Newbie...frustrated, don't even have CPAP yet =/

Hey all,

Quite a journey to get here, let me recap.

I'm a high school teacher, and I was always tired during the school year as I work crazy 12 hour days. My family, friends and girlfriend had always complained about my snoring(last year or so), and I didn't really feel the sleepiness/tiredness until the past summer. Since I was off for the summer, I shouldn't feel that tired after waking up and have no energy to do anything. I decided to seek out an ENT, and after a visit they sent me for a sleep study. You would think that's a smooth process, but the time from the ENT referring me to a Sleep Study Center to them actually calling me back was 3 weeks. I was barely able to schedule the study before I went back to work. Finally, I was diagnosed with severe obstructive sleep apnea.

About two weeks later, I was called back in for a second study so they could determine what settings and such I would need for me CPAP machine. I actually got a great sleep that night and felt like a different person. They told me they would file the paper work with my ENT the following day. This was over three weeks ago, and my ENT still hasn't gotten anything. I have been calling multiple times a day...I can't believe how bad the service is. Now today, I get a bill from my insurance stating that I must pay $1500 of the cost of the original sleep study....are you kidding me? I'm still paying off student loans and trying to move in with my girlfriend, and that is how much they cover for severe OSA? I haven't any idea how much they are going to charge me for the follow up study, let alone the machines.

Sorry to vent but this has been a horrible ordeal. I am so tired of being tired(no pun intended), dealing with poor service, and now I am getting slammed with bills. Is there anything I can do to help with the costs, or the insurance companies don't view this as a major thing?

I would show up in person to get the sleep study results in your hand. Then make appoint with Neurologist they are usually better
to handle OSA. My family doctor sent me to Neurologist.

Hi - welcome to the run around! It's hard, but you're actually doing better than many others who've had to wait longer. As far as money goes - not knowing your particular insurance set-up it's hard to comment (never mind that I'm Canadian ) on the study costs, but a lot of companies, or programs will want you to go on rent-to-own for machines (and masks), which in the end will cost you a lot, so you need to ask your insce. co. if they have any problem with your just buying things outright on your own and then submitting the bills, because doing that is a lot less expensive. What's also important is that you get your doctor to write a script for the machine you want... i.e. a fully data capable one that lets you keep track on your computer, of daily progress - as opposed to what we call 'bricks' (crappy machines) that only track 'compliance'. In other words how often and for how long you use the machine - but that info is useful only to your insce. co. (as you already know the answers), but you want a machine that gives you all the parameters so you can be be really informed about things and be your own advocate (and tweaker) for therapy. But don't tell the MD's or DME's (dealers) you'll necessarily be doing all that - especially the tweaking part - because it makes them nervous when pts actually take control of their own health. Anyhow, welcome again, and expect others to have more to say here.

Oh, and get the full study results (yours by law, if only a copy) and not just the summary.

If your insurance is not helping with paying for equipment;
I have purchased most of my equipment from cpap.com. --at way lower cost than the local scalpers charge.
This is not a paid message, but they do sponsor this forum.

My sleep studies required pre approval in order to be covered. My insurance company also frequently bounces claims for lack of pre approval, when it has actually been completed. Check the fine print on the statement of benefits and see why they denied it. It may be an error, and the claim can be resubmitted. The facility that did the sleep study should have been aware of this requirement.

Good luck!

What is your deductible? What is your co pay after your deductible is met? Will your insurance be doing the rent to own thing or buying out right. If rent to own...your deductible will likely come around January 1 and you will be on the hook for the entire machine rental.
You need to do your homework. You call your insurance and find out for sure what to expect. Don't rely on what a DME might tell you..they can't possibly know all the details of all the different insurance plans out there. You need to do it yourself to find out exactly what they pay, when they pay and what to expect.
See this blog
http://maskarrayed.wordpress.com/what-y ... me-part-i/
and this one
http://maskarrayed.wordpress.com/

That $1500 may be the deductible and the worst of your expenses...I don't know because I don't know your insurance plan.

If your insurance does the rent to own thing (so much each month until you satisfy any usage requirements then you own it) and it goes past Dec 31 for those months (some are 3 months, some are 10 months some are 13 months) then you can expect to be responsible for the entire monthly rental after Jan 1 and the new deductible kicks in. It might be cheaper in the long run to purchase your machine on your own and let the DME just do the mask stuff because you may want to try different masks and they aren't cheap.

If I was paying $1,500.00 they would be putting a copy of the results in my hand thats for sure.

You have been receiving great advice so far.
Now to summarize, Get your complete sleep study. while you are there get a copy of the total bill not just your portion.
Look at the sleep study and ask questions until you understand what it say and means.

Find a knowledgeable sleep doctor, not an easy task. I used the internet to search for sleep doctors in my area, then started calling and found one i liked. You will need to communicate well with him.

Next determine which machine you need/want and get a prescription in your hand specifying the exact band and model and part number of the machine. I did that and they still tried to hand me a lesser machine, but I had done my research and was able to recognize the difference from across the room. The RT acted dumb (acted? benefit of the doubt here) until I had her read the model number on the prescription and the manufacturers info that I had printed from the internet and brought with. She fumbled for a minute on what to say and then went to the warehouse and got the correct equipment. When I asked for the price of the equipment I got stonewalled. They said I was renting and the rental amount was on the invoice, a bit over 10% a month of the suggested full retail.

Find out exactly what your insurance plan covers, your deductible and your copay. Your horse may be gone and the barn burned down, but you will need to figure out where you are going from here. You may also need to learn to negotiate, start with the sleep lab. My sleep doctor has his own sleep lab and only charges $800 for a full sleep study. there was a survey a few days ago on another group apnea board dot com (no spaces) indicating what people pay for a sleep study. You might want to look at that before you begin your negotiation.

Today I called the insurance and discovered I am on a perpetual rental. I currently have no copay on the rental, but the insurance company will be paying for the machine every nine months. People wonder why their insurance premiums are so high. I will be going to an insurance meeting tomorrow to hear about the great enhancements to my current plan for the new year, this topic will come up.

Sory for the novel. Good luck. And ask lots of questions here BEFORE you sign anything else in your quest for sleep.