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Need Advice about Timing of Surgery



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So I had my initial consultation with surgeon yesterday and all went very well. The only catch was he requested I do a sleep study prior to surgery. I was a little surprised because I don't snore (according to my wife) and I have trouble with insomnia where I can't go to sleep but once I get to sleep I rarely wake up in the middle of the night.

I researched my insurance and basically I have $1100 deductible with about $900 left this year so instead of that going toward my surgery, now I'm going to have to pay that toward sleep study plus the surgery copay which does make a difference. Also, based on what insurance told me I should not have to do the 6 month diet requirement. However, I've read enough horror stories on the forum to know that you don't always get the right information. The administrator at the surgeon's office said she would be in contact with my insurance and get the requirements in writing but I'm not sure how long that is going to take.

So my fear is if I have the sleep study done now and for whatever reason I have to wait to meet requirements for insurance approval until next year then I'm out the deductible this year plus will have to pay the deductible next year. I have read several posts referring to some other surgeons in the area that do not require the sleep study but I REALLY like the one I have chosen and the hospital he is affiliated with so I hate to change at this point.

Has anyone been through this type of scenario before and if so how did you handle it?

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I would do the sleep study. If you have apnea it may get you approved easier and lord knows these insurance companies make you jump through many hoops before you get approved. Take a look at my list below - I had to do all of that, and that was after the 6 months. I had the sleep test done years ago so they already had on record that I had sleep apnea. The more reasons you can give the insurance company to show them that you are a good candidate for this surgery, the better your chances of being approved.

As far as deductible - if your deductible is $1100 and you have $900 left to pay that is all you have to pay - whether it is for the sleep study or the surgeon, it is still going to cost you no more than $1100 total out of pocket for the year. So I assume you already paid some doctor $200, and say the sleep study costs $200, you now have $700 to pay to the surgeon. At least that is how I've always known it to work. Once you have spent your full $1100 out of pocket, be it at 1 doctor or 20 doctors, you still are paying no more than $1100. At least that is how mine works.

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