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Seeking advice on how to deal with health insurance company
#1
I was diagnosed with severe sleep apnea 7 to 8 years ago. My health insurance at that time paid for sleep study, cpap, mask etc.

Over the years I saw the doctor once, or twice, when I needed a new mask or tubes etc.

I have used the same machine since day 1 with no problems. I use it every single night.

Now, the machine is not functioning properly. The previous doctor does not take my new health insurance.

The new doctor is dealing with new insurer and won't send somebody to look at the machine or to have a new sleep study done. Instead they want me to do an at home test. In order to do this I can't use my cpap for the night. I think it is a terrible idea.

The doctor recommends me to call the health insurance company and complain.

Anybody have any tips? success stories?

Thank you!
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#2
The qualification for reimbursement comes from the insurance company. If you have old prescriptions or a copy of your original sleep study, it should be no problem to be approved for a new machine. Call them and find out what they need to qualify you for reimbursement or coverage.

An at home sleep study is not the end of the world. I think I have missed very few nights on the CPAP since I started in 2008. Once was last year when I left home without the power supply and was 300 miles away when I realized it. It was not a great night sleep, but I survived, and so will you. The priority is getting a machine ASAP. You might want to check Craigslist and see if someone nearby is selling one at a reasonable price. It's never a bad idea to have a backup, and you should not have waited this long to replace or backup your old S8.
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#3
It's probably something the doc has no control over. It's the insurance company.
They don't want to issue a new CPAP without proof of necessity.

Since your present CPAP is not functioning properly; why not do a home sturdy w/o CPAP?

An option, if you have the former prescription is to buy online -- I bought my second machine from Supplier #2 on the list (top of page.)
You'll get a good deal; but your insurance will not reimburse.

Admin Note:
JustMongo passed away in August 2017
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~ Rest in Peace ~
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#4
Hi Bosmer,
WELCOME! to the forum.!
Hang in there for more responses to your post and good luck getting your CPAP machine situation straightened out so you can get back to good therapy.
trish6hundred
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#5
Call your insurance company and ask them how old the study can be for them to accept it. In addition, ask them if you buy something from another supplier, if they reimburse out-of-network (you still need the study and the doc script). You will get your machine much cheaper this way. If your study falls into that guideline, go to your old doctor and get a copy of your original study. Then, get a new script from your doctor to get an auto-machine. At that point, he can decide whether he wants to add an oximeter and then make adjustments based on your automachine/oxygen levels.

If the insurance company does not accept your old study, then I would suggest you get a backup machine because it may take a month or longer (in my case 4 months) before you have a new machine. You can buy used or your doctor can choose to write you a script. There are some good, lower cost machines at some of our suppliers. The DevilBliss Intellipaper is a good one to choose from. Doesn't have all the bells and whistles of the top two, but it's a good machine with a long warranty.

If you decide you don't have the cash and want the insurance to cover it, you don't have a choice - make an appointment for a home study and suck it up. You need that machine and delays will simply make it that much longer without a machine. You want someone else to pay for something, you have to go through their hoops. I AGREE that once you have sleep apnea, you aren't likely to be cured and you can show from the run hours of your machine that you were a regular user. However, lots of things changed about 3 years ago when studies came out showing that half of patients never use their cpaps after a few months, so more hoops.
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