If Your Insurance Denies Coverage For Sleep Apnea Surgery Do Not Give Up
As someone who treats patients with sleep disorders all the time, I have the chance to speak with medical directors from many insurance companies often. These medical directors are generally very reasonable, with favorable reviews of the cases most of the time. Usually, the denials are related to our care not entirely fitting the guidelines that often are either outdated or written to cover only a limited range of procedures. The appeal process often involves the chance to explain the uniqueness of a case and rationale for pursuing a certain course of action, and it is helpful to speak directly with someone who can make allowances outside the set guidelines.
Although some health insurance companies are denying tests and treatment for sleep apnea, presumably because they think sleep apnea is not important, some life insurance companies are rejecting many applications from individuals with a diagnosis of sleep apnea at any point in time. I have written many letters on behalf of my patients, whether to indicate that they have been treated for their sleep apnea or that someone with mild sleep apnea does not actually have an increased risk of these events, even if moderate to severe sleep apnea does carry the risks. Although these also are not always successful, I am told that they do help.
What Is Inspire For Sleep Apnea What To Know About The New Treatment
Inspire is an alternative sleep apnea treatment to a traditional CPAP machine. Here’s how it works and who should use it.
Around 22 million Americans have sleep apnea. Traditional continuous positive airway pressure, or CPAP, machines can be loud, uncomfortable, and have a pesky mask and hose attached to the device. For some, sleeping with a CPAP machine is impossible. Despite seeming like a minor annoyance that might keep your partner up at night, there are several serious side effects of sleep apnea if left untreated, including high blood pressure, strokes and heart issues.
Now there’s a new alternative to CPAP machines. The Inspire system is the latest in obstructive sleep apnea treatment. By stimulating the tongue and airway muscles, Inspire aims to treat the underlying cause of sleep apnea, not just the symptoms.
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Inspire Therapy An Innovative Surgical Treatment For Osa
When patients with moderate to severe OSA do not respond to conservative treatments or cannot tolerate CPAP therapy, the ear, nose and throat specialists at University Hospitals may recommend Inspire surgery as a treatment option.
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Am I Eligible for Inspire Sleep?
Patients with moderate to severe sleep apnea may be eligible for Inspire Sleep Surgery. Learn More
Also known as hypoglossal nerve stimulation therapy, Inspire is a surgery in which a device is implanted in the neck and upper chest just below the collarbone . The device stimulates the hypoglossal nerve, which controls the muscles of the tongue. While you are sleeping, a sensing lead monitors your breathing, and it delivers mild stimulation to the hypoglossal nerve, causing the tongue to move and open the airway with each breath.
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What Causes Sleep Apnea
There are several factors that can cause sleep apnea in adults. The primary risk factor is obesity since fat deposits around the throat can press down on your upper airways and constrict normal breathing. The use of alcohol, smoking, and nasal congestion can all constrict your breathing as well. Other risk factors are hereditary, such as a naturally thicker neck, narrower throat, being male, being older, and a family history of sleep apnea.
Luckily, sleep apnea is treatable, with treatment usually combining lifestyle changes such as losing weight and quitting alcohol and smoking, to wearing a nighttime mask called continuous positive pressure device which keeps your airway open while you sleep. However, there is a new device that is more convenient and sleep-friendly than bulky CPAP masks Inspire Sleep.
Inspire Sleep Apnea Therapy Overview
Inspire Sleep Apnea Device is a small, fully implanted system that senses breathing patterns and delivers mild stimulation to help maintain an open airway during sleep. Upper airway stimulation technology provides a first of its kind alternative for those suffering from obstructive sleep apnea who are unable to tolerate or or get consistent benefit from CPAP therapy.
Comprehensive Sleep Care Center has the areas top sleep medicine specialists and 9 convenient locations in Virginia and Maryland to help evaluate you for possible Inspire Sleep Apnea Therapy.
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Anthem Blue Cross Sleep Apnea Coverage
Find doctors who treat Obstructive Sleep Apnea near Beavercreek, OH
Device are covered pieces of Durable Medical Equipment for Anthem Medicare. Advantage. Anthem. The DME MAC Local Coverage Determination for your area addresses coverage criteria for. that symptoms of obstructive sleep apnea are improved and objective evidence of adherence to use of the.
Apnea Hypopnea Index Sleep Apnea Positive Airway Pressure Devices Positive airway pressure machines, used with a variety of breathing masks, are the most widely used treatment for moderate and severe. Sleep Apnea Index Chart Sleep Apnea Index Chart | gopher.com Find Sleep Apnea Index Chart. Examine Now. Study Objectives: In patients with severe obstructive sleep apnea syndrome (
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Als Sleep Apnea central sleep apnea ALS/MND Support Group Forums hi all. I was wondering if anyone has any experience of central sleep apnea?. For the people that might not know my story a few months ago i Disorders. All Disorders. NINDS Binswangers Disease Information Page NINDS Brachial Plexus Injuries Information Page NINDS. Even if you
Pre-existing conditions: Pregnancy, sleep apnea could make you pay more Three of the largest insurers in the US United Healthcare, Cigna and Anthem Blue Cross Blue Shield considered a person generally uninsurable and could decline coverage without reviewing any medical records if an applicant had a.
