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Sleep as Mental Disorder for Insurance Coverage?
correspondence I'm having with a user about insurance coverage -- anyone else have thoughts?
Q: How's it going Mike. I ran across a post of yours while searching for other peoples experiences dealing with my insurance company (Anthem) regarding sleep issues. While I don't believe I have sleep apnea, I recently found out I have severe RLS during sleep (called periodic limb movement disorder) which makes me tired even after a full nights sleep. I have yet to see a specialist about this because I'm unsure of how it's covered by insurance. You stated in the post I found that you have Anthem Blue Cross of CA and PPO (which is exactly what I have) so I'm curious about a provision in the plan. It states that doctors visits for "Mental or Nervous Disorders" are excluded from a copay and they only cover $25 toward your visit. Are sleep disorders included in this? If I see a psychiatrist or neurologist will those visits be excluded? Is a sleep study excluded as well? What's your experience with dealing with insurance on all this?
A: good question. i don't think restless leg syndrome would be classified as a "mental or nervous" disorder for purposes of your insurance. i had no problem getting everything covered for Sleep Apnea, including the sleep study. I don't think it matters whether you see a neurologist or a psychiatrist. I'm throwing this up for the general group to see if anyone else has thoughts.
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Replies to This Discussion
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Permalink Reply by RockRpsgt on
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You just gotta love Anthem don't ya. I have been with them for going on 5 years now. When things go smooth I believe that I have the greatest insurance in the world. When they are bad I feel like a circus freak jumping through hoops. They have not only made it difficult for their clients, but for us medical practitioners as well. You have to be very careful when dealing with them.
Many things can cause PLMS. Vitamin defficiency, kidney problems, and a central nervous system disorder are just a few of the initiators of this disorder. I would not consider any of these "mental or nervous disorders." PLMS can also be an early warning sign for alzheimer's, Parkinson's, or dementia. I am no MD but I would have my sleep evaluated if I were you.
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