Sleep study?

chevtow41
on 3/28/14 1:55 am
DS on 11/11/14

How many people had to have a sleep study done before surgery? I had one done 6 years ago and had apnea, tried CPAP for 6 months and absolutely hated it - I never slept worse in my life. I needed pills to even fall asleep with it. I stopped using it, ended up losing weight, got rid of apnea and sold the machine on Craigslist. Now that I've regained weight I'm worried they'll make me take the test and I'll have to use that damn machine again until after surgery when I lose weight.  Plus the cost, yuck.

I have my initial appointment 4-9-14 at University of Chicago and I'm thinking of all the stuff that may happen already. LOL. Always have to worry about something. 

How many people had to do 6 months supervised weight loss? I have UMR/United Healthcare and I've been given different answers every time I've talked to them. One rep said no, one said 6 months, and another said 6 months maybe but you're in a self funded program so maybe not. GEE glad I called them :)  I've even heard of Docs sending in paperwork without the 6 months and it getting approved and vice versa. Always have to keep us guessing.

I work in package delivery so if I need 6 months I will probably have to wait till next year because of the Christmas rush. Can't imagine waiting another 8 months or so. Seems goofy to tell a very unhealthy obese person to just keep on waiting - like a ticking time bomb :(  I'm actually off work with a  herniated disc in my back, so losing the weight would be a big help to recovery I think. 

Anyway, all insight appreciated and thanks for letting do a mini-rant ;)

Russ

PattyL
on 3/28/14 6:28 am

The ASMBS has said the diet is not necessary.  But the insurance companies hang on to the idea hoping you will fail to comply or give up.  It's a game like so many of these requirements.  I agree that being diagnosed with apnea again won't make much difference to you if you won't use the CPAP.  BUT it's another co-morbidity you can use to help you get the surgery!  Your back is probably a co-morbidity too.

Sometimes it just takes time.  One thing I would suggest you do is actually sit down and READ your insurance policy.  No, don't call them and ask, read it for yourself!  Take notes.  Underline important parts.  More than once or twice, people have been able to use the policy itself to get surgery.  READ the actual document!

Yep, the waiting and all the endless busy work sucks.  But the time is going to pass one way or another and at least you are doing something positive and moving towards a goal.

chevtow41
on 3/28/14 1:12 pm
DS on 11/11/14

My actual policy states it is covered if it is a "medical necessity". Then goes on to use legalese to make "necessity" be whatever they decide. Oh well after being injured I'm used to playing their little games. Oftentimes the squeaky wheel does indeed get the grease :)  I appreciate your answer and all the other answers I've seen you post for others ( I've been reading back posts to try and find answers and info if possible).

PattyL
on 3/28/14 5:33 pm

Then you are in luck!  If the diet and all those other things are not written in the policy.....  Just get the LOMN and submit!  Then start appealing!

Irishnurse
on 3/28/14 8:40 am
DS on 04/17/13

I had one. I had mild sleep apnea then they proceeded to try and sell me the machine etc. I did not let them talk me into it. I knew two months after surgery it would be gone. 

        

        
SW-340, CW-164, GW-150, 14 pounds to go...

    

chevtow41
on 3/28/14 1:07 pm
DS on 11/11/14

I feel the same way. I won't use the machine anyway unless the surgeon plans to check the recorder. Seems silly to take more prescriptions just to sleep with it.

PeteA
on 3/28/14 12:29 pm - Parma, OH
DS on 04/15/13

I had the sleep study and got a CPAP several months before the surgery. Luckily after the first 2 weeks I got used to it. I had a nose pillow mask with an adjustable PAP (APAP) that seemed better than a normal CPAP.

My surgeon wanted me to do it because it is supposed to help when you go under anesthesia. For him it was only about eliminating surgical issues.

Have them submit your papers for pre-approval and then you will know for sure about the 6 months. It doesn't hurt if they deny for that reason. Then you know you need to do it. Just be cause you get approval doesn't mean you hae to schedule right away - you could schedule after the Christmas rush.

It's a stupid requirement. If you did WW or something like it they may take that instead.

Good luck. I went round  and round with insurance before going self pay.

HW 552 CW 198 SW 464 4/15/13 - Lap DS by Dr. Philip Schauer - Cleveland Clinic.

chevtow41
on 3/28/14 1:06 pm
DS on 11/11/14

Thanks Pete. I hope they'll submit the paperwork right away, as I've seen some insurance companies waive the 6 months if BMI is over 50. I do understand it could still take months to fulfill any other pre-op requirements. Hopefully I don't have to fight them like you did.

meq815
on 3/29/14 1:25 pm - PA

I had a sleep study, only bc I think my surgeon orders it for all his patients. I knew going in I did not have sleep apnea. And I was right. 

    

    

Vicki PNW
on 3/30/14 2:50 am

My surgeon required sleep study before I could have my DS.  I had to have 2 sleep studies because my 1st one didn't have enough sleep data for analysis.  I was able to get more than a minimum of sleep in my 2nd one and was diagnosed with OSA and was prescribed a CPAP machine.  That machine went with me when I had my DS.  After several months, I no longer needed the CPAP machine.

I had UHC at the time of my DS and was not required to have any supervised weight loss because I was able to document at least 5 years of failed attempts at weight reduction.  Furthermore, my surgeon did not require me to lose any weight, but I did lose about 20# in the month prior to my surgery.  That weight loss made it easier for my surgeon to operate.

Best of luck at your appointment.

Vicki

DS (lap) with Dr. Clifford Deveney. Cholecystectomy (lap) with Dr. Clifford Deveney 19 months post-op.

Has not weighed myself since 1/2010.  Letting my clothes gauge my progress instead.

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