(02-28-2015, 12:22 PM)Luxsit5280 Wrote: Anyone who has dealt with Insurance understands that the experience can be trying and painful at times. I first met with my PCP in November to discuss having a new sleep study done. It is important that along the way, you work through the process with your PCP, Sleep Center, DME and Insurance. I had to have two studies done, I was trying to get everything done by the end of last year, but the process took more time than expected.
Here's some things I learned:
If you get a referral from your PCP for a Sleep Study, call your insurance to check to see that the Sleep Center is in-network. If not, you are going to have an uphill battle.
Ask the Sleep Center which DME they work with? Some Centers push patients to specific providers, who may or may not be in-network for your Insurance.
Check out the proposed DME, look them up on BBB, do they have a supply program - where they ship you CPAP supplies on a 90 day cycle. The better ones do.
When you get the Sleep Study done, ask for a follow-up appointment with the Pulmonary MD. You should tell your Pumonary MD any other medical issues you have, Obesity, Hypertension, Heart Issues like AFib, Diabetes. These all need to go into the report that they write. You should get a Prescription that should have the type of Machine: CPAP/BiPAP and type of mask: Nasal Pillow, Nasal Mask, Full Face Mask, and your pressure setting. Make sure they don't put specific model/manufacturer on the prescription, this leaves you more flexibility in picking the equipment. You should get a copy of the Sleep Study and the Report from the MD. The report needs to have the correct codes.
Choose a DME, for some the choice may be limited to in-network providers. I use an out-of-network DME. I am not going to say why other than we have an arrangement that benefits us both. Some DME push certain equipment. Do some research, read the equipment reviews here. There's plenty of good information to help you choose. Most DME can order equipment that they don't normally carry.
I had a second BiPAP study done in mid-January. It took almost another month to get all the paperwork from the Sleep Center to the DME in a format they requested. It took a long time for the Sleep Center to post all my claims to my insurance. It took about a week and a half to get paperwork straightened out between my DME and Sleep Center. It seemed to be more painful that it should have been. Get the name of the contact with your DME, and talk to them weekly about the status. They are working on multiple patients at one time, and the squeaky wheel get attention. Don't be an a-hole, they are doing their job. Glacier speed it seems at times
Be patient, be persistent, be respectful...
Thanks for the advice, Lux. Apart from yesterday's experience, the rest of my experience over the past 3 months has been good, except for minor annoyances such as not being able to directly connect with my particular branch of the sleep clinic and limited office hours. I got reports of my sleep test and titration on both follow ups and I like my doctor.