Cigna refused to cover my sleep study

[jtravel]

My DR requested 95811 Split night titration study over a month ago.
Received a letter today from CIGNA telling me that CareCentrix, Inc reviewed the request and found it not medically necessary.
Has anyone else ran into this type of problem?
They wanted me to do a home sleep test first to confirm I need treatment.
DR rejected that because he says you will just have to go for a titration study before they would prescribe a machine.
It's been well established I have sleep Apnea from sleep studies I had many years ago. My old Cpap broke and the DR could not give me a prescription for a new machine without a sleep study.
I could wait no longer and purchased used from a board member and it has been a huge help my sleep but still not 100% by any means.

[Cardsfan]

It sounds like u were approved for an at home sleep test. Are you going to do it? That's what my ins. covered.

[cancun]

Many insurance companies are requiring a home study first now so you should just do that. I also don't know why your doctor "can't" write you an RX for a new machine since you were already on CPAP. Unless the insurance refuses to cover a new one without a sleep study. Many insurance companies are also doing home titrations with an APAP machine.

[jtravel]

I had actually originally requested the home sleep study specifically with my primary care DR bit he was totally against it.
He said they could not do the Titration study part in my home and I would need to go to the sleep lab anyways.
We already know I have sleep Apena and the PR system one 550 is recording Centrals mostly. My DR feels I need a lab study to find out what is actually going on with me.
Using the PR system one 550 purchased second hand has been a huge help in and of itself but something is still not right.
the Pulse Oximeter I purchased and have used over night also shows drops in Sp02 levels during the night when using the Apap machine.
I explained this all to Cigna customer service and they were polite but said careCentrix is the only one that handles sleep problems.
They forwarded me to Carecentrix and I explained everything again to them and they suggested I have my DR request a Peer review.
I will have to make another appointment and discuss all this with my DR and see what he says.
I'm just glad I decided to move on my own and purchase the old used machine from a forum member here when I did.
Waking up in the middle of the night gasping for breath and then not being able to go back to sleep for several hours because I felt I was drowning and could not breath.
That has stopped. I still wakeup but can adjust the mask and go back to sleep without being in panic mode. I'm actually getting periods of 2-3 hours where I don't wakeup during the night.
The wife said she has not heard me gasp for breath or snore now that I use the machine. It was effecting her because she could not sleep worrying about me. now she sleeps better knowing the machine is keeping tabs on me.

[Guest]

I had actually originally requested the home sleep study

and now you dont want to do it?

[cancun]

I had actually originally requested the home sleep study specifically with my primary care DR bit he was totally against it.
He said they could not do the Titration study part in my home and I would need to go to the sleep lab anyways.
We already know I have sleep Apena and the PR system one 550 is recording Centrals mostly. My DR feels I need a lab study to find out what is actually going on with me.
Using the PR system one 550 purchased second hand has been a huge help in and of itself but something is still not right.
the Pulse Oximeter I purchased and have used over night also shows drops in Sp02 levels during the night when using the Apap machine.
I explained this all to Cigna customer service and they were polite but said careCentrix is the only one that handles sleep problems.
They forwarded me to Carecentrix and I explained everything again to them and they suggested I have my DR request a Peer review.
I will have to make another appointment and discuss all this with my DR and see what he says.
I'm just glad I decided to move on my own and purchase the old used machine from a forum member here when I did.
Waking up in the middle of the night gasping for breath and then not being able to go back to sleep for several hours because I felt I was drowning and could not breath.
That has stopped. I still wakeup but can adjust the mask and go back to sleep without being in panic mode. I'm actually getting periods of 2-3 hours where I don't wakeup during the night.
The wife said she has not heard me gasp for breath or snore now that I use the machine. It was effecting her because she could not sleep worrying about me. now she sleeps better knowing the machine is keeping tabs on me.

I also have Cigna and have to deal with CareCentrix now, but didn't when I was first diagnosed last year. Have you been able to download Sleepyhead so you can post your results and see if the experienced members here can't help you out? They know more than the doctors most if not all of the time. Not to denigrate your Primary Care Doctor but do you think he is up to date on Sleep apnea? While waiting for the peer review try posting some results and see what kind of help you can get here.

Good luck to you.

