Many times we get patient’s calling in asking how they should proceed with getting a setup on a new machine. This will be their first machine, they’ve endured a sleep test, and now they have no idea how to proceed. Here at Monitor Medical it’s a fairly simple process. Here is a break down of how the process should go an ideal world:
Step One: Feeling sleepy? Your significant other complaining about your snoring? Falling asleep at your desk or behind the wheel? Consult your doctor!
Step Two: Your doctor will then send you to have a sleep study where you will discover that you stop breathing during the night, hence diagnosing you with sleep apnea.
Step Three: Your doctor sends your results and prescription to us so that we can get your setup with the machine.
Step Four: We verify your insurance and discuss your benefits with you. You come in, get educated on the machine, and then take it home.
Step Five: No more sleep apnea!
Unfortunately, we live in the real world and things aren’t always sunshine and rainbows; meaning, we experience a few (or a lot of) hiccups along the way. Now, the first few steps are the same; it’s step three and onward that can start to get tricky.
Depending on what insurance you have, there are certain things that are required. Most commercial insurances (basically, everything except Medicare) require a valid RX and sleep study in order to get setup. An office visit note discussing your sleep apnea is also required, typically something recent – around the same time your prescription was written. If we do not receive that information we have to go back and forth with the doctor’s office requesting the necessary paperwork.
If you’re a Medicare patient, the required paperwork is much more extensive. Putting it nicely, Medicare is ridiculously particular when it comes to verbiage on the required paperwork. If it does not specifically say ‘patient is benefiting from and should continue using machine’ they will deny the insurance claim and you will be stuck with an 800 (sometimes more!) dollar bill. I know I would hate for that to happen to me, so I would also hate for that to happen to you!
When someone from the company tells you that we are working on obtaining the paperwork required by your insurance, we really are doing our best to obtaining that as quickly as possible! I am not putting the blame on anyone, but it is all about communication – between us and your doctor’s office and between us and you, our patients.
As you can tell, getting setup up is not always a walk in the park, but we do our best to work as quickly as possible to get you setup with your new machine. Of course we know that you are needing this therapy to get a good nights sleep and live your best life, and we want nothing more than to help you do that.