Take home study vs. Overnight Polysomnogram

I got into an argument with my neurologist about this, and I wanted to see what everyone's collective wisdom thinks....

I had a take home study, with the pulse oximeter, which indicated I have moderate to severe apnea. I've never had a polysomnogram. It's been over a year and I'm still sleeping 16-20 hours a day. the neurologist is really resistant to having me do a polysomnogram and even told me that NONE of the Kaisers near me are equipped to do an overnight polysomnogram, which seems a bit like malpractice.

Is a take home study really adequate to diagnose possible sleep disorders, including apnea, without having a follow up ps?

Sarah

[quote="lawdognellie"]I got into an argument with my neurologist about this, and I wanted to see what everyone's collective wisdom thinks....

I had a take home study, with the pulse oximeter, which indicated I have moderate to severe apnea. I've never had a polysomnogram. It's been over a year and I'm still sleeping 16-20 hours a day. the neurologist is really resistant to having me do a polysomnogram and even told me that NONE of the Kaisers near me are equipped to do an overnight polysomnogram, which seems a bit like malpractice.

Is a take home study really adequate to diagnose possible sleep disorders, including apnea, without having a follow up ps?

Sarah

Lawdognellie, if it were me, and I thought I needed a PSG, then I'd get one, regardless of what idiotic rules my insurance or HMO had. I'm sure that there are provisions in the contract with Kaiser which permit both you and them leeway when their standard practices fail to provide a proper diagnosis.

Several possible avenues come to mind:
- In lieu of PSG's, what diagnostic tests does Kaiser allow for diagnose of other sleep disorders? Ask your docs directly. (It's a pretty good bet they know.)
- I'd be looking through the fine print with Kaiser and on the phone with them, for hours at a time if need be. If/when you find the loophole, it'll be a lot easier to convince one of your docs to order whatever tests are needed.
- Have a lawyer write a letter. (Not fashionable, but might be effective, and would be a lot less expensive than paying out-of-pocket for a PSG.)
- If all else fails, pay for a PSG on your own, and then see if you can get reimbursement from Kaiser through small claims court, or perhaps some other way.

Bottom line: What's your health worth to you? If you believe that additional diagnostic tests are warranted, including a PSG, then you owe it to your health to pursue getting your problems properly diagnosed.

Just my $0.02. (And not all that different from what I did when I decided, after failing a PSG, to rent an oximeter on my own. When the results showed significant desaturations, I simply asked my sleep doc to provide me a machine prescription. With the prescription I then simply purchased a Respironics BiPAP-auto online, without worrying too much about whether insurance was going to reimburse me, or not - they eventually did, by the way.)

Regards,
Bill

Hummm.lawdog..
What happened between 1:05 AM when you
has a PSG sheduled, and at 1:10 AM you
were blasting Kaiser for not providing one?

1:05AM:
" Contact Member services. Believe it or not, but they are usually really helpful, especially if you phrase it in a pre-litigation way. For instance, I contacted them about the fact that the Kaiser near me won't do polysomnograms at the hospital, and mentioned that it seemed odd since all the sleep disorder associations state that an at home test is only good for diagnosing apnea provided that a follow up overnight study is done....magically, I have one scheduled in a few weeks..lawdognellie

1:10AM: "the neurologist is really resistant to having me do a polysomnogram and even told me that NONE of the Kaisers near me are equipped to do an overnight polysomnogram, which seems a bit like malpractice."...lawdognellie

???? What am I missing here? Do you have to pay the full amount out-of-pocket?

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CPAPopedia Keywords Contained In This Post (Click For Definition): Polysomnogram

I have one scheduled....now...but it took a SURGEON needing it to get it scheduled, and a LOT of harassing the neurologist on my part. She still didn't want to run it, but she finally did after I threatened suit. The reason for my post is just that it seems that Kaisers practice of not doing a PSG is malpractice, which is why I want to know what everyone's thoughts are on how important a PSG is comparative to the take home test. If the insurance refuses to do the basic test, and therefore are not able to diagnose conditions, they could be in a lot of trouble....

BTW, to whomever suggested having a lawyer write my notes, I'm a 3rd year law student who is studying to practice health care/ disability law. My docs all know this, so when I push, my doctors will back down. I'm pretty sure it's actually been written in my charts b/c if I mention that whatever ails me is interfering with law school, they put a rush on things and if I contact member services, let's just say they are highly accommodating.

Sarah