Social Networking

Insurance Issues

Getting a Sleep Study is Difficult

So after much fuss and much confusion, I finally got my sleep study ordered. Apparently my insurance requires that a “Sleep Specialist” order the Sleep Study, so I had to make two appointments, one to go in and see a Sleep Specialist which I’m gonna do on the 4th, and then he will order the Sleep Study.

I’ve had sleep studies before, so I know what they are like. You go in and they glue a bunch of wires to your head and face, put an EKG on you, put a thing on your finger that test your O2 saturations, and attach wires to your legs so they can tell how often you move. Then with all these wires on you are supposed to go to sleep so that they can study how many times you stop breathing, wake up choking and all that good stuff.

Getting this sleep study was a nightmare though I tell you. Since I already have sleep apnea and we know that, there was no need to order a full sleep study, only a sleep study titration, which means they don’t have to prove I have sleep apnea, they only have to test how bad it is to make sure that my CPAP is working and that the air pressures are set right. Since my last sleep study was about 4 years ago, and I currently weight about 60lbs more than I did when they did that study, there is plenty of reasons for my insurance, who won’t cover anything that has to be done pre operative, to cover this. So we asked my Primary Care Physician to order the test.

Once that was done I was referred to two different sleep study centers, both of which were telling me they were booked out till September or October. Oh hell no. I am NOT waiting till October to get this sleep study when it is one of the last things I have to do to mark off all the boxes on my pre-operative work up list. So screw the referrals, I decided I would find a sleep center on my own. Armed with Google I found Northwest Primary Care and their Sleep Health Center in Clackamas Oregon. I called and low and behold they had an appointment the following week. Booked till October my plump butt!

So I have that appointment on the 4th, my last Physiologist appointment on the 9th and my one month follow up after being on this pre-operative diet for a month on the 9th as well, busy! Busy! Busy! My blood sugars are still doing totally awesome! I’ll post some more recent numbers soon for those interested.

Something Other than Waiting!

Alright, so, I heard back from the WLS coordinator at SWMC and we found out that for sure the insurance covers 85% and not 100% so from here on forward this is what we know for sure.

  • Insurance will cover NOTHING pre-operative.
  • Insurance will cover surgery, up to $25,000 Lifetime Maximum so long as all three, Surgeon, Anesthesiologist and Facility are all in network. Insurance will pay 85% of contracted rate, after I’ve met my $300 deductible, up to $25,000.
  • Insurance will NOT cover complications
  • Insurance will NOT cover Post Operative Follow-up

So this is what I have to work with. Now the good news! The journey is REALLY beginning! I have to go in for blood work on Saturday, July 10th, and then I have my first series of appointments on Wednesday July 14th. From what I understand I have quite a bit to do on my appointment on Wednesday, they said I will probably be there for the better part of 4 hours. I’m going to be going to two classes, meeting with the physician and meeting with the nutritionist.

We went over the list of things that my insurance requires I do before they will approve surgery, and the surgery has to be approved before hand or they wont pay, but most the things they require me to do are the same things that SWMC requires that you do within their program. So after my appointment on the 14th, I can expect to have to meeting with a psychiatrist as well. I was also told that I would probably have more appointments with the Nutritionist because I’m going to have to lose a bit of weight before they will send me to the surgeon, my BMI has to be under 60%, and that’s probably going to be about 45lbs I need to lose.  We’ll see what they have to say on the 14th.

My quit smoking date was March 25th so I won’t meet the 6 month no nicotine requirement until September 25th,  so I have a bit of time to get down to what they require, I’ve crash dieted before and been successful, so I have faith that I can do it.

I feel like a huge weight has been lifted off my shoulders knowing that I am finally getting somewhere with this. Thank goodness. I have a few new recipes that I tried out last week that I want to share, but I’ll work on getting those up later this week. Jason is taking the 14th of work to go with me, so that’s awesome.  I’m eager to see what comes next. None of it his happening fast enough, I feel like it’s taking forever, but I know I’m further into the journey than I have ever been before and I’m finding a lot of contentment in that.

Related Posts Plugin for WordPress, Blogger...

Author: Pandora Williams

Author of Desperately Seeking Slender

This is #MyBariLife

BariLife has decided to send me back to Paris to represent the WLS Community as I attempt to find my love of running again.
Please take the time to visit their website and check them out!

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 4,662 other subscribers

DSS on Twitter

Proud Member of the OAC

Grab My Button