"please keep me updated about oximeters "
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CPAP Equipment Snafu
I changed providers to Blue Cross recently, and now my equipment provider is saying I don't qualify to be reimbursed for CPAP supplies because although my diagnostic test had me down as "mild" sleep apnea with an AHI of ~9.0, and a subsequent titration sleep study pegged me as having "moderate" sleep apnea with an AHI of 19.3, they say they need to go off the first test results, which would require some other diagnosis (depression, etc.) to justify reimbursement for CPAP supplies. I showed them the doctor's note of cardiac arrhythmias on my sleep study, but apparently that, plus an AHI of 19.3 wasn't good enough for them ;-)
Ok, so it's just a matter of getting someone who's not a total idiot on the other end of the phone and explaining the situation to that person (perhaps the supervisor there). But still, i think if i'm going through this and I know what's up, how many people are jerked around and out of the system because of this kind of incompetence. Makes me angry.
Ok, so it's just a matter of getting someone who's not a total idiot on the other end of the phone and explaining the situation to that person (perhaps the supervisor there). But still, i think if i'm going through this and I know what's up, how many people are jerked around and out of the system because of this kind of incompetence. Makes me angry.
Views: 8
Replies to This Discussion
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Permalink Reply by sleepycarol on
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How was your oxygen destats? I would think that would be a contributing factor as well (provided that you oxygen levels dipped below 90).
In my opinion, I think sleep apnea is a progressive disease and only gets worse without treatment. I know I have probably suffered for at least 15 or 20 years with it. I think it has contributed to my health problems and if it would have been treated earlier I could have avoided some of the long term consequences.
Yet, not one doctor that I ever saw even suggested a sleep study. Not when I was under the care of a neurologist several years ago, not when I was having some problems with angina, GERD, etc. I had to ask my PCP for a sleep study which did order for me. Then I was diagnosed with severe sleep apnea.
Even within the different insurance plans there can be vast differences in the coverage. For many years our insurance company didn't cover any sleep disorders including sleep studies, treatment, etc. Apparently the coverage changed the year I asked for my sleep study as our book still had them as not covered but when I called and inquired they said they would cover it and what they would pay.
Grrrrrrrrrrr!!! Most of us could tell stories about the ineptness of the industry.
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Permalink Reply by Mike on
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Spoke to the rep earlier today, who had on my suggestion spoken to her supervisor to get an answer as to why they needed to go off the diagnostic study and not the titration study, and somehow it's all cleared up now, and they're sending me the equipment and billing Blue Cross. Information is power. Don't take no for an answer.
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Permalink Reply by Judy on
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Good on you for persevering, Mike!!! And good luck w/your therapy. I sure hope you are provided w/a fully data capable CPAP and not just some compliance data only CPAP.
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yes, I have a fully data capable machine, along with the encore viewer software and a smart card reader, and track my data every couple of weeks or when i have a problem, whichever comes first.
my machine is the respironics m series w/a-flex.
Judy said:Good on you for persevering, Mike!!! And good luck w/your therapy. I sure hope you are provided w/a fully data capable CPAP and not just some compliance data only CPAP.
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