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Treatment for UARS
I was diagnosed with UARS (6/08) and initially treated with CPAP, resulting in worsening of my symptoms. A mandibular advancement device was recommended (04/09) resulting in immediate improvement of symptoms! Insurance paid the expected 80% on the CPAP and supplies, as well as for the MAD, which was prior authorized.
In 06/09 my husband was also diagnosed with UARS. He opted to try the CPAP, so he was fitted for new CPAP supplies and used my machine. His symptoms have not improved on CPAP and his sleep doc referred him for a mandibular device. The very same insurance company paid for the CPAP supplies. They have denied prior auth on the mandibular device. UARS is described in the current policy, but it does not qualify for medical management, rather only surgical management??????
Has something changed recently regarding treatment of UARS? My understanding was that the interventions are the same as for OSA (i.e., CPAP, dental appliance). This is so frustrating!
In 06/09 my husband was also diagnosed with UARS. He opted to try the CPAP, so he was fitted for new CPAP supplies and used my machine. His symptoms have not improved on CPAP and his sleep doc referred him for a mandibular device. The very same insurance company paid for the CPAP supplies. They have denied prior auth on the mandibular device. UARS is described in the current policy, but it does not qualify for medical management, rather only surgical management??????
Has something changed recently regarding treatment of UARS? My understanding was that the interventions are the same as for OSA (i.e., CPAP, dental appliance). This is so frustrating!
Views: 191
Replies to This Discussion
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Permalink Reply by Steven Y. Park, MD on
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Just write back to point out their inconsistency and also the fact that UARS is a legitimate medical condition that's treated using similar treatment options that we use for sleep apnea. Remind them that untreated, it can lead to or cause a variety of medical conditions such as hypothyroidism, obesity, anxiety, depression, chronic fatigue issues, sinus problems, loss of productivity, and later on may turn into true obstructive sleep apnea, which has it's own long list of complications, including death. Most insurance companies will approve your situation, but multiple appeals are needed. Both OSA and UARS are anatomic conditions and should be treated as such with either CPAP, dental devices, or surgery. Dr. David Lawler has extensive experience with oral appliances and UARS and may have references to back up your letter.
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Permalink Reply by Rock Conner RRT on
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As 99 said, insurance companies can change their rules. There are a number of dubiously qualified providers selling oral appliances with limited success. Their ineffective actions are obscuring the fine work of qualified practitioners of dental sleep medicine. Some insurers have responded to the inconsistencies by pulling back reimbursement for oral appliance approaches to OSA.
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Permalink Reply by SaraLynn on
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Interestingly, according to how the policy reads for UARS, it does not qualify for intervention with CPAP either (only surgical intervention, which is ridiculous as his primary issue is tongue collapse). The only reason he was able to get CPAP was because we owned a very good one that was not being used, and by the way, insurance paid for the fittings and supplies for the CPAP?
Rock Conner RRT said:As 99 said, insurance companies can change their rules. There are a number of dubiously qualified providers selling oral appliances with limited success. Their ineffective actions are obscuring the fine work of qualified practitioners of dental sleep medicine. Some insurers have responded to the inconsistencies by pulling back reimbursement for oral appliance approaches to OSA.
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