Tuesday, April 30, 2013

Continuing to Breathe

Lyn has been on oxygen support at night for over a year now.  She needs it because her blood oxygen saturation levels plummet to dangerously low levels when she sleeps.  Normally, a person would be tested for sleep apnea and be placed on a CPAP machine.  Lyn is now cooperative with this idea and has refused a doctor's request to undergo a sleep study.  As a result, she uses an oxygen condenser for breathing support.

Lyn's insurance requires an annual review of this need which means she has to have a mobile blood oximetry test performed one night without the use of the condenser.  This has happened.  They also  require that her physician perform an in-person check up to confirm the oximetry results.  This has also happened.  The test results and the physician both have documented Lyn's continuing need for the oxygen condenser.  Her insurance is currently refusing to cover her use of it.

As of Monday, the insurance is asking for the doctor's notes; not just the doctor's official report to prove that Lyn needs the condenser.  The doctor's office is confused by this, but they are releasing the notes to Mom today.  The insurance provider is refusing to accept anything that is not a part of Lyn's medical file.

The hoops the insurance company is making everyone jump through is challenging but not surprising.  If they can get away with not paying for the condenser, they will do so because the monthly cost of the condenser is more than Mom's mortgage.

Hopefully, today's activities to provide the insurance company with the ever changing documentation they want will suffice and they will continue to cover this for Lyn.

1 comment:

  1. Because of her Sundowner's, the Alzheimers and mental challenges she would NEVER be able to have the sleep study done. She isn't able to sleep any place but her own bed and they can't or won't do a mobile study @ home.

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