Not sure where to turn

dasuchbe · Post by **dasuchbe** » Mon Oct 23, 2006 4:55 pm

I have suffered with sleep problems for years. My wife and others tell me I snore terribly and that I stop breathing while I sleep. I wake up sometimes every 30 to 60 minutes. I am tired all of the time. If I sit for extended times, I have trouble staying awake. I have nodded off a few times while driving. I think you know where I am going.

After much discussion, I convinced my doctor to reccomend me for a sleep study. I am overweight ((350#)) and my doctor felt that this was causing the apnea. But I convinced her to let me get help with my sleeping to give me energy to get active again.

Anyway, I was scheduled for a sleep study tonight. I took off from work early to get ready and to pre-certify with my insurance. Thats when they told me that my insurance does not cover the study.

Now I do not know what to do, I cannot afford the 3000 for the study.

Does anyone know of anyplace that I can turn too? I am in that damned loop hole that I make too much money for SRS and not enough to pay for anything.

I AM NOT looking for a handout, don't get me wrong, I just don't know what to do now

cflame1 · Post by **cflame1** » Mon Oct 23, 2006 4:57 pm

cpap.com has a new sleep strip system for $150... if results show a need they will prescribe an APAP

Snoredog · Post by **Snoredog** » Mon Oct 23, 2006 5:00 pm

you are just in time:

viewtopic/t14578/At-Home-Obstructive-Sl ... lable.html

It has a link to order the test strip, but the above explains it.

dasuchbe · Post by **dasuchbe** » Mon Oct 23, 2006 5:17 pm

But that does not help me to pay for the equipment. They said that they cover NOTHING. Not even the prescription

SelfSeeker · Post by **SelfSeeker** » Mon Oct 23, 2006 5:22 pm

dasuchbe,

Sorry to hear about your problem.

Do any county hospitals do the sleep lab test?

Do a search for financial aid or getting machines. Someone posted a similar question and there were ideas or places to turn.

Good Luck.

Guest · Post by **Guest** » Mon Oct 23, 2006 5:28 pm

The biggest drawback is that there will basically be no way to get a cpap covered without a Sleep Study.

I would call your insurance and ask to speak with a case manager or someone similar who can help you try and work out how to get special approval for the test and for the cpap.

If your insurance does not cover either a cpap or the sleep study (And I would be really supprised if there was no way to gain coverage for either) then I would speak with the doctors office staff to see if they can suggest any routes to go down to get donated or low cost equipment.

kreesti · Post by **kreesti** » Mon Oct 23, 2006 5:55 pm

dasuchbe-

I am sorry to hear about all the problems you are having. I don't know why insurance won't cover the test... treating sleep apnea helps lower blood pressure, decreases risk of all sorts of other complications. it is so shortsighted of companies not to cover this. Is there an appeals process through your insurer? It also sounds like your Primary Care Provider is not very up-to-date on the issues re: sleep apnea... if she doesn't think the test is necessary, she's not going to be much of an advocate with your insurers.

I would talk to the insurers directly about the sleep study. alot of the time you will get a different answer as a subscriber/member if you ask directly (work the system) vs. just letting "the system" work for you... if they still say no directly to you, find out what the appeals process is... this type of preventative medicine is just the sort of thing that should be covered... apnea and weight gain can be a "chicken and egg" process that results in increased apnea and increased weight gain. - I am not saying you shouldn't be working on losing weight, I am just saying that being apneic makes it really hard to have any energy to do so.

I agree with "guest" that the insurers should cover the test and/or the equipment.

You could also look for a university hospital or medical school in your area if you don't have luck with your insurance...

also, if you can switch plans to another plan through your job that covers the testing, that might be an option, too. Sometimes the higher premium (or higher deductible) pays off in the long run. That might take until your next open enrollment period, but it's worth considering.

Also, FYI, even if you did qualify for SSD (soc sec disab.) it's two years before you're covered under medicare.

Such fun... of course, we can always hope blowing winds of the economy and politics (i.e. health care costs for GM add $5000 to the cost of every car) will finally turn into a groundswell of support for some sort of universal/minimum coverage (not exactly your problem, but being a nurse, I had to toss that in.)

