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Permalink Reply by Banyon on August 20, 2010 at 7:39am

Provigil is FDA approved for treatment of narcolepsy and excessive sleepiness associated with obstructive sleep apnea obstructive sleep apnea-hypopnea syndrome and shift-work sleep disorder. Medicare will pay for Provigil only for one of those three diagnoses.

You indicate your diagnosis is hypersomnia. This diagnosis is insufficient for Medicare. Any appeal will fail.

If your diagnosis includes any one or more of the three approved diagnoses, you should get the doctor to file the letter again showing the correct diagnosis.

If sleep apnea is the cause (you did not say) of your hypersomnia, it should be fairly easy to get the doctor to file the correct diagnosis and get the Medicare claim approved.

BTW, Provigil treats a symptom, what are you doing to treat the underlying cause?

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Permalink Reply by RockRpsgt on August 22, 2010 at 9:20pm

hypersomnia is a sleep disorder and is not always a symptom of bad sleep. Have you had a sleep study Carol? Without one you will not get approved for the meds.

Banyon said:

Provigil is FDA approved for treatment of narcolepsy and excessive sleepiness associated with obstructive sleep apnea obstructive sleep apnea-hypopnea syndrome and shift-work sleep disorder. Medicare will pay for Provigil only for one of those three diagnoses.

You indicate your diagnosis is hypersomnia. This diagnosis is insufficient for Medicare. Any appeal will fail.

If your diagnosis includes any one or more of the three approved diagnoses, you should get the doctor to file the letter again showing the correct diagnosis.

If sleep apnea is the cause (you did not say) of your hypersomnia, it should be fairly easy to get the doctor to file the correct diagnosis and get the Medicare claim approved.

BTW, Provigil treats a symptom, what are you doing to treat the underlying cause?

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Permalink Reply by Carol V. Krantz on August 23, 2010 at 3:37am

Rock Hinkle said:

hypersomnia is a sleep disorder and is not always a symptom of bad sleep. Have you had a sleep study Carol? Without one you will not get approved for the meds.

Banyon said:

Provigil is FDA approved for treatment of narcolepsy and excessive sleepiness associated with obstructive sleep apnea obstructive sleep apnea-hypopnea syndrome and shift-work sleep disorder. Medicare will pay for Provigil only for one of those three diagnoses.

You indicate your diagnosis is hypersomnia. This diagnosis is insufficient for Medicare. Any appeal will fail.

If your diagnosis includes any one or more of the three approved diagnoses, you should get the doctor to file the letter again showing the correct diagnosis.

If sleep apnea is the cause (you did not say) of your hypersomnia, it should be fairly easy to get the doctor to file the correct diagnosis and get the Medicare claim approved.

BTW, Provigil treats a symptom, what are you doing to treat the underlying cause?

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Permalink Reply by Carol V. Krantz on August 23, 2010 at 3:43am

I don't know what the underlying cause of my Hypersomnia is. I spoke with a Sleep Doctor's office & they told me I need bot just an overnight study but, an all day & night study which I think I will do & maybe it will tirn out i do in fact have Narcolepsy & not Hypersomnia. It seems impossible to fight any Governmental entity & yet, aren't we the people, supposed to be the Government? I am thinking of buying a gun as I'm afraid that right will be taken away from us. I believe the rights of Americans are being taken away right out from underneath our noses & we are all oblivious to it. Thanks to all of you for your comments to try to help me. Carol

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