[LSAT]

I had actually originally requested the home sleep study specifically with my primary care DR bit he was totally against it.
He said they could not do the Titration study part in my home and I would need to go to the sleep lab anyways.
We already know I have sleep Apena and the PR system one 550 is recording Centrals mostly. My DR feels I need a lab study to find out what is actually going on with me.
Using the PR system one 550 purchased second hand has been a huge help in and of itself but something is still not right.
the Pulse Oximeter I purchased and have used over night also shows drops in Sp02 levels during the night when using the Apap machine.
I explained this all to Cigna customer service and they were polite but said careCentrix is the only one that handles sleep problems.
They forwarded me to Carecentrix and I explained everything again to them and they suggested I have my DR request a Peer review.
I will have to make another appointment and discuss all this with my DR and see what he says.
I'm just glad I decided to move on my own and purchase the old used machine from a forum member here when I did.
Waking up in the middle of the night gasping for breath and then not being able to go back to sleep for several hours because I felt I was drowning and could not breath.
That has stopped. I still wakeup but can adjust the mask and go back to sleep without being in panic mode. I'm actually getting periods of 2-3 hours where I don't wakeup during the night.
The wife said she has not heard me gasp for breath or snore now that I use the machine. It was effecting her because she could not sleep worrying about me. now she sleeps better knowing the machine is keeping tabs on me.

Sounds to me that your doctor has some connection to the sleep lab. If you do a home study he doesn't get his $$$$$.

[jtravel]

[I also have Cigna and have to deal with CareCentrix now, but didn't when I was first diagnosed last year. Have you been able to download Sleepyhead so you can post your results and see if the experienced members here can't help you out? They know more than the doctors most if not all of the time. Not to denigrate your Primary Care Doctor but do you think he is up to date on Sleep apnea? While waiting for the peer review try posting some results and see what kind of help you can get here.
Good luck to you.

I have posted sleepyhead graphs in a different thread a week or so back.
I would prefer to do the sleep study at home if the Titration study can also be done at home. I was told it couldn't be done at home by the CareCentrix Customer service rep I spoke to on the phone as well as my DR. Maybe the CareCentrix rep didn't know what he was talking about?

[Pugsy]

Formal titration sleep studies can't be done at home...no way for the sleep tech to be involved or adjust the pressures as needed. It can't be done.

The only home titration that can be done is by using various settings on the machine for various nights and then come up with whichever works best. It takes more nights but it can be done. And it can be done with either cpap or apap mode being used.

Most likely what could/would happen is this
get the home study and then you get verification of the diagnosis to make the insurance happy that they saved X amount of dollars over an in lab diagnostic study...so the home study says...yep...OSA...then maybe they will cover an in lab titration sleep study but beware...some insurance companies are now saying just dispense apap machines and let the machine sort it out. Kaiser does this routinely and have been doing it that way for years and they save the in lab studies for the problem situations where going the standard route doesn't work out.

For anyone wondering...here's the thread where the report images are mentioned.
viewtopic.php?f=1&t=112034&st=0&sk=t&sd=a

Your situation would probably fall into the "problem" category in that things are going on that can't be explained easily. You probably really need an in lab diagnostic as well as titration study because of the centrals but your insurance is throwing up a huge road block...I don't know if your doctor can get them to make a special situation allowance or not.
It depends on the depth/data level of the home study (some are more detailed than others) as to whether centrals are easily and accurately identified and in your situation it's kinda important to know about the centrals.

Caught between the proverbial rock and a hard place for sure.

[palerider]

Formal titration sleep studies can't be done at home...no way for the sleep tech to be involved or adjust the pressures as needed. It can't be done.

well, it COULD be.. if they bring their EEG and lab machine to your house, and sit in your bedroom watching you sleep

probably cost a lot extra though.

[Pugsy]

well, it COULD be.. if they bring their EEG and lab machine to your house, and sit in your bedroom watching you sleep

probably cost a lot extra though.

Well maybe in France they could do it since they supposedly offer a much more personal level of medical care.

It's probably a good thing they can't come to my house. The sleep tech at my titration study was a first class asshole and I might be tempted to feed him to the dogs/cats/coons/possums or if I could find a black bear that would be even better.

[palerider]

well, it COULD be.. if they bring their EEG and lab machine to your house, and sit in your bedroom watching you sleep

probably cost a lot extra though.

Well maybe in France they could do it since they supposedly offer a much more personal level of medical care.

they do, they do housecalls... when a friend was over there last summer, a foot doctor came to the house and worked on his ingrown toenails and some other feet problems he was having... I thought he was kidding at first.

It's probably a good thing they can't come to my house. The sleep tech at my titration study was a first class asshole and I might be tempted to feed him to the dogs/cats/coons/possums or if I could find a black bear that would be even better.

well, that would certainly improve his behavior after that..

[jnk...]

improve his behavior

It is my understanding that modification of black-bear behavior should not be attempted without proper training.

[palerider]

improve his behavior

It is my understanding that modification of black-bear behavior should not be attempted without proper training.

:snort: the black bear is probably better behaved than the sleep tech in question

[Pugsy]

:snort: the black bear is probably better behaved than the sleep tech in question

For sure...besides the black bear won't be telling me blatant lies that I know were total bullshit and acting like he knew it all...you know me...I don't do well when lied to and especially when I am lied to by a know it all asshole.