Alwyn - Treatment Analysis

[alwyns42]

Thanks Sleeprider,

The weird thing is my stats are not that bad when I go back to my lower pressure which was 7, BUT then I don't feel refreshed and full of energy.


I am insured and in the 'lucky' position that my deductible has been reached already.  Problem is I recently got surprise billed by a Mayo sleep doctor and have to foot a $1k bill because my insurance don't want to budge.

I have a sleep study scheduled with them in 10 days (they think I can maybe go off CPAP, but the data they looked at was much better at that time), but I am thinking of finding other sleep doctors and scheduling with them which might incur 2 - 3 month delay.

Reasons being:
1) The local Mayo doctors are not really impressive (have poor ratings), and like I said they do surprise or balance billing even though I'm covered for Mayo itself.
2) They pull the tricks where they have a cheaper doctor interview you and then someone comes in for 10 seconds and they super bill you.
3) Even though the sleep study might be covered, I still need to confirm, I suspect the doctor I'll be seeing after the study is not covered by insurance so there may be another $1k bill coming up.
4) I am not sure they will make conclusions that will be what we need.

I will try to find out if the insurance is covering the upcoming sleep test as in-network or not and if the doctor who will discuss the results is covered.


What do you advise?   

I am based in the Golden Isles and considering travelling to Savannah or Atlanta for sleep study/doctors.  Mayo was in Jacksonville FL.

[Sleeprider]

What kind of doctor provides services not covered or approved by your insurance without telling you first? What was the denied service? I am very leery of specialists, and you are involved in some of the most ego driven specialists that exists. I would far rather deal with a doctor that discusses issues with me on a doctor/patient basis and is open to my inputs and opinions. Your situation with Mayo would have me running. I dealt with a specialist on my first diagnosis in 2008, and have never used a specialist as a "treating physician". Have you ever asked your primary doctor to manage your CPAP care? What do these specialists really bring to the table?

Your CPAP data suggests a fairly persistent flow limitation that om Auto CPAP mode results in increases in pressure that have no therapeutic benefit. Additional pressure support would resolve the flow limits, and higher trigger sensitivity would likely reduce the incidence of CA that seems to occur with higher pressure and EPR.

[alwyns42]

It was an initial sleep meeting where they looked at my stats and machine settings and decides whether you need or can do another sleep study.

I previously saw a doctor at the same Mayo and it was covered by insurance.  So I thought ok I'll make an appointment since Mayo is on my insurance (as a whole I thought).  The thing is they assign who you will see and apparently even though that person works at Mayo they can bill you separately and they don't need to accept your insurance.  In fact I have this theory that some of them just don't care.

In this case they said my appointment is with Dr. X.  I didn't verify if Dr. X is on my insurance because I thought I was covered at Mayo.  It was this typical session where an understudy of someone asks you a bunch of questions.  Then the last 2 minutes Dr. Y shows up and just summarizes what Dr. X said, but Dr. Y is the one who bills you.  So I could not have verified in advance if Dr. Y was on my insurance anyway.

So the insurance didn't deny but they classified it as out of network and when I sent in a complaint they didn't process it as "I should have been billed by Mayo" but as, "We did it correctly because this doctor is not in your network".

The weird thing is Dr. X got pre-approval for my sleep study.  I need to check if it is in-network, but how can Dr. X get that kind of pre-approval without accepting my insurance?


On your question about primary physician managing my care.  I have found a great primary physician with the best bedside manner.  Can a primary physician order a sleep study?


On the pressure I have the same suspicion.  No matter how high I put my upper limit in pressure, the CPAP will chase it.  I also suspect that the cause of the CA's could be neurological, but I guess we figure that out when I'm on ASV.


Same thing happened with a dermatologist.  Got referred to his practice, he accepts insurance and then the nurse that does the actual work bills you but doesn't accept the same insurance as the doctor who owns the practice.  I really DO NOT LIKE the US health system.

Last night I had pressure fixed at 9 with EPR 2 and my AHI was 0.7, BUT I feel sh*t and was awake the whole night

[SarcasticDave94]

Yeah, run from Mayo, it's not so good for your health. When you have to second guess whether your visit is in network or not, or if you'll be second billed, you're adding unnecessary stress. Fight or flight should have kicked in. They don't deserve your loyalty or business. Fire and replace.

I too think you're headed to VAuto. Try primary care for the Apnea therapy, it's worth a shot.