How long from sleep study to getting Cpap?

[lanndi]

Do you think it will pay off to be a huge pest? I was thinking of calling the doctors office every day until I know for sure he sent in the pre-authorization form once again. I just wonder if this would be such a big issue if he had ordered a cpap instead of a bipap? I'm guessing bipap is more expensive?

Be a pest! Don't be a mushroom!

Be on the phone w/ your insurance co; the docs office and the DME as often as it takes to get results. Find out from your ins co what they need to authorize your machine. Communicate that to the doctor -- you can even write it up for the doc and fax it over. THere's no reason this should take his office more than two days. You have to be your own advocate or you may never get satisfaction!

[LisaEileen]

Thanksfor all the advice and encouragement! I was talking with my husband about this last night. As I said, I really believe that all my health issues are due to my lack of sleep for too many years. I am on 7 medications. Thankfully, Medicaid pays for them. But, I have seen how much they shell out per month to pay for them and it is MORE than what they would have to pay for a bipap machine. I know I'm being optimistic here, but I really believe that once I get this sleep issue straightened out, all my health issues are going to start getting better. That means, getting off some of the expensive meds I'm on...which would end up costing Medicaid less in the long run. I'm worried that once they finally approve something, it's going to be something less than ideal. I'm sure Medicaid isn't going to pay for something top of the line. I'll probably get something used and out of date. Anyway, I'm going to call again today and make sure that someone is on the ball and doing SOMETHING.

[ramirezi]

It took me over 6 months to finally get the CPAP. My doctor wrote a prescription and I don't think he ever turned it in. So hopefully you don't have a situation with a flaky doctors office who ignores all phone calls and won't turn in the prescription. As soon as the company got the script, they called me and had me in within 24 hours to pick it up.

It went something like:
10/08 Sleep study #1 I slept 4 hours over 8 hours.
12/08 results from sleep study #1, tells me a titration (even though he ordered CPAP be done during sleep study #1 but Tech didn't feel I needed it!)
1/09 Sleep study #2 I slept about 3 hours over 8 hours.
3/09 results from sleep study #2, doctor claims he has written a prescription for auto CPAP machine and sent it in
4/09 I call to see why I haven't been contacted. They told me it's a long process and goes through my insurance first. I called my insurance, they said nothing has arrived and it will take 2 weeks for approval after that.
5/09 Hear nothing, leaving messages on voice mail weekly. Even contact my doctor to let him know all phone calls aren't picked up and all voice mails. Also keep calling insurance and they keep telling me there's no order yet.
6/22/09 Get phone call from company and it's the wrong company. But I still can't get anything corrected by leaving voice mails so I finally said fine, just call her back and go to this place.
6/24/09 Finally picked up the CPAP.

[LisaEileen]

I just called the home health agency once again. The doctor sent the pre authorization forms into the insurance again. I was told that now they have to re-review my case and it might not take 2 more weeks...it might take a full MONTH. They are so sorry they can't speed things along. I am so livid right now it isn't even funny! I have never heard of this taking this long for anyone else. I'm guessing it's because I have Medicaid for my insurance provider. I guess because I'm poor, my health isn't that important. I even explained to them that this lack of sleep is making me extremely depressed and I can't properly take care of my autistic 3 1/2 year old because of the depression and exhaustion. That's when they told me they were "so very sorry." Whatever. I was told yet once again that I should take naps when I can. HELLO, isn't anyone listening to me?! I have an autistic 3 year old who requires me to be awake at every moment she is awake or she will either try to escape the house or completely trash my house. She has figured out how to break every lock we have put on all the doors. I am not exaggerating when I say I can't take a nap. I think I'm going to go in the bathroom and cry now.

[Pugsy]

Medicaid requirements (whatever they are) have never been designed to help. Instead they have been designed to weed out potential costly claims. Typically Medicaid is state regulated so what works in one state might not work in another state.

