Small rant

[ShallowBreather]

So the sleep study said I have severe OSA and CSA, but when it comes down to getting a second sleep study so that they can titrate me, it’s “wait ten days because we need to make sure your insurance will cover it.” Has anybody ever heard of insurance not covering it? Isn’t this a potentially life threatening ailment? So, I called back after giving them time to get the approval and “I’m sorry there we can only move the date up one day. No more openings.”

Last night was horrible. It’s got me cranky. I apologize.


Does anybody know if they’ll send home with a machine (probably need ASV), or do they order them from Neptune? I’m so ready to have this over.

[Dog Slobber]

Insurance doesn't cover things all the time.

Sometimes it's excluded, sometime bureaucracy, sometimes just delayed.

Problem is, when there is an insurance issue, too many people make it the problem of the service provider and they get stuck without getting paid. People have the right to get paid and to take steps to ensure payment method is in place before performing the service.

[Pugsy]

Does anybody know if they’ll send home with a machine (probably need ASV), or do they order them from Neptune? I’m so ready to have this over.

Doubtful that you will go home after the titration sleep study with a machine unless the place doing the titration sleep study also sells/dispenses machines. Most do not and even if they did we have to get insurance okay AND the place has to have the particular machine in stock on the shelf.....and if you do need ASV...most places don't keep that model in stock due to cost.
It is almost always something that has to be ordered.

[ShallowBreather]

Bummer. I hope it doesn’t take very long.

Yes, I understand people need to get paid, but they have access to my coverages and know my insurance is excellent. I don’t want anybody to get stuck holding the bag, but that doesn’t apply here.

Oh well.

I guess money rules the world.

[Pugsy]

I guess money rules the world.

Always has and always will. It is what it is.
That and red tape.

If you already know who your equipment supplier will be (and they are NOT the place doing the titration sleep study) you might call and ask if they even have the ASV (assuming that is what will be prescribed) in stock or will they have to order it.
At least get some sort of idea on a time frame.

[Dog Slobber]

Yes, I understand people need to get paid, but they have access to my coverages and know my insurance is excellent. I don’t want anybody to get stuck holding the bag, but that doesn’t apply here.

Different insurances have different processes and delays to to verify the procedure will be covered.

They deal with hundreds of carriers and plans all the time, their process is designed to accommodate such delays. They *may* have access to your coverages, but they *don't* have access to what coverages you've used, without an inquiry and approval.

[ShallowBreather]

Different insurances have different processes and delays to to verify the procedure will be covered.

They deal with hundreds of carriers and plans all the time, their process is designed to accommodate such delays. They *may* have access to your coverages, but they *don't* have access to what coverages you've used, without an inquiry and approval.

Thanks for that. Good big picture stuff. I can appreciate it now that I'm awake.

[ShallowBreather]

If you already know who your equipment supplier will be (and they are NOT the place doing the titration sleep study) you might call and ask if they even have the ASV (assuming that is what will be prescribed) in stock or will they have to order it.
At least get some sort of idea on a time frame.

That's a good idea, but I need more help. I'm in the very large Cleveland Clinic network of doctors. Who normally orders the equipment? My primary is the one that ordered the first sleep study and the second. He's a general family doc. Would it be him? Or would it be somebody from the sleep lab? I haven't spoken to my primary since the initial consultation when he ordered the 1st study, and it was a nurse who sent me a message via MyChart that the 2nd study was ordered.

Thank you for help with this.

[Pugsy]

The doctor who interprets the sleep study will recommend machine and settings.
Usually this information then gets conveyed to the referring doctor who then notifies equipment supplier who you should be able to choose who that is. You and your insurance decide who dispenses equipment.

[SleepGeek]

Does anybody know if they’ll send home with a machine (probably need ASV), or do they order them from Neptune? I’m so ready to have this over.

As already mentioned - that is not likely. Which is why I said what I did in your other thread.
IME it can take a month or more for to get your equipment and the delay is normally the insurance.

From what I'm told, even after the insurance approves it does not mean they will pay it - so much depends on how it is billed and the codes used. So yea there is a lot behind the scenes we don't know about.
This was all BC = Before Covid and BR = Before Recall which I feel is straining our healthcare system.

Have you asked to be put on a cancellation list? Many sleep labs will do that but that means you will have to respond on a short notice. Wear shorts for all the leads they use on your legs.

I guess money rules the world.

Isn't that the sad truth. And any lab or sleep doc that also sells this equipment is in it for more of the money and not the best place to buy equipment from.

Stay away from Apria but you already know that. But also Lincare and Rotech should be watched with both eyes. Get personal references in your area if you can.

Unfortunately, this sleep business is full of slimy characters.