I am so angry and disappointed

[xchecker]

Having completed my titration study my sleep doctor sent the polysomnography report and prescription to my designated DME. I stopped in the DME yesterday to introduce myself and get a sense of what product lines they carry, etc. The DME staff then came out and said to me:

"Oh, we got your paperwork from the doctor but sent it back. It doesn't meet your insurance (Aetna) standard for treatment. Your AHI was only 3.5 and it needs to be at least 5.0"

I was stunned. At my titration the technician (who had also done my polysomnogram) apologized that no one had gotten back to me about the results and told me that I had scored "severe" and had an average of 66 events per hour. The titration went well and I was excited to get started.

I looked at the Report my doctor sent to the DME and it shows only 2 apneas, 1 central and 17 hypopneas during the entire night of my poly. I can't figure what justified the written impression "Severe obstructive sleep disorder with obstructive/central/mixed apneas/hypopneas..." What justified the expense of the titration study?
Oddly enough when we did the titration I had 20 events just in the 10 minutes I was at 4cm of pressure. By the time they cranked me up to 11cm I only had one in 45 minutes.

I feel misinformed and mislead. I thought I had found the source of my sleep issues and the solution for it. Now it seems all that has been taken away from me. My wife, bless her, said if I really feel like it helps we can just buy the equipment and use it regardless of the test or insurance. Anyway, my doctor has a lot of explaining to do and I am awaiting his call. GRRRRRR!

[LSAT]

Ask for a copy of the titration....it's yours...you paid for it.

[darco]

I was diagnosed w/moderate sleep apnea (AHI 23) but my oxygen level was in the 90's so my insurance rejected my claim. Luckily my sleep Dr stepped up for me and got me approved.
Good luck

d

[englandsf]

Why not get both reports in full and then arrange a visit with the doctor to discuss? There's a disconnect here - yes?

[DeadlySleep]

Your AHI was only 3.5 and it needs to be at least 5.0

told me that I had scored "severe" and had an average of 66 events per hour

I believe someone confused you with ychecker.

[Julie]

Hmm - those two reports are radically different and may have just gotten the wrong names on them before they were sent out. You must check into it.

[xchecker]

Hmm - those two reports are radically different and may have just gotten the wrong names on them before they were sent out. You must check into it.

This was one of my first thoughts - "Did they mix up my data with someone else? Send the wrong report?"

I need to hear from the doctor. None of it is making sense to me at this point.

[Wulfman...]

Having completed my titration study my sleep doctor sent the polysomnography report and prescription to my designated DME. I stopped in the DME yesterday to introduce myself and get a sense of what product lines they carry, etc. The DME staff then came out and said to me:

"Oh, we got your paperwork from the doctor but sent it back. It doesn't meet your insurance (Aetna) standard for treatment. Your AHI was only 3.5 and it needs to be at least 5.0"

I was stunned. At my titration the technician (who had also done my polysomnogram) apologized that no one had gotten back to me about the results and told me that I had scored "severe" and had an average of 66 events per hour. The titration went well and I was excited to get started.

I looked at the Report my doctor sent to the DME and it shows only 2 apneas, 1 central and 17 hypopneas during the entire night of my poly. I can't figure what justified the written impression "Severe obstructive sleep disorder with obstructive/central/mixed apneas/hypopneas..." What justified the expense of the titration study?
Oddly enough when we did the titration I had 20 events just in the 10 minutes I was at 4cm of pressure. By the time they cranked me up to 11cm I only had one in 45 minutes.

I feel misinformed and mislead. I thought I had found the source of my sleep issues and the solution for it. Now it seems all that has been taken away from me. My wife, bless her, said if I really feel like it helps we can just buy the equipment and use it regardless of the test or insurance. Anyway, my doctor has a lot of explaining to do and I am awaiting his call. GRRRRRR!

I agree with your wife.


Den

.

[BlackSpinner]

If they were looking at the titration report - well that was what was aimed for, right?

Get complete printouts of both the sleep study and the titration report. Then call your insurance to find another DME

[Sharrykb]

If they were looking at the titration report - well that was what was aimed for, right?

Get complete printouts of both the sleep study and the titration report. Then call your insurance to find another DME

I agree - it sounds to me like the DME is looking at the numbers from the Titration, which is your TREATED AHI, and it is your UNTREATED numbers that the insurance company looks at when determining whether you qualify for CPAP treatment.

I would be questioning the competency of this DME...

[palerider]

said if I really feel like it helps we can just buy the equipment and use it regardless of the test or insurance.

you'll probably save a lot of time and frustration, and possibly money, going that route.

[xchecker]

Good news! Someone messed up the reports (if that can be considered good) so the DME was seeing my titration results rather than my original test results. I had an AHI of 66.1 on my first test, so the doctor resent that to the DME and now the DME is happy, my insurer is happy and I am happy.

Thank goodness and thank you all for letting me vent over this.

[BlackSpinner]

Good news! Someone messed up the reports (if that can be considered good) so the DME was seeing my titration results rather than my original test results. I had an AHI of 66.1 on my first test, so the doctor resent that to the DME and now the DME is happy, my insurer is happy and I am happy.

Thank goodness and thank you all for letting me vent over this.

Sometimes getting good cpap therapy reads a lot like one of those Quest fairy tales. You have to overcome impossible obstacles but if you make friends with the Salmon, the Ant and the singing Bird you can slay the dragons and wriggle your way to the "Happy ever after"

[Nick Danger]

Good news! Someone messed up the reports (if that can be considered good) so the DME was seeing my titration results rather than my original test results. I had an AHI of 66.1 on my first test, so the doctor resent that to the DME and now the DME is happy, my insurer is happy and I am happy.

Thank goodness and thank you all for letting me vent over this.

Nice catch, Sharry!!

[Sharrykb]

Good news! Someone messed up the reports (if that can be considered good) so the DME was seeing my titration results rather than my original test results. I had an AHI of 66.1 on my first test, so the doctor resent that to the DME and now the DME is happy, my insurer is happy and I am happy.

Thank goodness and thank you all for letting me vent over this.

Nice catch, Sharry!!

It was the only thing that could possibly explain this problem. Well other than just a completely stupid DME, which is always possible too...