I would be tempted to try to verify exactly what data is needed to document meeting criteria for CPAP treatment and compare that with sleep study data. Medicaid reimbursement rates are very low and the DME might (not saying that they are) but might be dragging heels a bit because they aren't going to make much money to speak of on this transaction. Certainly not the amounts they can get from private insurance. It wouldn't be the first time that a Medicaid patient got the short end of the stick.

Remember those stories about DME's telling people that their insurance wouldn't pay for a data capable machine at all which is a lie? They aren't always completely truthful (understatement).

That said, the other way they look at it is very much like what my sleep doctor's nurse told me (in a nice way). They simply do not look at sleep apnea treatment as something that is an emergency. I was told that sleep apnea was something I had for quite some time and it hadn't killed me yet so they don't get in a real big hurry and/or worry about getting all this stuff done on a timely basis. Medicaid or other insurance criteria for CPAP treatment is just a number and they don't factor in private wants or needs. No, its not fair but that is the way it is.

I was fortunate in that I found an individual selling a machine that suited my wants and I had saved up the money to get it just in case I found one. My out of pocket expenses were about the same after I factor in purchasing the humidifier outright and the rental copays. I maybe even saved a few bucks. I know that you don't have the funds to do this. Any chance that you know someone that you could borrow a machine from?? Something to get you by and some treatment while waiting to jump through all the criteria hoops?

[Muse-Inc]

Ah, LisaEileen, I'm sorry life is so tough right now .

My friend's 2 yr old was outside with dad who was fiddling with the car. Unbeknowst to dad, son grabs screwdriver goes around to the front of the car and proceeds to unscrew the headlights and every other screw inside the headlight assembly he could reach when he yanked them out of the car...can you imagine how upset dad was when he checked his son? The kid also figured out how to undo/break every door lock they used...one time he grabbed his potty chair, climbed up on the back (wonder he didn't fall), used a stick he'd found and pushed up the catch at the top of the door so he could get out. Makes me think of the mischief your little one likely gets into too.

Good thing you're here learning what you need.

Best wishes for some peace, quiet, and rest and maybe your little one to take a really loooong nap...soon.

[Sly]

Hi Lisa,
Sorry you're having a rough time.
I called the Sleep Study Hospital, they sent me to my Dr. on Friday June 12. He sent the orders to the Hospital and they called me on June 15th and was able to snag a cancellation and was in that night. I slept for 3 hours, the came in and said they needed to put the mask on me for the rest of the night. They read the study and wrote the script by June 19nd and I emailed my orders to cpap.com I drove to cpap.com (I live 20 miles from them) on the 24th and picked mine up....set and ready to go.

So start to finish was 12 days, but I hear that's a rarity?

Good Luck!!!

[LisaEileen]

Any chance that you know someone that you could borrow a machine from?? Something to get you by and some treatment while waiting to jump through all the criteria hoops?

Funny thing is...my Dad used a Cpap. He died in June of 2007 of bile duct cancer. His machine was really old and noisy, so my Mom told the home health people they could take it and donate it to someone who needed it. Who would have known that 2 years later I could have used it as a back up. I'm not sure how that would have worked since my dr ordered a bipap for me though? I'm still really confused about all this.

It's so sad that they can't even bring me something to use until my insurance is done messing around. My thought is that eventually you'd think they'd have to come through since my doctor says this is something I need...wouldn't you think that would be the case? They told me that a bipap is around $500 a month to rent, is that true?

[Pugsy]

They told me that a bipap is around $500 a month to rent, is that true?

They might "bill" that amount but I doubt very seriously if they get paid that amount. BiPaps are more expensive, this is true. With Medicaid or Medicare there is usually a significant write off from the amount billed and what is actually "allowed" and paid. Medicaid is state funded, so their fee structure can vary from state to state.

