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Looking for help with insurance coverage - Printable Version

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Looking for help with insurance coverage - 3rdMarDiv - 07-11-2019

Since I've been on CPAP I have spoken to my family about my experiences. My daughter said her husband snores, stops breathing frequently, is drowsy a lot, lack of energy, etc, etc. At my suggestion my Son-In-Law talked to his GP about it and he was referred to a sleep clinic and did the at home study. He learned that yes all of that is correct, that he definitely has sleep apnea. They set him up for a titration overnight and he had to wait 6 weeks, but then 2 days prior to the exam the sleep clinic called and said the insurance cancelled it. (BCBS)

My daughter can't get straight answers from the insurance company nor can the sleep clinic. 

My Son-In-Law works for one of the big 3 in Detroit, but is in limbo for now. The insurance company did say that he could get a machine prescription from his GP. His GP has never dealt with Sleep Apnea much less wrote a script for it. The GP did send him to the sleep clinic originally.

Any help or suggestions would be appreciated.
Thanks


RE: Looking for help with insurance coverage - dmeRT - 07-11-2019

insurance likely did not approve the titration study because it is not necessary. his home study showed OSA so now all he needs is a prescription for an auto cpap. take the prescription and a copy of the home sleep test to any DME. they should be able to help you from there...


RE: Looking for help with insurance coverage - Sleepster - 07-11-2019

Get copies of all of the results produced by the sleep lab. Not just the summary, but all the data.

I suspect that they have not filed their paperwork correctly with the insurance company. Once you have copies of the sleep lab results we should be able to tell you what machine is needed, and what the settings on the machine should be. If he can't get a doctor to write him a prescription for a machine then he can always try to buy one from one of the online providers (we maintain a list here) or he could buy on craigslist. I have gotten some great deals on craigslist, and when I had a machine that wasn't working for me I sold it on craigslist. I even made a small profit after offering it to my friends at cost.


RE: Looking for help with insurance coverage - ColoradoMom - 07-11-2019

Individual insurance policies vary, but I have BCBS and my sleep doc told me that BCBS typically only covers in home sleep studies and an APAP machine (no in lab titration). 
Did your son-in-law see a doc in sleep medicine? If so that is the doctor who should prescribe the APAP machine. 
My personal opinion is that as long as your son-in-law doesn’t have any other medical issues, an APAP titration is actually better than the limited data generated sleeping one night in a lab.
Keep on the sleep lab, he has the diagnosis all they need to do is fax the script to the DME and your son will have his machine in a couple of days. Be sure your son inquires about the policy on masks. Typically if a mask doesn’t work you can exchange it within the first 30 days.

My son and I both have sleep apnea. My son has a Dreamstation and I have the ResMed. Like many on this forum I feel ResMed makes a superior machine. I recommend that your son-in-law asks that the doctor specify a ResMed  Airsence 10 APAP in the prescription.
Also be sure that your son-in-law knows that insurance will require a follow up visit with the prescribing doctor 30-90 days after he starts APAP.
I don’t know if it is typical, but my BCBS plan monitors compliance for the entire 13 month “rental” period.


RE: Looking for help with insurance coverage - 3rdMarDiv - 07-11-2019

Thank you Sleepster, ColoradoMom and dmeRT. You guys are great and I just forwarded your information.  Thanks 

I'll post any activity on this matter.

Sleep-well