BC/BS ILL... Sleep Apenea, High Colesterol, 38 BMI

mrscrash2u · April 15, 2008

Hi all, I went through the consult, 6 month diet., meeting with dietision, (sp?) only to be rejected in December 07. In Feb. 08 I met with my Primary Care Phys. to begin the appeal process, he checked my heart, liver, blood, etc....Yes, I have high colesterol and he suggested I pay for the surgery my self. I insisted on the sleep Apenea test. Well guess what, I've got it and pretty severe. Now, my doc. and the sleep clinic both want to "cure" me by making me sleep with a stupid mask on my face every night!! The sleep clinic isn't on my list of providers either so now I also have a bill from them close to $900. for the 2 sleep studies. (the part my ins. won't cover) My question is, do I have to do this "cure" for the insurance company to proceed with the appeal for the Lap-Band or can I put my foot down and refuse (I'm not going to sleep next to my husband looking like Darth Vader!!! :huh2: and being so confined I can't sleep anyway!) I already told my doctor I couldn't tolerate the mask and 3 days later he called in the order for the machine. They called me today to let me know the cost. Has anyone else had to do all of this nonsense too? Now we are mid way through April and I'm still not getting anywhere...Help

MSG's_SGM · April 15, 2008

Well, I can't say that I know about your ins., but I do know about the CPAP and yes, it is odd and weird to get used to, but I love how I feel after I get up now...hours earlier to boot. My husband says it is easier to sleep with me (it is quiet and I wasn't)lol. I was told that the machine runs around $1200. I am very blessed to have Tricare. I hope your appeal goes through without a hitch.

cleanteeth · April 15, 2008

Wow.. what can I say to you to change your mind. First of all my husband wants me alive. and the CPAP will keep me that way. My family has a history of sleep apnea plus I'm very overweight. Your apnea is affecting your health. I didn't want the thing, and have had to learn to adjust to it, but I wanted to live more. I started craving sleep, and the mask because it would allow me to sleep. I'm hoping that by doing the band I will be able to get rid of the mask, but if I don't.. I will live with it. I've had family members die of heart problems that are directly related to sleep apnea. Please try again! I was lucky that my insurance covered it, but I would have paid the money for me to sleep and my hubby to also. I didn't snore much, but do shallow breathing and restless leg syndrome. My husband said I'm much less "active" after the CPAP.

Good luck to you.

alegna242 · April 15, 2008

hi

As a sleep tech I do have to let you know that using the CPAP will help in more ways than you realize. Using your CPAP will help you loose weight by letting you sleep correctly thus, allowing your body to heal itself and lower stress hormones that cause weight gain. These are just things that will help in the short term. Long term is so much more. I know it's hard to get used to, like anything thats good for us, you have to sacrifice. Most people that have problems with CPAP is because of a incorrect mask fit. Call your lab or Medical equipment company and see about different masks. If you have any questions feel free to ask. :huh2:

msstant · April 15, 2008

Hi,

I did not have a high enough BMI without getting tested for sleep apnea. I only have moderate sleep apnea but it made a world of difference when I started with the mask. Even before I had the lap band done I stopped having the headaches, I wasn't as forgetful, my joints ached less and I didn't have the restless leg syndrome. I just took Benadryl for a few days to help me get use to the mask. Now I fall asleep quicker and sleep much better. My husband has severe sleep apnea and has had one for 8 years, I expect he has a good chance of needing one even after he loses the weight.

mrscrash2u · April 17, 2008

Thanks for all of your input on using the CPAP. At least now, I am considering it. I did call my doc and they sent in my appeal on Monday April 14th. Don't know how long it takes to hear something. I am thinking about calling BCBS on Friday to check on it. I hope it's good news this time. I'll keep you all posted.

Thanks again.

NicoleW8ing · April 17, 2008

Thanks for all of your input on using the CPAP. At least now, I am considering it. I did call my doc and they sent in my appeal on Monday April 14th. Don't know how long it takes to hear something. I am thinking about calling BCBS on Friday to check on it. I hope it's good news this time. I'll keep you all posted.
Thanks again.

BCBS NC took about a week to deny my appeal.

Are you being denied because your BMI is too low?

Well, is it possible you can throw a few rocks in your pockets and scrunch down a bit when they measure your height? I had to do similar things because my BMI is too high (just the opposite) :thumbup: with BCBS of NC.

Good luck and please keep us posted.

msstant · April 17, 2008

Get the doctors office to measure your height again. You lose height as you get older, especially as our weight makes most of us hunch over more. I did that and was surprised and will not tell how much shorter they said I am.

mrscrash2u · April 18, 2008

Hi,

When they denied me in Dec. I only had the high cholesterol and my BMI wasn't high enough (around 36.5 I think). Since then I have been tested for the sleep apenea and my doc. measured my height 2 weeks ago. Turns out, I'm not the 5'6" that I was in high school, I am exactly 5'5" now. That also made my BMI go up since Dec. So, we'll see what happens.