[Tanya]

I read the posts regarding the delay b/c I felt like it was taking too long to get my cpap and was shocked at the stories. I went to my doctor 7/7/09 and was referred to sleep clinic and went on 7/17/09 was called back for second sunday three business days later and went into wear cpap on 7/25/09. Then was called four business days later to say I have mild obstructive sleep apnea and with increased events during REM. I asked for a copy of results the second night and the AHI was 6.9, RDI 8.5, 33 apneas, 1 mixed event , and 8 hyponeas. I was given a heart monitor by the cardiologist on 7/7/09 for 30 days till next appointment with is tomorrow on 8/7/09. Just mailed it back . Had heart palpations, headaches, fatiqued and so forth. I weigh 150 and is 5ft. 6.5ins. I thought I would get my cpap sometime this week, but that's not happening. After reading your comments, I called my insurance and found out the rent the machine, I have a 2000 a year max on DME with a 20% coinsurance pay. Homelink has had my paperwork since Monday and today is Thursday morning and they have not contacted the insurance. So after talking to the insurance company, I called back to Homelink and asked for my rep. and told her that this is important to me even though I have mild apnea I need my machine and how long is the process b/c I have an appt. tomorrow with my cardiologist and their is no point in paying him 180.00 and I have no comments on the use of the machine and before I call to change the appt. please give me an estimate on the time frame. She said give me an hour and I will call you back with an answer. Being persistent can sometimes make a difference. I will wait for her call and hopefully the contracted she selected in my area will call soon. I can only imagine with mod/severe apnea how people feel.

[drj130]

I started my xPAP traveling back on Jun 2nd. That was when I did my first study. Then I had a second one around the 12th of Jun with the results on the 15th. Then I had to wait, lovely military people I get to deal with, until the 10th of Jul for my titration. Was suppose to see the doc that day, but he had to visit Iraq. I finally received my device on the 29th of July. My DME kept trying to get me to take a F&P machine. I was lucky and won that battle.

David

[zaban3]

I had sleep study on June 18 and was told I met criteria for sleep apnea but did not sleep enough to do titration that night. Doctor did report on June 20. Got call on June 22 to come in for titration study on June 23. Went home with Auto-pap next morning for home titration since I did not sleep enough to get pressure. Meeting to go over results with sleep doc on June 20. Doc said I can keep apap and don't need to switch out for cpap ( I would not have given it back anyway).

I have been pleased with the care I have gotten so far.

[Sleepless and angry]

I've been waiting over a year at this point. Had my doctor's appointment last year in January, the sleep study took forever to get because of insurance. Then when I finally had my sleep study in November I was told I had it and they would send my information to a pharmacy counter. After waiting the month they told me it would take I was told my insurance information was too hard to read and they would need it again. I gave them my information and then was told I waiting too long after my doctor's appointment and I had to reschedule with my specialist......The best part is I call my insurance company and they say to just ask for a new prescription, which was wrong. So no I have to wait up to 3 months again for my appointment with a SPECIALIST, which I will then need to see a few months after that for the follow-up.... So yea I'm over a year in and no CPAP or better sleep because I guess my insurance hates me.

[palerider]

I just bought mine on craigslist... no waiting, no BS with doctors.

[library lady]

I was fortunate enough that my Dr. meets patients when you wake up from sleep study and gives you instant results. I got my machine the same day masks and all. It was about 2 weeks from intial appointment to sleep study. So 2 weeks in all. Until then I used oxygen at night just to be safe

I had pretty much the same experience. Saw sleep doc one day, the next night went for my split study, and in the morning met with the doc again for the results. Could have gotten the RX and machine that same day, but I wasn't sure I wanted to do cpap at all, so went home to think about it, did some research and then realized that cpap was the best option and called the doc back. As soon as I got the RX I went downtown to the cpap store at Mayo Clinic and got my machine, spent about an hour with a tech who taught me the ropes. A week after my sleep study I was using the machine... in fits and starts at first while getting used to the routine and the mask, finally settling in to it and it's been just 3 years now since I started.