losing my mind over ins/ sleep study

[KayleighsMommy 16]

I have BC/BS of IL. I called my surgeons office to make a initial appt. they took my insurance info, called back and told me I had "excellent benefits" ... bariatric coverage, no copay, no deductible, no prerequisites, the insurance girl at the office told me she wished she had such good coverage.

Now comes the rub... I am still waiting on a preauthorization...the doctors office said they faxed in on Wednesday...they claimed they never got it...she has been trying all day to refax it...been unable to get through. Also..the doctor is sure I have sleep apnea (by my symptoms) he will not do the surgery without a sleep study (btw..I also have a incarcerated hernia he will fix at the same time) The problem is BC/BS is giving a hassle about the sleep study...they want 12 months of documentation of sleep issues...now correct me if I'm wrong...but if you have been compaining to your doctor about waking up gasping at night for a year and your doctor has not already sent you for a sleep study, isn't he pretty much a moron?????

I called the ins co today to find out what they want...they had it documented that I had a BMI over 38 (way over), extreme snoring, daytime sleepiness, etc.

The service rep game me the runaround...told me it could take anywhere from 14 days to 2 months for a reevaluation, once my doctor sent all the required info....which of course, they did, since she told me what was listed. She kind of suggested I keep my scheduled appt and send it in for reevaluation. I asked her if they found I had sleep apnea would that be considered medically necessary for the test. She actually had the gall to tell me "it depends on what your benefits are"...mind you this is after going round and round for 30 minutes about what "medical neccessity" is. I told her "You're the one with my benefits in front of you...tell me what they cover". The first thing they she said was medical neccessity can be determined by a sleep study WTF?????? :tt1: At this point I was almost in tears, practically yelling at her...then my cable went out and dropped the call. I am sooooo livid at his insurance co.

What is the chance of them paying for Lap Band if they won't even pay for a simple sleep study??????????????????? <rhetorical question...just my frustration showing>

Sorry for the novel...just had to vent.

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[Parvathi 2]

I don't have any advice to offer, as I'm in Australia and over here it was as simple as going to the doctor and him saying I qualified. I never had to talk to my insurance company, they just approved it cause he said so.

But having a place to vent (like here) is wonderful. Rest assured, many people have battled this insurance battle before you and have come out the other side, band in tow. Keep your chin up.

[MerryHearted 20]

The problem is BC/BS is giving a hassle about the sleep study...they want 12 months of documentation of sleep issues...now correct me if I'm wrong...but if you have been compaining to your doctor about waking up gasping at night for a year and your doctor has not already sent you for a sleep study, isn't he pretty much a moron?????

Wow, that's ridiculous! 12 months documentation of sleep issues to get a sleep study done?? Are they out of their freaking minds??

I hope you get this resolved asap.

[KayleighsMommy 16]

That's the thing...the girl at the doctors office told me they send people for sleep studies every day and have never heard of this before. The woman at the sleep center told me she has NEVER seen this kind of insurance pushback on a sleep study either. Figures they

would have to start with me <sigh>

[KayleighsMommy 16]

Wow, that's ridiculous! 12 months documentation of sleep issues to get a sleep study done?? Are they out of their freaking minds??

I hope you get this resolved asap.

I gues they are ;(((

[Tamihott 0]

Have you ever tried to go onto bcbsil.com website and look up the medical policy on the sleep study. I just had a sleep study and then after the fact decided I would check to see if it was a covered benefit!! Duh! I went on the website and got all the info I needed. It looks to me that I will have no problem with coverage. If you need any help lookin up the info just shoot me an email!

[KayleighsMommy 16]

Have you ever tried to go onto bcbsil.com website and look up the medical policy on the sleep study. I just had a sleep study and then after the fact decided I would check to see if it was a covered benefit!! Duh! I went on the website and got all the info I needed. It looks to me that I will have no problem with coverage. If you need any help lookin up the info just shoot me an email!

That's the problem...they tell me it is covered...if it's "medically neccessary", and according to what she read to me medical neccessity can be proven by a sleep study. All I know is they WILL NOT authorize it without 12 months documentation, though they did tell me they can send it for review...that will take 2 weeks to 3 months!!!! Oh well, I guess if they refuse to preauthorize the lapband surgery, as I suspect they will..after reading how hard it has been for everyone else (even though my dr's office was told bariatric services are fully covered) I will have plenty of time to fight them over this test <sigh>

I cannot find anything on the bcbsil website. It really is not very user friendly. Hmmmm..what a suprise...NOT!