Good luck.

buckeyered · Post by **buckeyered** » Mon Oct 23, 2006 6:22 pm

The sleep study is costly, even with my insurance I still had to pay out of pocket around a thousand dollars, the equipment was also covered by my insurance but the out of pocket part of it was very high as well.
I did all the above before I found this site and did a lot of reading and help from it's members and I have learned more here than any of my sleep studies.
I now know I can buy the equipment either used from members here or new from cpap.com and it will usually be cheaper than my co-pays. With this new service from cpap.com you could use it and let them prescribe what you need and then buy the equipment from cpap.com, yes it will cost you but I think it is cheaper for me to do it this way than go through my insurance which is changing Jan 1st so I don't know if my coverage is going to get better or worse.
I would still go up the chain with your insurance to make sure you were not given incorrect information.

dasuchbe · Post by **dasuchbe** » Mon Oct 23, 2006 6:31 pm

I work for a fairly large company, 350+ employees. But I live in south eastern Kansas, so nothing is close.

My wife reminded me that one lab we spoke to checked my insurance and that they were told it did cover it, so I am going to follow up on that. The problem is that the lab that DID get told the sleep study was covered was at a hospital that is out of my network.

Thanks so much for the ideas so far. I have found the AWAKE website and am going to look into that as well as yelling at my insurance company AND MY EMPLOYER!

This is so rediculous that we pay so much for insurance then they are denying us at EVERY TURN!! I am so fed up with it.

CRMW · Post by **CRMW** » Mon Oct 23, 2006 7:07 pm

Well if worse comes to worse.

New Equipment from CPAP.COM
Sleep Strip test - $150
CPAP GoodKnight 420G - $255 (Would have to confirm APAP not required with Sleep strip test)
Mask FlexiFit HC431 - $110 (Fits the most people as it comes with 3 sizes of seals)

Total - $415 ($580 if you want a heated humidifier)

Another option would be used equipment.

CRMW

justplainbill · Post by **justplainbill** » Mon Oct 23, 2006 7:30 pm

I am not sure whether this would be a useful resource for you or not, but I did run across a reference regarding a group called Awake in America which reportedly helps arrange sleep studies and/or equipment for people in need. A link to them (courtesy of the American Sleep Apnea Association website) is: http://www.awakeinamerica.org/DonateRelief/

This is about the full extent of my knowledge of this group. Perhaps some other members may know something more about them.

Best wishes in any case,
Bill

Guest · Post by **Guest** » Tue Oct 24, 2006 4:52 am

CPAP.COM has very good prices on the PAPs.

Get the study from them if you can work that into your budget, then go to yahoo auctions and get a machine if you canot afford one from cpap.com..

You can get a good macine at good prices.
Auto papa go for about 250.0.

plain cpap sometimes for 75.00 to 200.00.

an APAP will help if you cannot afford a titration study.
There ARE ways top SAFELY treat your consition.

northernlights · Post by **northernlights** » Tue Oct 24, 2006 8:23 am

It still amazes me that the world's richest country cannot provide this type of medical care for its citizens. I find this a pitiful situation for someone to be in. You obviously need this treatment, but have these financial obstacles in your way. My heart goes out to you. Certainly its not my intent to gloat, but thank god I live in a country where not only are yearly sleep studies paid for by the gov't, but the equipment as well. Its no wonder that my wife became a Canadian citizen last month (she's from Baltimore).
Best of luck!

Steve.

KansasRT · Post by **KansasRT** » Tue Oct 24, 2006 8:26 am

I would talk to your DR about these issues. Some sleep labs do a certain number of studies every month at no cost, or low cost. Also, some sleep labs in my part of Kansas offer charity care that will cover the study. As far as equipment, some DME's in this area have given away used equipment for free, or new equipment at a really reduced rate. I know personally that I work with patients to get them what they need. If you don't mind elaborating, what type of insurance do you have? I am working with other Dr, RT and PSG tech's to get sleep studies and treatments covered.

Guest · Post by **Guest** » Tue Oct 24, 2006 1:23 pm

You might also look on Yahoo cpap auctions.

Mask

Additional Comments: 16 cm x 14 cm