Florida Blue won't pay for a follow-up sleep test

It had been over five years since my first sleep test, and I was led to believe that after five years I was supposed to get a new machine, which required a new test to prove I still needed it. Maybe that changed, or maybe it was wrong. I was told a year or so ago I couldn't get a new machine because with the Phillips recall, all machines were in too high demand to just hand them out like candy. If mine was broken, I could get one, but it's still working.

"...the requested service(s) does not meet the definition of Medical Necessity as defined in your Benefit Booklet or Contract and will not be covered for payment purposes by Florida Blue for the following reasons:

A repeat Home Sleep Apnea Test (HSAT) is not needed as your Obstructive Sleep Apnea (OSA) was confirmed in the past. Repeating this test may be useful in certain cases when symptoms of OSA return. For example, if you had a change in your heart health status or had more than a ten percent change in your weight... ...Your doctor did not say that you have any symptoms of OSA. For this reason, we cannot approve this service."

I'm waiting for the doctor's office to call back with their opinion.

Depends on the insurance. I had my first sleep test in 2008 (Medicare) that determined that I had sleep apnea. Never had an other until I requested one in 2024. I had 4 machines during those 16 years.

JJR wrote: ↑

Tue Mar 18, 2025 12:26 pm

It had been over five years since my first sleep test, and I was led to believe that after five years I was supposed to get a new machine, which required a new test to prove I still needed it.

Many health insurance policies follow closely the Medicare guidelines. Medicare does not require a current sleep study. They do require a statement from the doctor that you use and benefit from CPAP. And an order from the doctor for a new machine.

ChicagoGranny wrote: ↑

Wed Mar 19, 2025 7:30 am

JJR wrote: ↑

Tue Mar 18, 2025 12:26 pm

It had been over five years since my first sleep test, and I was led to believe that after five years I was supposed to get a new machine, which required a new test to prove I still needed it.

Many health insurance policies follow closely the Medicare guidelines. Medicare does not require a current sleep study. They do require a statement from the doctor that you use and benefit from CPAP. And an order from the doctor for a new machine.

That's what my mother in law did for hers, on Medicare. My wife thinks mine would be the same for some reason.

The doctor's office still hasn't gotten back with me yet.

JJR wrote: ↑

Wed Mar 19, 2025 11:43 am

That's what

What is "what"?

She got a test and new machine, through Medicare. I guess I can wait four more years and do the same.

JJR wrote: ↑

Tue Mar 18, 2025 12:26 pm

It had been over five years since my first sleep test, and I was led to believe that after five years I was supposed to get a new machine, which required a new test to prove I still needed it.

Did you talk to BCBS/FL? Don't think having a new test is required:

I did call them, or it could have been "Carecentrix," their gatekeeper who sent the denial letter.

I can't find what you posted on the Florida Blue website, do you mind pointing me to the source?

Thank you, I’ll pass that along!

The doc’s office said yes the new machine is covered by insurance, but the sleep test is the snag. They’re STILL trying to find the magic spell to release the sleep test from the evil insurance dragon’s lair. Meaning, they haven’t looked into it yet.

Finally heard from the doc, I'm getting a new machine (paid for by insurance) and don't need a sleep study.

JJR wrote: ↑

Tue Apr 08, 2025 2:40 pm

Finally heard from the doc, I'm getting a new machine (paid for by insurance) and don't need a sleep study.

YAY!!

2 1/2 weeks and no machine yet…

JJR wrote: ↑

Sat Apr 26, 2025 9:21 am

2 1/2 weeks and no machine yet…

Are you calling every week? Or just waiting?