What are we to do?

Topics related to in home sleep testing (portable monitoring)

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What are we to do?

Postby cruzin' for a snoozin' » Tue Dec 11, 2012 6:18 pm

Ok, so I work for a closed lab. All pts. see a sleep specialist first, and all pts. are carefully screened to determine candidacy for HST vs. In-lab testing. Most of the in-lab studies are being denied by Aetna and Coventry regardless of the circumstances. We are fighting hard for our pts. This should be illegal.....these damn ins. companies are taking away rights from pts. and physicians; Pts. don't have the right to choose or participate in their own healthcare, and physicians loose the ability to do whats best for their pt. We have already seen HST results come back from "nationwide" companies that are totally bogus. They don't even care! As long as the ins. company saves money and the PCPs get their palms greased to order and "interpret" these HST, the pts. will loose. This is sad because there are still those of us out there that truly care about our patients and their wellbeing.
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Re: What are we to do?

Postby labman2 » Tue Dec 11, 2012 6:56 pm

cruzin' for a snoozin' wrote:Ok, so I work for a closed lab. All pts. see a sleep specialist first, and all pts. are carefully screened to determine candidacy for HST vs. In-lab testing. Most of the in-lab studies are being denied by Aetna and Coventry regardless of the circumstances. We are fighting hard for our pts. This should be illegal.....these damn ins. companies are taking away rights from pts. and physicians; Pts. don't have the right to choose or participate in their own healthcare, and physicians loose the ability to do whats best for their pt. We have already seen HST results come back from "nationwide" companies that are totally bogus. They don't even care! As long as the ins. company saves money and the PCPs get their palms greased to order and "interpret" these HST, the pts. will loose. This is sad because there are still those of us out there that truly care about our patients and their wellbeing.


Welcome to our nightmare....Please have your patients call the insurance company and let them know they desire a true sleep study... not a Home Apnea test...that doesnt even tell if you have the right person or if their is even sleep involved.... A sleep study should at minimum record sleep!
Perhaps they should get ask for a refund on their premiums for reduced services from what they originally paid for! :wink:
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Postby stars » Tue Dec 11, 2012 11:57 pm

So Mayan Apocalypse exist sleep medicine
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Postby Sleepin'Nan » Wed Dec 12, 2012 7:53 pm

So frustrated :x Just spent several days working to get a patient in here who met the guidelines set by the insurance company and they still denied an in lab study. What are we to do when the don't even follow their own guidelines? Their guidelines for an attended in-lab study for patients with Established OSA: follow-up studies:
#2 To re-evaluate the diagnosis of OSA and need for continued CPAP if there is significant weight loss (defined as 10% of body weight) since the most recent sleep study.
This guy lost 40lbs since his last test and says the pressure is too much so his doctor ordered a retitration. We call the insurance co with this info and yes they need a prior auth, then they requested a dr to dr review and still denied it... So they called the lab to inform us it was denied they said he could have an APAP. Then the person from the insurance company said it will be faster for the patient does that make since? I said no not really you do an APAP & start him on a minimal pressure it senses no events so he stay on 5 all night. How do you know he even still has OSA with an APAP. She said well let me take that back to the doctor. So she called back and said OK we will approve a HST does that make sense? Again I said not really you do a home study it is positive so he still needs CPAP but we don"t know the pressure. She said well then he will have an APAP @ home. I said OK so it will take 2 nights and you will pay for 2 test when the patient could of come to us for a split night that don't make sense but you make the rules. UUUGGGGGG!!
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Postby Water Boy » Wed Dec 12, 2012 10:11 pm

I can't understand how the AASM can be COMPLETELY quiet while the public has this scam perpetrated upon them. At least speak up and advocate for our patients, educate the media, do something to save their own skin.
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Postby tiredjohnny1 » Wed Dec 12, 2012 11:25 pm

Water Boy wrote:I can't understand how the AASM can be COMPLETELY quiet while the public has this scam perpetrated upon them. At least speak up and advocate for our patients, educate the media, do something to save their own skin.


AASM has one focus: advocate to make it legal for doctors to sell pap machines in their office. once the doctors can make money off the APAP machines sales, then that's ok with the AASM. Its all about the money. They have no interest in any other goals.
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Postby Drake » Thu Dec 13, 2012 5:04 am

So the BRPT and the AASM has not said one word?
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Postby stars » Thu Dec 13, 2012 6:13 am

money money money much better as any words.
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Postby cruzin' for a snoozin' » Thu Dec 13, 2012 2:24 pm

We are a large group. What can we do on a consumer advocacy level?
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Postby Amykr » Thu Dec 13, 2012 6:18 pm

Well the more we blog about sleep and sleep issues and testing and proper cpap set up the more the public will be informed and understand why a lab study is recommended versus in home testing. But if there are only a hand full of us blogging the truth than we cannot be heard.
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Postby somnonaut » Thu Dec 13, 2012 6:56 pm

Blogging here is preaching to the choir.
We need to speak our piece in other venues. Public blogs such as those that are controlled or manipulated by patients or others who have a vested or are hell bent on taking the Resmed Peter Farrell position of no need for sleep labs, will be much more useful places to state your case.

These prospective patients get pushed around by typically unknowing, or uncaring individuals who have other rationale for why they push these patients to take the non-lab route.
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Postby Amykr » Thu Dec 13, 2012 9:47 pm

Somno that is what I was talking about. I get between one and three hundred hits a day on my blog and I am becoming one of the resources like you all for the newspapers. But there are not enough public blogs out there to compete against the resmeds and respironics blogs
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Postby stars » Thu Dec 13, 2012 10:43 pm

I presume you vote for representative your state so why not sent all you blog link to him or her doest matter as well
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Postby Drake » Fri Dec 14, 2012 1:13 am

So how can one get into scoring HSTs ?
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Postby stars » Fri Dec 14, 2012 1:33 am

Score is score easy for hts
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