Talked to insurance, doctor and DME today, DENIED

[Guest]

It doesn't seem to me that we have all the information here. If you have a letter of medical nececssity from your sleep doctor (for a Bipap) I don't really see an grounds on which an insurance company can deny your getting one. I can see grounds for a letter to your state health commission.

As far as Encore Software goes, first week I checked it every day, second week once and I haven't read the card since.
We talk about monitoring our own treatment, but I wonder how many here actually continue monitoring after the newness of the gadget wears off.

[Slinky]

Just brand OCD on my forehead. I still download just about every day and I do at the very least check my stats via the LED screen. I doubt that I've missed 5 days of doing that since 09 Oct 06. But then even tho my CPAP buddy and my mask buddy and I are getting along well my sleep is still pretty fragmented and we haven't figured out why just yet. I had some PLMs but not that bad and only 2 MAs during my sleep evaluations and titration studies. I forget the number of Spontaneous Arousals and they may hold the clue. I have to get back to my sleep lab/doctor about this and haven't gotten around to doing so. Have been debating getting a second opinion and haven't found any place worth the effort to do so just yet. I had been considering U of M until I read of someone who had their evaluation and titration being done there being saddled w/a bare bones compliance data only CPAP. So much for U of M in my book. That leaves someone I've heard good things about over on the western side of the state.

[ozij]

2.5 years and counting (intentional pun...).

O.

[Wulfman...]

As far as Encore Software goes, first week I checked it every day, second week once and I haven't read the card since.
We talk about monitoring our own treatment, but I wonder how many here actually continue monitoring after the newness of the gadget wears off.

ME! < raises hand >

Almost as long as "ozij"......since I started on 05/14/05. (although my first actual download was a few days after that date)
I can PROVE my compliance and produce a report on each night's data (except the ones when I was sick in the beginning) if I would ever have to.

If any THING or any BODY caused this OC condition, it was my sleep doctor. I was bound and determined to prove him wrong.....and have.
Now, it's just part of my morning routine while my coffee is brewing. Kind of "Ho Hum", but can still be interesting......like a 0.0 AHI (this morning).....and watching trends (since I use single-pressure) or the results from switching from the UMFF to the Quattro (and back). One night last week, I wore my UMFF for the first 4 hours and the Quattro for the last 4 hours.....now THAT was interesting. (doesn't take much to entertain me)

Den

[Sleepdeprived]

[quote="cindyh"]Found out after talking to the ins company today that the have denied the bi pap.. I dont know what to do, they said i cant appeal it, that it isn't medically necessary.. but it is, o2 levels of 68 percent are too low, my doctor had talked to them and given them a letter of medical necessity also.. i guess I will be looking for a used machine?
I am tired of fooling with all of it, especially since my first sleep study was done may 10th.. i know i had the 2 titrations still, but its been a long time. They will be asking for the autopap back soon... The DME said they would talk to them one more time to see if there is anything else they can do, but I talked to them, my doc talked to them and the DME has been talking to them.. anyone know where i can get a good used bi pap that i can use the software with? What all units is the encore software compatible with?
Now, if i was only rich or could win the lottery. You know I have been questioning the autopap, but if it was working well, I wouldn't be tired all day.. There is my answer, nothing has changed on that part.
thanks for all your help