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I'm switching from private insurance to Medicare Part B/Medigap on May 1. I've learned from my doctor that Medicare has a more stringent requirement for diagnosis involving a 4% oxygen desaturation level vs the 3% required by other insurance companies. She was looking for the number in my Lofta sleep report, but not finding it quickly, so I offered to call Lofta and find out where it is. I called Lofta and had a very frustrating conversation. They claim that they cannot provide this statistic.
My doctor said that if the Lofta report doesn't include that number, she would give me a home sleep study kit to use after May 1. I'm reluctant to do this because it means, essentially, that I will have a very bad night's sleep without treatment.
I found a couple of places on the report that might be the number I need, but I'm not sure. I'm attaching screenshots with those places marked, and I would be grateful if anyone could let me know whether the number is there.
I'm puzzled by your doctor's stance. Your Lofta report clearly provides data using the 4% rule, separating those data from data using the 3% rule. Please point this out to your doctor! (And maybe get a new doctor?)
The screenshots I uploaded are from two reports that Lofta provided. Which value is it that will satisfy Medicare - pAHI 4% = 60 from the second document? Or is it the oxygen desaturation table, 4-9% 121 + 9-20% (6) = 127 from the first document?
The first document has the same O2 desaturation table as the second, but the first column is labeled 3-9% rather than 4-9%. So unless I had zero events between 3 and 4%, one of the columns is incorrect.
My doctor is great, you should all be so lucky. From my treatment thread:
"To my surprise, the doctor was wonderful. She spent a very long time with me, looked at my data with interest, brought up her own data on my therapy (the ResMed software, I imagine). She was very knowledgeable and thorough, covering everything in detail, including sleep hygeine and possible anxiety from focusing on data (I don't think this is a factor now, although it has been in the past). She said that she did support the BIPAP machine, and would order it through insurance. The DME has already been in touch and they are putting in the request to the insurance company."
Because I didn't want her to waste time poring over my report, I offered to find out from Lofta where the information is (thinking this would be easy). I'm not even sure that she has both reports.
Can someone tell me which number it is that Medicare needs?
