Well this is great......my gawd damn insurance denied my CPAP request.....

[a kennedy]

some number was at 4.7 and lowest it should read is 5, don't even know what the hell they're talking about. So......back to the damn drawing board. Sleep Dr. wants me to come to the sleep center clinic and stay overnight to take a better reading then my at home test. I'm just so pissed right now.......told the nurse that called I'd think about it. Damn.

[MOMFUDSKI]

1. Have doc write

a letter to ins co. That is how the game is played now.

[jimfields33]

3. The insurance company wants a sleep study done.

It’s an overnight test. If they have sleep apnea, the insurance will pay. The home test might not be adequate enough to make a decision.

[a kennedy]

20. My Dr. Just sent me this........

The insurance company just takes the sleep data and compares it against their criteria for level of obstruction. Your sleep obstruction is only mild so it may not meet their cut-off. However I think that is they knew that your oxygen desaturations (low oxygen) are severe and that your hemoglobin is high because of it, that they may reconsider. Let's try appealing the insurance company's decision. I am willing to send them a letter requesting the appeal. I have to have your permission to send in an appeal on your behalf. Would that be okay with you?

Otherwise, the other option is to do a more sensitive sleep study that would be overnight in the hospital. It is kind of like sleeping in a hotel but with some sensors attached.

I know all of this is frustrating! For us too. We just want to help make you healthier. Please let me know how you would like to proceed, or if you have any questions.

Sincerely,

So I’m pretty happy with this….think I’ll do the appeal, what can it hurt.

Thanks.

[vsrazdem]

2. Had that happen to me too. I have been on CPAP for about 20 years.

My original numbers were terrible. My doctor thought I should get a new maching and ordered a sleep study. I have Medicare and they said my numbers were just too high for Medicare to approve my machine because the cpap has helped remodel my airway to increase the numbers. They told me to stop using my maching for a month and re-do the test. I still work and told them there is no way I can stop using the maching and be able to stay awake to work my job, so my little old machine is still trudging away after 20 years.

[Hugh_Lebowski]

6. The machines are 100% addictive, once you've used them awhile you cannot sleep without them, period

Just stop using it for 1 month? Yeah, right.

You'll be a freaking basket case within about 48 hours.

What a joke.

[vsrazdem]

13. That's what I thought.

[jaxexpat]

4. The insurance companies don't trust the institutions which they caused to be created........

when they double-speak to their own rules. All for the sake of a few cents additional profit......I mean.........better health care. That's why there are self-administered at-home, tests with flaky results which they employ with scales nudged to their favor. Will they pay for the over-night sleep study? If taken to task I'm pretty sure they have to allow a second opinion.

The over-riding question will be, just how deeply into the Ins. Co's pocket is the Sleep Doctor nested?

Good luck with fighting these SOB's.

[Hugh_Lebowski]

5. When my old one died I gave up with the ins. co and just bought one, wasn't cheap like 850 or so

But when you need one, you NEED ONE and cannot be without it otherwise sleep is nigh-on impossible. It's basically a medical emergency.

My advice is get yourself an Rx for a machine (which I don't know if you already have or not, I did from 10 years prior) and just find a way to buy yourself one outright. Can always submit for a reimbursement from the Ins. Co, worth a try (I didn't bother myself cause I'm lazy). At minimum you may be able to deduct the cost from your taxes depending on the situation.

There's just so much rigamarole dealing with insurance companies and providers to secure the gear. Honestly the whole thing seemed like a total racket. If you can possibly afford to go around them, do it.

[a kennedy]

8. this all started because my blood pressure is high, AND high hemoglobin found out

during a pre medical exam for a total knee replacement. I'm just sick of all the bull shit. Was supposed to get the knee done in March, and here we are now damn near August just trying to get my blood ok'd for the surgery.

[a kennedy]

19. This is from my Dr........sounds encouraging for me.....

The insurance company just takes the sleep data and compares it against their criteria for level of obstruction. Your sleep obstruction is only mild so it may not meet their cut-off. However I think that is they knew that your oxygen desaturations (low oxygen) are severe and that your hemoglobin is high because of it, that they may reconsider. Let's try appealing the insurance company's decision. I am willing to send them a letter requesting the appeal. I have to have your permission to send in an appeal on your behalf. Would that be okay with you?

Otherwise, the other option is to do a more sensitive sleep study that would be overnight in the hospital. It is kind of like sleeping in a hotel but with some sensors attached.

I know all of this is frustrating! For us too. We just want to help make you healthier. Please let me know how you would like to proceed, or if you have any questions.

Sincerely,

So I think I’m gonna go with the appeal……..I thought it was so great of my Dr. To suggest this too.

[Hugh_Lebowski]

21. If you have a caring doc willing to go to bat for you, worth a shot!

Hope it works out

Doing the real sleep test also couldn't hurt it's way more accurate. Probably go to a sleep center for it rather than a hospital I'd imagine but I guess that may depend on availability in your area.

