Can't Get Sleep Study

[jshuler43]

Sorry, message got sent before I finished. Hope I am doing this right. Iim trying to get it posted correctly. If someone can help me delete previous post, I'm be grateful.

My 39 year old son has sleep apnea. He was tested 3 years ago and was put on an ASV Bipap. He had a lot of trouble with dry mouth. He didn't have a sleep dr to advise him. After about four months he quit using. Then about six months later, he had new insurance - Meficare/Medicaid Advantage plan. The old insurance came and got his Bipap.

My son's health has not been good, and I encouraged him to go to sleep dr and get help. Well, it's been three months and insurance is denying him another sleep study. ( His sleep dr says his past sleep study is too old. His dr can't seem to get the insurance to cover.).

My son is having a terrible time getting sleep. He is sleep deprived and I'm really concerned as he looks terrible and is mentally breaking down. He is taking Ambien from his PCP but it isn't helping enough. He can go to sleep, but wakes up all during the night. His sleep dr said he can't prescribe him medicine as he needs a sleep study. His PCP dr will probably prescribe something but we hoped to get a sleep dr input on the right medicine.

My son has some heart concerns. He is in the hospital now with acute pancreatitis. His nurse said he snores quite a bit.

But we seem to have no recourse. The dr said the insurance has turned them down twice and he can't do anything else.

[Julie]

What I'd like to suggest is that he look for an machine on Secondwindcpap.com and then can titrate himself (find the right pressure settings) at home. The company is excellent to deal with, the machines warrantied and also very good following reconditioning (and much less expensive than new) and many members here have used their services. There may be a problem with their wanting a prescription, but not necessarily - I know people who have not been asked to supply one or else have an older copy of one that can be mailed in. If you run into trouble there, please come back - to this thread - and we can make other suggestions and/or help your son get set up with the right machine (either from SWC) or even a member here who often has machines available (no script needed). We can also help him to use free software (SleepyHead) that will show many parameters of his overnight sleep experience and once we see that can advise re tweaking pressures, or with other advice.

[jshuler43]

Thanks for advice. Unfortunately my son is living on disability below poverty level. His wife has epilepsy and has serious problems but does not have disability yet. They are living off of $750 a month. Just barely enough for food and gas. So they can't afford anything. It is so sad and so frustrating that he needs to be on the Bipap and his insurance is refusing even a home study.

[Julie]

Do you not have a church connection, Lion's Club, a go-fund-me opportunity... something?

But I suggest you do keep this thread and/or new ones up here and any place else you can think of because someone might just be able to help - it's happened before that others here have e.g. back-up machines they aren't using, or ones they just haven't returned but don't use, etc. Don't give up!

[Cardsfan]

Isn't the original sleep study sufficient that he was diagnosed and given a prescription? My original prescription says it is good for 99 months or lifetime.

[Lucyhere]

You didn't say which insurance you have, but it's possible that you can appeal this decision. Same as a doctor who prescribes a med and the insurance company denies it. The doctor can appeal the decision if s/he thinks having the med is in your best interest. The patient generally wins if the doctor gets involved. Read the rules included with the contract your son signed and speak to the doctor.

My mistake... you did say which insurance he has.

[jshuler43]

All I know is dr said it was too old for him to go by.

The sleep study he did was weird. After first one he had to go back twice because his numbers were haywire. I think they said he had Central Apnea. Something about the testing messed up his apnea. So they put him in a very expensive ASV BiPap machine. P

[jshuler43]

Lucyhere- supposedly the dr has appealed twice and been turned down. Makes no sense to me. They have records he had bad sleep apnea. He is falling asleep all during the day. It seems it's almost criminal to deny him at least a machine. But they won't do that without a study and insurance won't even pay for home testing. I am so mad and frustrated.

[jshuler43]

The machine he had was BiPAP autoSV Advanced System One Series Bi-Flex with Humidifier, SD Card, and Heated Tube

Pretty expensive.

[Cardsfan]

Can you get a copy of the prescription from his original sleep test and the results?

[Lucyhere]

http://www.huffingtonpost.com/linda-ber ... 81538.html


This is dated 2011, but I think it's still relevant. Do you know that squeaky wheel story? The one that makes the most noise gets the most attention. Best of luck... I know this isn't easy.

[BlackSpinner]

Lucyhere- supposedly the dr has appealed twice and been turned down. Makes no sense to me. They have records he had bad sleep apnea. He is falling asleep all during the day. It seems it's almost criminal to deny him at least a machine. But they won't do that without a study and insurance won't even pay for home testing. I am so mad and frustrated.

I can't say I blame them. He was handed a top of the line machine and didn't use it. What makes you think it will be any better this time around?

[jshuler43]

they gave him machine and he tried to get help adjusting to it and got frustrated with no support. The reason they picked up machine was that he switched insurance. That insurance got their machine back. His new insurance does not even want him to have a home study, much less give him a machine. He didn't try to get another machine because he felt helpless in getting good results.

He's desperate for help as he mentally disintegrating from no sleep. I told him I had a good sleep dr and felt they would help him get adjusted. So that's why he went to sleep dr (his insurance doesn't cover my dr)

While he had problems, the machine was returned, so no one is out of a machine. I'm not sure how often they replace your machine but I would think after several years he should get support since it is affecting his health so dramatically.

[jshuler43]

In addition, he was very compliant for the first four months despite terrible dry mouth, which he bought mouthwashes, sprays etc for. He didn't get much relief that he could tell. That is the problem with getting referred to a DEM that didn't have any info for how to get good results. I would think if he has Central Apnea, that it is important to get support in getting this handled.

[BlackSpinner]

If he has central apnea the a home study is a waste of time. It can only handle obstructive apnea.