Does Sleep Apnea Improve Insurance Chances?

[IMSKINNY 160]

Hey, gang, I had a question! I was diagnosed with sleep apnea after using the home sleep delivery machine? Does that improve my chances of getting approved with a BMI of 40 plus and hypertension?

[Lauranbob Mc 94]

it all matters on your insurance company. I had all of that but I didnt have 2 years of medical records so I was unable to get it approved until i had the 2 years of medical records. It took me more than 18 months to get approved.

[BKMama 179]

It really depends on your plan. Some don't require any comorbidities with a BMI of 40 or more. But theoretically, it should help approval since it's an added comorbidity that has been proven to be helped or corrected completely with significant weight loss.

That said, there are people with a BMI over 40 with a list of comorbidities that get denied. Who knows what the ins. companies are thinking.....

[Vance_ 217]

It did for me. I have BCBS of Texas. BTW...I no longer have it!

[bubbachubbs 4]

I was approved on my first attempt in part due to my having sleep apnea.

[Kat Crowder 34]

I suggest finding out what your insurance company's medical policy on weight loss surgery is. It seems like most of the BCBS websites have Medical Policy under their "Providers" tab, and you can find what the specific requirements are.

I think it's important to educate yourself straight from the source, and get all the information you can. I'm finding that I really need to guide my surgeon's insurance person to gather the right information to submit, which is frustrating, but I'm the person most invested in getting my insurance approved.

Good luck!

[IMSKINNY 160]

Thanks folks for the information! I have some odd ins called CCMSI. They are a third party provider and one big beauracracy, if you ask me. I was told by my surgeon's office that my ins follows the same policy as Aetna, which, based on what I have read, is one of the better policies for this sort of thing. So, I think having sleep apnea helps because my BMI is over 40 and I take meds for hypertension. I go back for my 3rd meeting with the dietician and the NP on May 4. After that, I should only have one more visit, before the info is submitted to ins.

Everybody take a deep breath .... AND PRAY!! Thanks.

[IMSKINNY 160]

I know that I am probably over thinking this, but here goes. I was told I have sleep apnea and my insurer has approved renting the machine for sleep apnea for six months. Did anybody not get the machine and still got approved?

[BKMama 179]

An insurance company can't dictate you get treatment. However, with the hospital I'm working with, if you are diagnosed with apnea you MUST bring your machine with you to surgery or it will be cancelled. So I would check on that.

And honestly, I hope you don't take this the wrong way, but using the machine prior to surgery is for your benefit. If you have apnea, it means that while you're asleep from the anesthesia you will stop breathing. Why risk that? I'm annoyed about the CPAP ( I flip around like a fish when I'm sleeping so I already know it's not going to be comfortable LOL) but if it's one more thing that will help me get through this surgery successfully then I'm going to suck it up. Once we drop the pounds, there's a good chance we won't need them anymore.

[Mews 37]

As BKmama said, with sleep apnea you can stop breathing when you are in recovery and still under the effects of anesthesia. However, because of the anesthesia you won't wake up. It's a really scary thought.

As for the CPAP itself, it does take a little while to get used to it. It was about a month for me. Now I can't sleep without it. You'd be amazed how much better your sleep will get using the machine.

[Kat Crowder 34]

It was my results from my sleep study that scared me into definitely pursuing this. My oxygen levels get scary-low if I sleep without my CPAP. Like, potential-brain-damage-y low. I thought I was such a lazy loser for not feeling like getting out of bed in the morning for work - but I didn't feel like my brain was working because it wasn't! Sleep apnea can be a killer, please use your CPAP machine. It can make you feel like a new person. I had one of my best weight loss and maintain periods when I was first diagnosed with sleep apnea in 2004 - went from 230 down to 150, felt alive and like exercising and such. But I stopped using it when the apnea went away for a while, and my habits got worse and I gained the weight and the apnea back with a vengeance.

[IMSKINNY 160]

Wow! You guys have really scared me! I guess I will get the machine and try it. I have been very groggy in the AM over the last 2 years. The sleep apnea probably coincides with my weight moving past my comfortable weight level.

I wonder if the insurer is thinking that they will pay for renting the machine for 6 months, rather than buying it, because they expect me to have the surgery shortly? I hope so!

[Mews 37]

Wow! You guys have really scared me! I guess I will get the machine and try it. I have been very groggy in the AM over the last 2 years. The sleep apnea probably coincides with my weight moving past my comfortable weight level.

I wonder if the insurer is thinking that they will pay for renting the machine for 6 months' date=' rather than buying it, because they expect me to have the surgery shortly? I hope so![/quote']

The usually only rent the machine at first to see if you actually use it. I had to have a few visits with my pulmonologist where I brought a data card from the machine to see how often I was using it and for how long. After that they bought me the machine.

Don't be scared. I think it's a great invention and now I can finally sleep at night.

[IMSKINNY 160]

The usually only rent the machine at first to see if you actually use it. I had to have a few visits with my pulmonologist where I brought a data card from the machine to see how often I was using it and for how long. After that they bought me the machine.

Don't be scared. I think it's a great invention and now I can finally sleep at night.

That's what the sleep people told me too, but she said my insurer never asked for the data download, which would reveal if I was using the machine. She thought that was odd, but maybe that means the insurer doesn't know what they're doing!

[BKMama 179]

Yeah, that's the other reason in going to suck it up. I'm always exhausted. Always. 6 hours of sleep or 10. It's so frustrating. I don't even know what waking up refreshed feels like.

My insurer rents for 6 months too. Seems common.