Cost of sleep study - Humana

[SarcasticDave94]

Wow that seems bogus IMO. Feel sorry for you regarding their incompetence. Imagine a car lot saying they can't tell you what they'd allow for a trade in until a regional correspondence office in 5 business days informs you what's allowed. Major fail for customer support. I could be way off base, but how can they expect you to believe they don't know what they'll accept as sleep study charges?

[Sleeprider]

Let me offer a few alternative suggestions. Your husband has plenty of symptoms for a doctor to prescribe CPAP therapy and auto-titration based on his symptoms alone. This could be done by is primary physician. Working with your doctor you need to detail the physical symptoms, your observations as his spouse concerning snoring, breathing cessations and anything else. Combined with his physical characteristics (large neck size, obstructed airway and symptoms) your doctor could simply bypass the diagnostic sleep study and prescribe an auto CPAP. It is quite easy from that point to buy an auto CPAP from any of the many online suppliers for much less than the Humana DMEs and save a lot of money.

Alternatively many online DMEs like Supplier #30 offer full home sleep study and prescription services that will result in the prescription. They work with many insurance companies, so check them out. Even if you are covered "out-of-network" with a $4000 deductible you will still be thousands ahead.

All you need is a prescription. You can get it from your primary doctor or an online company like Supplier #30. With an auto CPAP like the Resmed Airsense 10 Autoset, self titration is easy, and this forum can guide and coach your husband through the process. Your total out of pocket including home sleep test, prescription, and equipment will be close to $1000, and a DME like Supplier #30 will bill your insurance so at least you get credited for the deductible. This alternative is less than 25% of what you have been considering. There is no reason for your husband not to get his life back and improve his health.

One final option exists. Look in your local and nearby Craigslist, or use Search Tempest for CPAP machines. You will often find the Airsense 10 Autoset new at less than $500 and used machines for considerably less with no prescription required. There are some risks in buying this way, and you will be mostly on your own except for forum support, but at least you will have treatment.

[AlanE]

Sounds like the run around and I bet not all that information is needed. Just a way to reject the claim. Sleeprider has some good advice.

Imagine a car lot saying they can't tell you what they'd allow for a trade in until a regional correspondence office in 5 business days informs you what's allowed. Major fail for customer support.

Sorry to move off-topic but I had a dealer try to tell me something similar. Paraphrasing: "We can't tell you what we'll give you for your trade in until we see what we can sell it at auction for." Umm... I went to another dealer.

[Renetrips]

Sleeprider, thank you so much for those suggestions - I will show this to my husband.  I just talked with the person at Sleepworks who was trying to check into things for me, and she spoke with the billing person at the hospital, who said the information has to come from Humana.  Of course.   

Attached is a copy of what we did at home with the pulse oximeter.  Maybe since the family doctor said it was diagnostic he would be willing to just prescribe - that would be great!

[SarcasticDave94]

Once again, Sleeprider has the best solution.

FWIW this "we're not able to tell you the price until you commit" actually seems to happen more often than expected. I was about to become a JB Hunt lease driver in '08, when my roommate asked for the prices of the used truck tractors. Answer was "we can't tell you until you sign". Our reply "I won't sign it if I don't see numbers". Oh sorry Dave, you no longer qualify for a job here, you live too far away from our terminal...

Best wishes that you can make some sort of progress Renetrips.

[Renetrips]

Thanks, Dave!  I'm feeling a little more hopeful.  : I have run into this before with pharmacy stuff - "We can't tell you how much it is until we submit it".  It's ridiculous.

[SHargett]

You may have to wait until after the pre-authorization to get the amount they will allow and what you will pay.

Good luck - insurance is often confusing and frustrating!

[Renetrips]

Just heard from the nurse at Humana - the lab study is denied, he will need a home study, which is great with us if treatment can be ordered from that.  If it can and if he uses an APAP, does he still need a lab study for titration?  Might we actually get by with only doing the home study?

[Walla Walla]

You can do a self titration with the APAP.

[sheepless]

but if you want a prescription from them and you want to run it through insurance they'll likely require a night in the sleep center for titration. at least that's how it worked for me with premera insurance.