"please keep me updated about oximeters "
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How does your insurance handle sleep apnea?
When I finally got a diagnosis of OSA, I chose to go on CPAP even though my sleep doctor's first recommendation was to see an ENT and have surgery. I was on CPAP for a year until I finally got other, totally unrelated medical issues treated. My medical insurance had no issue with paying for the sleep test or with paying for the CPAP and supplies. However, when I was ready to have surgeries to correct the congenital and non-congenital hereditary causes of the OSA, they required prior authorization that showed that I had tried to use CPAP for at least a year and had difficulties with it (headaches caused by the headgear, as well as chronic sore throat and dry eyes) and that there was reason to believe that the surgery would be helpful (Mallampati class 3/4). After having a septoplasty for deviated septum, and a UPPP, and a submucusal inferior turbinoplasty, I no longer needed my CPAP.
Once I realized that I had been living with OSA all of my life, I realized that my oldest son most likely had it too. I urged him to get a sleep test. When he finally did, he tested positive. In his case, his medical insurance would pay for the sleep test and surgery. He had not been at his job long enough to have any PTO (and there was no short-term disability available) and he did not even want to undergo a UPPP any way. His doctor had ordered Bi-PAP for him. When he went to get one, he discovered that his insurance would not pay for the machine or supplies at all. He told them he could get a CPAP for free (mine since I no longer needed it). They translated his Rx for a CPAP. Then they showed him the cost of supplies. No way could he afford them. They reduced the price as much as they could. He still couldn't afford the supplies. They divided it up into 6 equal installments (no interest). He finally could afford it.
What experience have other people had with their insurance? Testing - covered? Surgery - covered, covered only with prior approval, not covered? Machine and supplies - covered or not covered? Equipment covered in full, after such things as deductibles and copays are considered, or covered only up to 50%?
(PS I'm going to check out if there is an AWAKE around here that can help my son with the cost of supplies since he can't afford replacement tubes and masks.)
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Replies to This Discussion
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Permalink Reply by Banyon on
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Jo E said: When he went to get one, he discovered that his insurance would not pay for the machine or supplies at all.
Who told him that, the insurance company or the DME? Typically insurance companies will pay (after deductibles) for BiPAPs if the pressure requirements are high. What are your son's pressure requirements? Who "translated" the BiPAP script to CPAP?
If the DME told you the insurance would not pay, I would ask the insurance company. DMEs are well known for incompetence and carelessness with the truth.
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