newbie getting impatient! question for ya'll...

Ok, don't hurt me yet.... I have searched and read the newbie stuff and everything, I promise. Anyway, I am 22 and was just diagnosed with OSA (39 apneas/hour is what they said... so I guess that's not *too* bad, but I have been feeling terrible), have had my 2 sleep studies (the inital one and the titration), and am now apparently waiting for the insurance company to "pre-approve" my doctor's prescription for equipment. My question is this:

How long does it usually take this "pre-approval" stuff to happen? Is there something I can do to speed it up?

I am usually a very proactive person when it comes to this kind of stuff and especially in this case because I am experiencing that frustration of knowing that there is treatment for what is going on with me (all the usual symptoms) but having to wait for the red tape to fall. I get the impression from what I've read so far that there will be another uphill battle once I am given equipment, but am fairly optimistic at this point as my 2nd sleep study went very well and I was not discomforted at all by the mask they used or the pressure settings. (But that could have been the sleeping pill doc gave me ) So here's my other question:

What about using provigil very short term until this equipment thing gets sorted out? The sleep tech at my sleep lab asked me why the doctor had not already prescribed it, as I mentioned to her that I am desperately trying to finish up my senior year of college and have been flat exhausted for months. I am glad the doctors have figured out why --- but I'm terrified that I won't get help in time to get ANY productive sleep in time for finals (I know I can't expect instant results even when I do get my CPAP equipment)...

Does anyone have any tips/advice/encouragement? Do I keep bugging my doctor relentlessly, call the insurance company myself, relax and suck it up, or what?

Thanks so much for any words of wisdom you can offer, I am so comforted just knowing this wealth of info is here.

Bugging your doctor relentlessly probably won't help much. Calling your doctor to let him/her know that you want to accelerate this as the condition is affecting your quality of life would be a more productive call. Just let him/her know that you will make the calls to the insurance company and that you will appreciate his/her support. Calling the insurance company is, in my opinion, the better way to go. Right now they're the one holding things up.

"Yes, I know there is a process, but after months of testing we finally have a diagnosis for a condition that is treatable. I don't understand why anyone would have a process that withholds treatment from a patient. Doesn't that create a legal risk to the insurance company?"

I think you get the idea. Insurance companies generally think we're dumb and they're in a position of power. I know that's a rather broad generalization, and there are some that respond more quickly, but I also think that overall my statement is correct. Notice the buzz phrases in bold.

This may be easy for you or it may take some prodding. In any event, good luck on your finals! (I work at a university in the IT department)

I'm 22 and recently diagnosed too! 14 days and still waiting for that call. And yes I have called the doc but he was on vacation again. Bah.

Do your homework and identify the machine(s) you'd be willing to accept. Do you want to monitor your therapy? Look at the many excellent postings by 'Slinky' and get prepared to deal with the DME regarding masks and machines.
Good luck!

Good luck to all of you newbies! I agree with lktnky; read up on the machines and insist on your doctor writing you a prescription for one that is data capable and by that I mean one that doesn't just show compliance data, but will tell you how much your mask leaked, what pressures you needed at different times of the night, how many AIs and HIs you had during your sleep period, as well as your median, 95th percentile and highest. I personally recommend that you insist on an auto PAP (APAP) machine which will deliver straight CPAP therapy but still allow for APAP if it works best for you.

Some DMEs will try to give you the cheapest machine they can get you to accept. Don't be forced into that - get what you want. You will have to have your doctor on board with it, however, and he will have to write the prescrption specifically.

Good luck and stick with the forum. There are lots of good people with experience to share with you as you begin your journey into the world of the "hoseheads".

tootiredtostudyforfinals wrote:Ok, don't hurt me yet.... I have searched and read the newbie stuff and everything, I promise. Anyway, I am 22 and was just diagnosed with OSA (39 apneas/hour is what they said... so I guess that's not *too* bad, but I have been feeling terrible), have had my 2 sleep studies (the inital one and the titration), and am now apparently waiting for the insurance company to "pre-approve" my doctor's prescription for equipment. My question is this:

How long does it usually take this "pre-approval" stuff to happen? Is there something I can do to speed it up?

According to WHOM? (are you waiting for pre-approval)

My sleep doctor's office (apparently) dropped the ball and didn't fax the results from my sleep study to my insurance provider. Then they SUPPOSEDLY did......but my insurance provider's office didn't receive them......then they had to fax them again (after I jumped on their butts).
All of this cost me about another 10 days of delay. I had been in pretty frequent contact with my insurance provider throughout this whole process. I was purchasing my equipment from CPAP.COM and was ready to tell them to ship it, but I was waiting for all of the approval process to get finalized. My insurance reimbursed me for 80% of my purchase, but I wanted to make SURE that all the i's were dotted and the t's were crossed beforehand.

You might want to do some checking with your insurance provider (if you already haven't) to find out what the holdup is.
Somebody may have dropped the ball in your case, too.


Den

A little cheat sheet to help you familiarize yourself with the names of machines that can give you useful information and those that can't:

My list of machines that record "full data" (AHI and leak info) and those that don't -- as of October 2008:
viewtopic.php?p=307168#p307168

A lot depends on how speedily your Dr. and/or Drs. office works and a lot depends on your insurance. I left one Drs. office for a variety of reasons, but one of them being they were extremely slow to get out paperwork. I took my daughter in there with symptoms of a UTI. They prescribed medication and a full two months later, they I got her labs back in the mail. There was no infection! They were just as "speedy" in mailing me back my labs. And I never got a copy of the original report, but something the Dr. typed up. I know better than to blindly believe such a thing because mistakes can (and have been) made. I overheard the receptionist say to another patient that any mail that came or went was first sent to another branch where it would usually sit for several weeks before being dealt with.

When my husband needed surgery about a year ago, he needed referrals to be able to see various Drs. He is in the military. His insurance is different than mine. I can pretty much go wherever I want (assuming they take my insurance and it's not a mental health issue) and I need no referral. Not so with him!

Well, he had trouble at every turn! The specialist would need to see him, but couldn't because the paperwork hadn't been put through. He had to make countless calls to get the paperwork into the right hands. In one case, they found the form sitting on a desk of a person who had the day off. She wasn't going to be back till Monday morning at 9, but the procedure he needed to have done was scheduled for 8 that Monday morning.

If I were you, I would start with the Drs. office. Ask them if the paperwork has been submitted. If so, then try calling the insurance company. Hopefully it's not like mine. Occasionally I will make a call and actually get the right department and a person who knows something! But most of the time I will be told I have the wrong department, will get shuffled from person to person, getting disconnected many times along the way. And of course there is the series of annoying pre-recorded messages I have to listen to and respond to. Sometimes I can push a button on the phone but mostly they want me to speak into the phone. Someone will invariably shout from the background, demand my attention, or I will cough, or the TV will get turned on or something and it will mis-register on the phone so I get sent to the wrong department or it hangs up on me.