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Compliance Monitor For Oral Appliances
The American Academy of Sleep Medicine and the AADSMs clinical practice guideline on The treatment of obstructive sleep apnea and snoring with oral appliance therapy stated that There are several recent non-RCTs published that report on the use of objective adherence monitors in OAs. Further RCTs are needed to evaluate the efficacy of these monitors and also to compare it with the CPAP objective adherence rate.
Furthermore,, an UpToDate reviews on Oral appliances in the treatment of obstructive sleep apnea in adults does not mention the use of compliance monitors.
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Cms National Coverage Policy
Title XVIII of the Social Security Act, §1862 allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Title XVIII of the Social Security Act, §1862 Items and services related to research and experimentation.
Title XVIII of the Social Security Act, §1862 states Medicare will not cover any services or procedures associated with routine physical checkups.
CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §60.1 Incident To Physicians Professional Services, §110 Durable Medical Equipment General
CMS Internet-Only Manual, Pub 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §160.7 Electrical Nerve Stimulators Chapter 1, Part 4, §240.4 Continuous Positive Airway Pressure Therapy For Obstructive Sleep Apnea Chapter 1, Part 4, §240.4.1 Sleep Testing for Obstructive Sleep Apnea
How Is Sleep Apnea Diagnosed
Your doctor will probably examine you and ask about your past health. He or she may also ask you or your sleep partner about your snoring and sleep behavior and how tired you feel during the day.
Your doctor may suggest a sleep study. A sleep study may take place in your home or at a sleep center, where you will spend the night. Sleep studies find out how often you stop breathing or have too little air flowing into your lungs during sleep. They also find out how much oxygen you have in your blood during sleep. You may have blood tests and X-rays.
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Medicare Guidelines For Cpap
How Was The Study Of Upper Airway Stimulation Costs Done
This study was designed to provide a general estimate of the costs and effectiveness of Upper Airway Stimulation. We used established cost-effectiveness analysis methods. Direct healthcare costs were almost $43,000 these were the Medicare payment amounts for healthcare costs like the surgical implantation procedure and additional sleep studies and office visits, minus the cost savings for reducing potential sleep apnea complications . To be conservative, we did not include financial benefits that may be seen with sleep apnea treatment, such as improved worker productivity, that can occur with sleep apnea treatment.
The effectiveness evaluation was based on the STAR Trial publication, in which 66% of patients receiving the device achieved a dramatic improvement or resolution of their sleep apnea. The trial data were used to estimate the reduction in adverse outcomes , based on published studies of other sleep apnea treatments. These outcomes were combined to show that Upper Airway Stimulation provides 1.09 QALYs over a persons lifetime.
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Does Medicare Cover Dental Appliances To Treat Sleep Apnea
Sleep apnea is a serious disorder that affects your bodys ability to breath while you are sleeping. It results in your breathing stopping and restarting randomly, which can be dangerous for your overall health. The most common form of sleep apnea is obstructive sleep apnea, and Medicare does offer coverage for some dental appliances that can be used by Medicare recipients to address this issue.
What is Sleep Apnea?Sleep apnea is described as a sleep disorder that results in the cessation of breathing, and the various types include obstructive sleep apnea, central sleep apnea, and complex sleep apnea syndrome. Obstructive sleep apnea is by far the most common sleep apnea diagnosis, and it is the main problem that Medicare coverage offers services for.
Obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles are responsible for providing support for the tonsils, throat, and tongue, and when they relax, the opening in your mouth and throat can become much smaller. This limits airflow and can make it difficult for your body to get enough oxygen as you sleep.
If the body senses that its oxygen levels are dropping too low, it briefly wakes the individual up to improve breathing and increase airflow by contracting the throat muscles and opening the airway. However, this period of awakening is usually very short and often unnoticeable.
Humana Now Provides Coverage For Inspire Upper Airway Stimulation
Health plan provider Humana Inc will provide coverage for Inspire Medical Systems Incs Inspire upper airway stimulation therapy for obstructive sleep apnea, effective August 27.
We are thrilled to receive this positive coverage decision from Humana. Commercial health plans continue to update their coverage policies to include Inspire therapy, providing an increasing number of patients and physicians with access to our safe and effective therapy, says Tim Herbert, president and CEO of Inspire, in a release. With the addition of Humana, we now have 59 coverage policies, representing over 207 million lives, that cover Inspire therapy.
