December and I had met my deductible. A few weeks later, it would have been the new year and I would have owed the first $500, plus my 20% copay.

All I can say is "thank goodness for the kindness of strangers" because I have seen quite a few people on here getting the help they need when insurance and financial hurdles block the road to their treatment.

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metsfan302
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Re: Insurance rejects Dr's Sleep Study referral

Post by metsfan302 » Wed Nov 25, 2015 12:21 pm

Well I heard from the Sleep Center to inform me that indeed this new Pre-Auth to the insurance for an attended sleep study from my sleep dr was denied from the insurance company. They said they did send the appeal paperwork to him so hopefully he appeals it, if the insurance company does send me appeal papers I am going to fill them out with all sorts of info etc! Not going to let this go, I need to see what is going on with these centrals/obstructive events etc

Have a great thanksgiving everyone!

Eric

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