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Insurance denial of CPAP machine for UARS
My physician recommended the use of a CPAP machine for my UARS (Upper Airway Resistance Syndrome). Living in India, the machine was expensive - $1,600. My insurance has denied the purchase of the machine, giving this response "CPAP for the treatment of patients with upper airway resistance syndrome (UARS) as treatment of UARS are considered experimental and investigational; therefore not considered medically necessary." Determination of need seems to be based on the AHI index, which isn't applicable to UARS.
Has anyone else had this experience? If you submitted an appeal were you successful? Any tips?
Has anyone else had this experience? If you submitted an appeal were you successful? Any tips?
Views: 49
Replies to This Discussion
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Permalink Reply by Daniel on
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I have heard of this type of denial before. Your physician can write a letter that you can show your insurance company, but I wouldn't be terribly optimistic that they'll change their mind.
If the cost of CPAP is going to come out of your own pocket, perhaps you can save some money by purchasing the device online. It sounds like your physician is sophisticated about sleep and may be able to provide the support you'd be missing from a bricks and mortar provider.
Daniel
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Permalink Reply by Mike on
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you can get one of the top of the line machines for half that price buying from one of the US online retailers. i wonder also whether if you go in for another sleep test, say when you're congested or something, whether the UARS would switch on the continuum to full blown apnea. it's a fine line, as i understand it, and different tests on different days might yield different results. that said, if i were you i'd go with dan's suggestion and buy a machine online.
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