Saturday, October 04, 2008

Coverage for CPAP

Sometimes a patient will have symptoms of obstructive sleep apnea but they don't meet their insurance company's strict criteria for coverage of a cpap machine. I wrote the following on the AASM discussion board, in response to another poster's suggestion of a dental appliance or the Pillar procedure:

Often oral appliances ($1400-1500) and pillar implants have to be paid for out of pocket. If a patient can afford this, they should be able to afford a cpap machine, even if there is no insurance coverage for it. Many payors will cover a cpap titration even if the patients don't meet criteria for coverage of a cpap machine. For example, if a medicare pt has a lot of hypopneas with less than 4% desat, I will call it OSA (327.23) if the pt has syxs and their is a lot of sleep fragmentation from the hypopneas. The cpap titration would be covered, but not the cpap machine. Medicare's strict criteria are for the coverage of a cpap machine, and not for the diagnosis of OSA itself. A cpap machine can usually be obtained for under the cost of a dental appliance.

There are additional options for the treatment of mild OSA. I often suggest the trio of avoiding sleeping in the supine position, weight loss, and a steroid nasal spray.
Some of my patients have found the Anti-Snore Shirt helpful.

4 comments:

azhar said...

good insight dr. rack.

from dr. azhar majeed

Michael Rack, MD said...

Thanks, Azhar.
good to hear from you.

Congratulations on getting the MBA.

Are you going to the 2009 ACP annual meeting in Philadelphia??

Michael

REM-A-TEE said...

Hello Dr. Rack, The Anti Snore Shirt brochure at your clinic has a coupon code "MCR864" for 10% which will work for anyone who's interested.

sean

citrusvalleymd said...

mike,
send me your e-mail address:
amajeedmd@hotmail.com
thanks,
azhar