The Humana coverage decision includes the expanded age range approved by the US Food and Drug Administration in April 2020 to include patients 18 years and older
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Measurements Of Central Corneal Thickness Intra
In a prospective study, Teberik and associates evaluated the intra-ocular pressure , central corneal thickness , and peri-papillary RNFL thickness in patients with OSAS. A total of 103 patients with OSAS and 37 healthy subjects were enrolled. All participants underwent comprehensive ophthalmic examinations. Main outcome measures were IOP by Goldmann applanation tonometry, CCT measurement using ultrasound pachymetry and peri-papillary RNFL thickness measured by spectral-domain optical coherence tomography . The differences between the mean values of RNFL thickness in all quadrants were similar in both groups and were not statistically significant . The IOP and CCT measurement averages of all patients with OSAS were lower than the control group. However, these differences were not statistically significant. There was no correlation between the AHI, lowest oxygen saturation or BMI and the peri-papillary RNFL thickness, IOP or CCT when OSAS group was divided by severity. The authors concluded that the findings of this study suggested that peri-papillary RNFL thickness, IOP or CCT did not differ significantly between OSAS and control groups. These researchers also found no correlation between AHI, LAST and BMI and RNFL, CCT and IOP.
Bcbs Wants You To Try Lifestyle Modification
Alongside treatment with oral appliances or CPAP, BCBSNE may recommend that you attempt to reduce your sleep apnea or cure it with lifestyle modification.
Some of the recommended modifications include weight loss, allowing yourself enough time for sleep, side sleeping, quitting smoking with a supervised program, and avoidance of alcohol, caffeine, and sedatives before bedtime. These are not considered standalone treatments, but they are recommended as supplemental treatments that may be recommended when appropriate.
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With No Competition Minnesota Maker Of Sleep Apnea Device Doubled Sales Last Year
Inspire Medical Systems Inc. makes an implantable device to treat sleep apnea, but the company’s financials are far from sleepy.
The Golden Valley-based company announced Tuesday after market close that its 2021 revenue would be between $233 million and $233.4 million, a robust increase of about 102% over the previous year.
In 2016, the company tallied just $16.4 million in revenue. The preliminary numbers for 2021 represent a 1,300% increase in its sales over the last five years. It ranks among the fastest-growing public companies in Minnesota.
The company said its rapid growth is fueled by high consumer demand and low or no competition from other device makers.
Inspire developed the first-ever implantable neurostimulation device to treat obstructive sleep apnea. No one else has created a similar product and brought it to market. In its niche, Inspire Medical has zero competition.
“We are the only ones doing this,” said Tim Herbert, Inspire’s chief executive. Other companies have competing products in development, but they are still several years away from approval by the U.S. Food and Drug Administration , he said.
Until now, sleeping masks have been the standard treatment for sleep apnea. These mask devices provide continuous positive airway pressure , but many patients find them uncomfortable.
The company recently received FDA approval for a Bluetooth-enabled patient remote control that pairs with the implanted device.
Questions To Ask Your Sleep Surgeon
It is important to have a comprehensive understanding of the role of this treatment in your condition. The first choice for the treatment of obstructive sleep apnea is the use of continuous positive airway pressure . Success with this treatment requires proper mask fitting and optimal device settings.
Once you have exhausted treatment options with your board-certified sleep physician, it may be necessary to consider the role of the Inspire hypoglossal nerve stimulator. Consider some of these questions to ask the surgeon:
- Am I a good candidate for the surgery?
- If you couldnât do this surgery, what would they recommend as treatment instead?
- How often have they done this procedure?
- What is their success rate in resolving sleep apnea ?
- How many patients have complications such as bleeding, infection, or device removal?
- How will I know if the therapy works well for me?
- Do they have support to work through the insurance approval process?
- Will I have testing after the device is placed to determine settings and response to therapy?
- Who will I follow up with once the surgery is complete?
There may be additional considerations based on your specific circumstances.
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How Much Will I Have To Pay Out Of Pocket For This Procedure
Every insurance plan is different. Generally, the co-pay costs for Inspire therapy should be similar to co-pays for other out-patient surgical procedures. Some patients may have secondary benefits or supplemental coverage that will offset their co-pay. Your Inspire therapy team will help you through this process.
Patients receiving Inspire experience significant reductions in sleep apnea events and significant improvements in quality of life and daytime functioning. Contact the team of experts at Comprehensive Sleep Care Center to find out if Inspire Sleep Apnea Therapy is right for you.
How Does Inspire Work
The Inspire device delivers what’s called “hypoglossal nerve stimulation therapy” while you sleep. Previously it was connected to two places in your body — the hypoglossal nerve and your ribs. As of March 2021, the need for the second lead to the ribs is no longer necessary. That eliminates an incision and, according to Inspire, reduces the procedure time by 20%. Now it’s connected only to your hypoglossal nerve, which stimulates the tongue and airway muscles that open your airway. The battery of Inspire is placed beneath your collar bone.
Each time you breathe, the Inspire device sends an impulse to the hypoglossal nerve. This combats sleep apnea by keeping your airways open. According to Inspire, the stimulation is subtle and is designed to not wake you up, meaning it shouldn’t be painful or uncomfortable.
The Inspire isn’t constantly sending impulses to your nerves. Instead, you can remote control it. It’s recommended that you turn it on at night and turn it off when you wake up for your day.
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