Thursday, September 1, 2016

Sleep Apnea Redoux

Insurance is great.  It covers the majority of a health issue, but it’s not without its headaches.  Here’s the lowdown on my sleep study drama.  (and only because I am in a whining mood about it all)

Saw the surgeon 7/7/2016.  Was given a list of appointments that need to be taken care of before we can submit everything to the insurance company.  Included in that list was to see a pulmonary physician.  I didn’t hear from anyone on this referral until I started making some calls to see what the hold-up was.  They finally called around 8/9 and said they wouldn’t be able to fit me in to see them until 9/14.  I freaked out a little bit because this was 6 weeks out away and I had already waited 4 weeks just to get the call from them.  I called the surgeon’s office again and they found me another pulmonary doctor, in a nearby town.  His office scheduled me in for the consult 8/11 and my sleep study was completed 8/12.  I was scheduled to follow up with this same doctor 8/24.  So, at this point, I have been playing the waiting game on this issue alone for 7 weeks (which would have been 10 weeks without the 2nd referral).

Now the results are that I have mild apnea.  The doctor tells me he wants to send a referral to the medical supply company to fit me for a cpap.  This is 8/24.  The assure me it should only take a couple days to hear back from them, once it is submitted to insurance for approval.  I wait until 8/29, and call the doctor again.  They tell me they submitted the information, but the insurance is denying the request because my apnea isn’t severe enough to warrant what they are asking.  (in other words, they don’t want to pay).  I am told they are going to send over more information that will include my other comorbidities and it shouldn’t be a problem.  (why wasn’t this done to begin with?)  So, today, 9/1/2016, I still have not heard anything so I call the doctor again.  I once more get the run-around, as expected, but finally the medical supply company calls me to say that they finally resubmitted to the insurance yesterday.  They expect a result in 7-10 business days.

The caveat to all of this is that the doctor is requiring 30 days of usage on the cpap that is positive before he will give me the approval for my surgery.

I also call the surgeon’s office, because I have not heard a peep from them since I saw them 7/7 and am not very sure they even still have me in their file since I haven’t been having monthly appointments with them to follow up on weight loss, etc.  The doctor’s nurse calls me and tells me she will have the insurance coordinator give me a call today and she can go over the details with me.

I speak with Sandra, she’s very nice and understanding and assures me that I am still on their list, she knows I want to get this show on the road, but any diagnosis of sleep apnea is serious and the surgeon will NOT allow anything to be submitted until that is resolved.  She tells me that once I get the cpap, and find that it’s working really well, (2 weeks) I should call the pulmonary doctor and see if that is enough information to give approval.  I tell her that I don’t think this doctor is going to change his policy for me.  However, I do ask her, if I am able to get the all clear on the sleep apnea….how soon could I get my surgery.  Her rough estimate was NOVEMBER.  So….I am fine with that.  I just want the rest of this to go a bit more smoothly.

I know everyone has a lengthy process to be qualified for this surgery.  I didn’t realize it would affect my emotions so much.  But I sure am on a rollercoaster!


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