sleep study denial

Oliviawashere
on 11/19/14 12:21 pm

I was all set to get my sleep study done this Friday, turns out my insurance denied it for a 2nd time. Now my pulmonilogist is going to try an appeal it... What's the chance that'll happen? Just so incredibly frustrating, that was my last step of the puzzle before I got a date, and now it's setting me back and Idk how much it's setting me back :(

NYMom222
on 11/19/14 12:53 pm
RNY on 07/23/14

Do you have symptoms of sleep apnea? Some surgeons consider it standard, but if you don't have symptoms the insurance company may not. My pulmonologist  didn't make me get one. Even though the surgeon's nurse who goes over the charts (not the actual doctor) balked a little, he sent clearance and that was that. Good Luck.

Cynthia 5'11" RNY 7/23/2014

Goal reached 17 months. 220lb Weight Loss
Plastic Surgery Dr. Joseph Michaels - LBL and Hernia Repair 2/29/16, Arm Lift, BL, 5/2/16, Leg Lift 7/25/16

#lifeisanadventure #fightthegoodfight #noregrets

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poet_kelly
on 11/19/14 7:11 pm - OH

Why did the insurance deny it?

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Oliviawashere
on 11/19/14 11:10 pm

My insurance company believes it's not medically necessary 

poet_kelly
on 11/19/14 11:13 pm - OH

Is it medically necessary?  Do you have symptoms of sleep apnea or something?  Or is it just something your surgeon wants done on all patients, whether it's medically necessary or not?

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Oliviawashere
on 11/20/14 12:11 am

I do not have any symptoms of sleep apnea no. It is a requirment from the surgeon. So I would expect my insurance company to fight it, and after the appeal, I assume it still wont be covered

poet_kelly
on 11/20/14 12:26 am - OH

OK.  I'd talk to your surgeon about it, about why he wants you to have one if it's not medically  necessary.  If he feels it is medically necessary, he should be able to explain that to the insurance company.  If he agrees it's not medically necessary, maybe he will waive the requirement.  Not all surgeons require a sleep study of all patients.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Oliviawashere
on 11/20/14 12:43 am

Thank you, I will talk to my surgeon as well. I know that the pulmonologist is trying to appeal it, and hopefully it will help. For now, the waiting game :) Whats a few more weeks.

poet_kelly
on 11/20/14 1:22 am - OH

I think you'll probably be able to get it worked out.  After all, you can't be the first person with no signs of sleep apnea whose surgeon wants a sleep study before surgery.  I imagine your surgeon is pretty good at getting things covered by insurance.  But also do talk to him because maybe it's not absolutely necessary to have one anyway.  Even if insurance does pay for it, who wants to mess with that if they don't have to?

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Cathy W.
on 11/19/14 10:29 pm

What was their reason for the denial? 

With your pulmo doctor appealing it, that will be more persuasive than you doing it on your own.

Best of luck to you!

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