Hello everyone,

I am sure everyone here has had insurance nightmares. I have a feeling that I am about to go down the nightmare road with mine....

Back in August when my primary doc referred me to the sleep doc, I found that Sleep Disorders are excluded on our insurance. I was able to get the Dr's to write a letter of Medical necessity for the sleep study. After one cancellation of the study I finally was able to get the first one done in September, with the authorization of the insurance. I knew that if I was diagnosed that I would need to get further letters of justification for treatment therapies. But hey I was just taking it one step at a time, and was happy to get the first study done. I was diagnosed the first week of September with Apnea, and had to schedule the second sleep study, which was scheduled then for this next monday.

I thought with the authorization that I recieved in August was for both sleep studies, then the next time I needed to have medical records and doc letters was after the second, with the tritaion levels and such. Also including the rental vs cost of the cpap.

Yesterday, I JUST GOT the letter of denial from the insurance for the first round of studies, and the doc consult. I was so upset. This was in the amount is about $2500 all together, that I thought would be covered at 80%. I was shocked, and called the insurance company yesterday, and the billing department at the sleep center. The sleep center said that sometimes after the insurance co authorizes, they will decline coverage. WHAT?! I was in a haze for the rest of the day. I called the insurance company, the rep said she would email the processor for further details.

After calming down last night, I started thinking I did not ask specific questions of the Insurance co. So first thing this morning, I called them again. I asked. Did you recieve the letter of medical necessity in August? They confirmed it was recieved. Then I asked, was the first consult, sleep study, and follow up appt authorized in augus?. The Rep was surprised when she found in the notes that they were to be authorized, and then all three were declined after the fact. She then emailed this info to the processor to take a look and reprocess. The rep was suppose to call me back today. I talked to her at 7AM... this morning. I called twice more today, and there was no word.

The last time I called I talked to a different rep. She looked at the notes, and started to say there was no word... Then her tone changed, and she "Strongly encourages me to call my rep early tmr morning." She even gave me her hours and extension #. I got the feeling she read something in the notes that she was not at liberty to tell me. So I am going to call the processor at 7am my time tmr morning to see what the heck is up.

I have no idea what to think. I am trying not to stress out about all of this. There is no way I can afford the first 3 apts, let alone go forward. I am so tired, that I feel like I am in a haze, then the more I think about all this, the more upset I get! I am afraid more so now that they might authorize me for the second round, and then deny it after the fact. Leaving me with $5000.00 worth of doctor bills... not included the cpap and accessories.

In the mean time I am talking to the sleep center. I have to cancel mondays sleep study, (well was suppose to cancel by today) to avoid a $300.00 cancellation fee. But they are letting me have until tomarrow to cancel.

Anyways, thank you for letting me vent. I am sure this will all pass. I am starting the think that the insurance is a legalized mafia organization... LOL just kidding... What are your thoughts on what I can do? I am trying to be diplomatic and kill them with kindness and trying to play their game... but that can only go so far... lol

Thank you,
Janey