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The Sleep Apnea Money Trail: Surgery

A friend, I'll call him Jason, was diagnosed with a case of moderate obstructive sleep apnea. A tech came to his house, set him up with CPAP and wished him good luck. That was a year ago. Since then, nobody's reached out to him to check up on his treatment, and although he feels better using the CPAP, he has grown increasingly frustrated with being tethered to a machine every night without knowing for sure that it's making a difference. His doctor's response? Referral to an ENT surgeon, who recommends a procedure to modify the structure of Jason's jaw, with the result that Jason's physical appearance would be altered, perhaps for the worse. The doctor claims a high rate of success and a quick recovery time.

Days before entering the operating room, Jason and I spoke and I told him the little I knew about surgery for OSA: that recovery time can be long and that the surgery is often deemed a "success" if it cuts down the magnitude of one's apnea and hypopnea events by 50%, even if you still have to use CPAP after the surgery to stay well. Jason postponed the surgery and asked his ENT for referrals to patients who had undergone similar operations before. The ENT hesitated and delayed, but finally put Jason in touch with another patient.

In an e-mail, Jason wrote: "The patient told me that he ate through a syringe on a liquid diet for 3 weeks. After three weeks, he was able to move to soft foods like mashed potatoes and soup, because he couldn’t eat solids and lost 40 pounds. It took him 2 months to go back to eating normal. The doctor told me maybe a few days to about a week of eating like this." Was the surgery a success? The patient had no idea.

When Jason called off the surgery and asked to be put on a data-capable CPAP machine that would give the doctor and Jason some sense of how his CPAP treatment was working, his physician refused. The reason? "The data capable machines," the doctor said, are "too expensive."

So, let's put this in perspective: on the one hand, we have the option to buy a data capable machine that could tell us how we are doing with CPAP every night so that, if necessary, adjustments could be made to optimize treatment. In a call today to a CPAP provider, I verified that such a machine, the Respironics M Series Pro CPAP, would cost a grand total of $459. They'd even throw in free shipping. And who knows, maybe Jason's insurance would even cover all or some portion of that whopping $459 price tag. On the other hand, we have an invasive, potentially disfiguring reconstruction of Jason's jaw that would leave him sucking food out of a straw for a couple of months, without any assurance of success, and with a cost of, oh, I don't know, maybe a little more than $459...

My recommendation is that Jason follow the money trail to the right answer. His doctor might lose out on the insurance company's reimbursement of thousands of dollars, but Jason might be better off.

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Comment by 99 on October 10, 2009 at 12:26am
follow the money trail is always a go idea and i thourghly agree

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