I'm a 50 year-old woman with no major health problems. I have always been physically active and played numerous sports until a couple years ago. I started experiencing intense fatigue that has gotten progressively worse. I am tired from the moment I get up in the morning. I rarely hear my alarm clock in the morning and oversleep a couple times a week. I've never been a napper. I don't fall asleep while working, driving or watching TV during the day.I am a Technical Account Manager for a technology company. By Friday afternoon I am mentally exhausted and experience decreased cognitive abilities. I stopped hiking and playing sports, because I'm just too tired. Even going to the dog park has become a major effort. I'm just too darn tired. I've gained over 40 pounds the last 18 months. After finding no other underlying medical problems, my family doc referred me to a sleep study center to rule out sleep apnea.
The next week the sleep center called me to schedule a study. The scheduler said she had checked my insurance the study would be covered at 100%. I was busy working and took her word for it. I scheduled the study and went to the center 3 weeks ago. The only person I saw at the sleep center was the tech who hooked me up to all the wires and unhooked me the next morning. The following week I followed up with my family doc. He gave me a copy of the test results, told me I had sleep apnea, and prescribed a CPAP titration study. The next day I called the sleep center. The scheduler setup an appointment and told me my insurance didn't require pre-authorization for a CPAP.
Last Friday night I went back to the sleep center for a CPAP titration test. When I got there, the tech showed me about 6 masks to include full face, provided some limited info, and asked me which one I wanted (how should I know?). I chose the Mirage FX, only because I have a friend with apnea and that's what he uses. At 4am the tech woke me up (I'm barely awake and cognizant). The tech said I didn't breathe through my mouth during the night, so the Mirage FX should be fine. He gave a Resmed Air10 CPAP with some basic information and tole me I should contact them every 3 months to get my mask and filter replaced. When I asked about follow-up I think he said I'd need a follow-up study in a year (this is now probably 4:30am, and I'm barely awake even after a cup of coffee). At that point we were finished, and I left. The only person I saw during this visit was the tech.
These are my concerns.
-Shouldn't I be following up with someone other than my family doctor? I have never seen or spoken to the doctor who interpreted my initial sleep study. I googled the interpreting doctor listed on the study results. He's an ENT doctor at a city 3 hours from here. He's certified in Sleep Medicine and Otolaryngology-Head and Neck Surgery. I have a friend who as apnea. He sees a neurologist.
-Shouldn't I be following up with a neurologist? What if my settings needs to be adjusted? I don't think my family doctor would be following up with. My CPAP is set to a pressure of 6.
I have been faithfully using my CPAP every night for the last 7 days. The machine shows I have a good mask seal and my AHI's range from .5 - .8 every night.
-How could my insurance cover this at 100% like I was told by the scheduler at the sleep center? Possible unethical medical insurance submissions by the sleep center? I have Aetna through my employer. Last week I reviewed my 2015 benefits plan, and it does NOT cover sleep studies or durable goods 100% like the sleep center had told me. My medical insurance covers 80%. Aetna's website even shows what the out of pocket expenses would be for various sleep centers in my area (this center was not listed). 15 years ago some procedures such as outpatient surgery and MRI's were covered 100%. In the last 10 years with the rising cost of healthcare, only preventative healthcare has been covered at 100%. My co-pays and deductibles have increased every year.
My initial study was performed March 7. As of today, the sleep center still has not filed either studies or CPAP with my insurance. Yesterday when I spoke to the nurse at my doctor's office, I told her about my insurance concerns. The nurse told me her husband had previously had a study at the same sleep center. They had been told by the sleep center prior to scheduling the study would be covered 100%, and when their insurance was billed the study was covered at 100%. Something about this just sounds like shady insurance filing practices.
-Reading through the boards, it sounds like I have been given a very limited machine. Shouldn't someone have talked to me about CPAP machine options? It's not like a CPAP is a disposable commodity that can be replaced in a few months.