[SpankMe]

7. That number is probably AHI

AHI - Apnea-Hypopnea Index - is the number of times per hour (averaged over the sleep period) that you stopped breathing or experienced an applicable obstructive event that would require the machine to provide enough airway pressure to overcome the deficit of that particular breath.

Five events per hour is the threshold where the doctors think sleep apnea begins. Almost everyone stops breathing a couple of times an hour. When the number of times hits five, they say you have sleep apnea and qualify for treatment (CPAP).

The home test isn't as accurate as the sleep lab. So, if the home test is borderline, they'll order an in-clinic overnighter.

Definitely do the sleep lab bit. If you're having other symptoms of sleep apnea, it's worth the extra effort to get it treated.

[a kennedy]

9. ......"The home test isn't as accurate as the sleep lab. So, if the home test is borderline,

they'll order an in-clinic overnighter." Yah, this is it I'm sure. It's just that I'm sick of all the BS. and thanks.

[ms liberty]

23. This. My test showed I stopped breathing17 times per hour

They called that moderate, lol. But it did get me a CPAP machine!
I'm a crescendo snorer, just like my mom was - so when my husband started bugging me about it, I knew I couldn't ignore him.
Editing to add, that was the home test; I didn't have to go to the sleep lab.

[Laffy Kat]

10. Keep trying. They'll eventually change their mind.

They like to make everyone miserable first.

[OrlandoDem2]

11. American health care. Ugh. We need Medicare for All or a public option.

[Wonder Why]

12. Do a real sleep test. Your home one is not likely as accurate nor

able to properly tell the difference between obstructive apneas and central apneas.

Obstructive - your airway is obstructed and that's pretty obvious to detect. My wife, in 2005, said I would stop breathing then suddenly start again. Sleep test easily confirmed it.
Central - your brain forgets to breathe momentarily. Very dangerous. My central numbers were high enough that, by themselves, justified the machine. Bad for the heart.

VERY foolish not to have the test. I've now had it multiple times. No pain, no day lost from work. No invasive procedure. They just have you sleep with a machine and you should also be able to decide what is best mask for you. The latter is critical to successful use.

You have to be persistent to get used to it or you will be one of the many people who just give it up. For the first month, I could only use it for 2 hours before taking it off for the rest of the night. A month later, I was up to 4 hours. A month after that, all night. Never looked back.

I had 30 apneas/hour in original test. My younger brother had 100!

Interesting story (at least to me): I got the CPAP just days before I went to NOL for Katrina as a Red Cross volunteer so I decided not to take it. BIG MISTAKE! The first night, they put about 60 of us up in cots in one big room (men & women intermixed) at an old K-Mart then sent us to our assignment. I slept just fine without it but the next morning everyone was complaining that someone snored all night and they couldn't sleep. I just slunk in the corner as I knew who was responsible as my wife had complained for many months about how loud I was. Needless to say, in my second tour of Katrina and all other tours to disasters, I took my CPAP. In the first Katrina tour, they assigned 2 to each hotel room but I was accidentally assigned with a woman who had a male-sounding name so they immediately gave us a room to ourselves and forgot so I had a private room and wasn't murdered by an angry roommate. On the second tour, my male roommate had issues so was sent home after a few days and, again, I was by myself. After that, I was fully used to the machine for all future disasters and never snored again so my bride of 51 years didn't smother me with a pillow.

[Warpy]

14. OK, that's a pretty small discrepancy, especially on a home test

so you should be able to fight those cheap motherfuckers and get your CPAP.

The sleep center test will be definitive and you can bet those cheapass shitweasels will get a call from your doctor

Please do the sleep center study. If you've got significant apnea, it can save your life.

[WhiteTara]

15. It will be okay

it may take longer than a minute, but your official sleep study will show you need it. These companies don't want to spend money and PAP machines cost some. Your doc will make it happen. Hold on and don't fret, it will be okay.

[a kennedy]

16. ♥️ thank you, I'm just not needing this now.

[WhiteTara]

17. We are all on edge and I share your

anxiety. Might be different things, but still the same. The oppressive heat, the unbearable waiting and the unholy watching all the ills and sins are coming home and it's hard to stay calm. I know. I had a meltdown this morning. The repair will take time. My anger is my downfall and sometimes it comes a deep cruelty of the spirit. It makes me cry.

[a kennedy]

18. ♥️ ♥️ ♥️

That’s all I do now is swear and cry. Thank you so much for your kind and supportive words.

[WhiteTara]

22. Fortunately I have a bit of a practice and when

I'm overwhelmed, I chant.
Om Mani Padme Hum
Behold the Jewel in the Lotus
(The lotus grows in mud and has to search its way to the surface to bloom into a fragrant flower.) So, I try to see what is the Jewel in my present moment as I am stuck in the Mud.

I also chant to Tara
Om Tara Tu Tara Turae Soho
Oh Tara I call on you for solace and wisdom and to calm my aching heart, so may it be.

When I am chanting I can't focus on the silly impermanent phenomena that is arising in my mind and before me.