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[Treatment] BCBSTN Denies Sleep Apnea Surgery
#1
Quote:Your doctor asked us to decide if 30520 Septoplasty, 30140 Submucous resction inferior turbinate, 42826 Tonsillectomy for treatment is covered by your health plan.

Based on the terms of your health plan, BlueCross BlueSheild of Tennessee did not approve the predetermination for:

septoplasty and Submucous resection inferior turbinate indicated for nasal obstruction when patien has received maximum medical treatment for symptoms and tonsillectomy is indicated when concurrent uvulopalatopharyngoplasty is being proposed for treatment of tonsillar hypertrophy and mild sleep apnea.

So, I just received the above letter. I haven't spoken to the doctor/hospital, yet going to the best 'hospital' in Middle TN. The doctor told me I would getting the UPP surgery and a septoplasty.

Any way I could an appeal? My deviated nasal spectum is actually from a car accident, and the surgery I had, I guess didn't correct it fully ten years ago.

They also state I have mild sleep apnea, when it is actually severe sleep apnea.

Or would I not have a chance at an appeal.
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#2
If you have severe sleep apnea, have you tried xPAP?

I have severe sleep apnea. My doctor in Houston would only refer me for surgery. Here in Kansas, I was sent for a sleep study. APAP has solved my problem without surgery. For me, a much better option.

Jeff
Sleep is worth the effort.
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#3
(11-12-2015, 06:52 PM)NashTrat Wrote:
Quote:Your doctor asked us to decide if 30520 Septoplasty, 30140 Submucous resction inferior turbinate, 42826 Tonsillectomy for treatment is covered by your health plan.

Based on the terms of your health plan, BlueCross BlueSheild of Tennessee did not approve the predetermination for:

septoplasty and Submucous resection inferior turbinate indicated for nasal obstruction when patien has received maximum medical treatment for symptoms and tonsillectomy is indicated when concurrent uvulopalatopharyngoplasty is being proposed for treatment of tonsillar hypertrophy and mild sleep apnea.

So, I just received the above letter. I haven't spoken to the doctor/hospital, yet going to the best 'hospital' in Middle TN. The doctor told me I would getting the UPP surgery and a septoplasty.

Any way I could an appeal? My deviated nasal spectum is actually from a car accident, and the surgery I had, I guess didn't correct it fully ten years ago.

They also state I have mild sleep apnea, when it is actually severe sleep apnea.

Or would I not have a chance at an appeal.

I've been successful on appeals. Your doc would need too write a great letter; and back it up with data.

Some insurers pro forma deny on first request. Then approve on appeal.
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.
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#4
G'day NashTrat, welcome to Apnea Board.

I don't know about the complexities of the insurance rules, so I won't comment on that. However I second Jeff's advice about considering CPAP if you haven't already done so. We've had quite a few members on the forum who have found the surgery either unsuccessful or only partly successful. It's also (apparently) very painful. CPAP therapy is relatively cheap, non-invasive and (usually) very effective.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
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#5
Hi NashTrat,
WELCOME! to the forum.!
Hang in there for more suggestions.
Much success to you.
trish6hundred
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#6
When I had BCBS they denied everything and had to be fought for everything. major PITA. That was about a decade ago... but they ate all my good will for a century!
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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