Sleep Study Expires?
Just got a call from my PCP stating that my insurance company will require a new sleep study to be done in order to justify my continued use of my CPAP device. The original split study was done in October of 2013. The brick machine I was issued at the time has been replaced by my current device on the advice of my PCP, who specializes in sleep medicine.
I know that sleep apnea is not "curable" per se but controlled through weight loss, surgery, and of course CPAP therapy. I'm curious as to why I have to go through another study to continue my treatment.
RE: Sleep Study Expires?
Have you changed insurance companies?
You would be wise to call your insurance company directly (not take a DME’s word) and ask what the requirements are.
How did you get your current machine without insurance approval?
RE: Sleep Study Expires?
If you have a copy of your last sleep study (you really should), you can contact your insurance company and request that they approve your new machine based on the previous sleep study. It would save them money and time. Since you can offer them the evidence of your original diagnosis, they would be wise to avoid this cost and inconvenience. I would not necessarily assume the doctor provided them this information, and they may not have it in their records, thus the need for a study.
If they do end up requiring a new study, just 5 years after your last study, please drop the name of the insurer, so I know who to avoid.
RE: Sleep Study Expires?
The original machine issued following the sleep study was paid for by my insurance company, and partially myself through co-pays. The insurance company I had at the time of the NEW machine issue was Coventry, Medicare supplement plan. It was prescribed by my PCP in August of 2017 and approved. He arranged everything with Coventry and I was shipped the current machine in September which I'm using now. I met the compliance requirements and everything was good.
I have since changed insurance during January open enrollment because Coventry was dropping my doctor and several of my meds. I am with Preferred Care Partners now, also Medicare supplement. I haven't figured out who is requesting the sleep study, but I did get a call from the DME (Apria) telling me I needed to see my doctor and discuss my CPAP therapy. I'm sure they are aware of my compliance because I was getting regular emails from Apria telling me how well I was doing with the therapy.
RE: Sleep Study Expires?
(02-22-2018, 12:03 PM)Sleeprider Wrote: If you have a copy of your last sleep study (you really should), you can contact your insurance company and request that they approve your new machine based on the previous sleep study.
If they do end up requiring a new study, just 5 years after your last study, please drop the name of the insurer, so I know who to avoid.
Sadly I don't have a copy of my original sleep study. I didn't think to get one at the time, but I'm sure the clinic where I had it done still has it. I never thought I would have the need for this information way back then.
This begs the question of why wouldn't whoever is requesting the new study just contact the clinic for a copy of the original.
I think I might need to contact both Apria and Preferred Care Partners and find out what the problem is.
RE: Sleep Study Expires?
My sleep study was performed 17 years ago. I have changed insurers twice since then and DMEs as well. I had no problem getting a new machine last year.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
02-22-2018, 04:17 PM
(This post was last modified: 02-22-2018, 04:22 PM by SarcasticDave94.
Edit Reason: additional info
)
RE: Sleep Study Expires?
Silly me, I thought the 99 year script should have covered you (yes I have both PSG and script). I guess your change of insurance companies may have caused this. Advise you get a big cup of coffee while dealing with the remotely located infamous Apria customer service. I know from experience, you'll be on the phone for about an hour each time you call them. Nevertheless, some of their CS agents really do a very good job of helping.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Sleep Study Expires?
I have a feeling there is a communication issue somewhere between my Apria and my insurance company.
It's very difficult to get proper information from my PCP office due to a language difference (strong Hispanic accent) and it doesn't sound like the girl I've been talking to has a full understanding of what's being asked. I will be visiting the office soon, so hopefully I can get more information then.
RE: Sleep Study Expires?
(02-22-2018, 04:17 PM)SarcasticDave94 Wrote: Advise you get a big cup of coffee while dealing with the remotely located infamous Apria customer service.
I agree, Dave. Coffee seems to even out even the most exasperating experience.
I will go fully armed for the occasion.
02-22-2018, 04:26 PM
(This post was last modified: 02-22-2018, 04:26 PM by SarcasticDave94.
Edit Reason: typo
)
RE: Sleep Study Expires?
(02-22-2018, 04:22 PM)upsman Wrote: I have a feeling there is a communication issue somewhere between my Apria and my insurance company.
It's very difficult to get proper information from my PCP office due to a language difference (strong Hispanic accent) and it doesn't sound like the girl I've been talking to has a full understanding of what's being asked. I will be visiting the office soon, so hopefully I can get more information then.
Your feeling is being confirmed by me, at least the Apria portion. Some of their Customer Service calls are handled off shore. My resolution was to make multiple calls until the issue at hand was resolved.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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