Suggestions to help quell my frustration!?!

I’m a state employee, and completed my insurance requirements back in late July. The last thing I needed for my surgeon was pulmonary clearance. I went to a pulmonologist, and passed all of the breathing tests and the lung X-ray came out clear (which was a relief for a new nonsmoker).  Then the pulmonologist suggested that I have a sleep study before I would be cleared for surgery. I went in for a sleep study and then met with the pulmonologist again for a follow-up (and to then get what I thought was clearance). She said that I had sleep apnea and needed another sleep study with a CPAP machine. During this visit I was scheduled for a follow up appointment for 10/13 to discuss the machine and presumably get cleared. I went back for the 2^nd sleep study and waited for the office to call me about the CPAP machine. After not hearing from them for almost 4 weeks, I call…THEY HAD NO RECORD OF AN ORDER OR ANYTHING! I had sit on the phone and wait for them to sort it all out. They finally gave me an appt. to pick up the machine and orientation on Oct. 1^st.  Yesterday (9/19) they left a msg. that they had to reschedule my follow up appt. for two weeks later than 10/13 because they want me to sleep with the machine for a month!

 

My frustration is this…two of my friends/coworkers also went to this practice and got cleared for surgery…one who also has sleep apnea (and no CPAP machine) and one who had a asthma issue while taking the tests! I happen to get the doctor who actually runs the sleep clinic (I know because the $2,000 worth of sleep tests have been billed to my insurance directly to her!)  I have had a variety of issues with this practice, one of which is that they may hold a check for 3 weeks (but bill my insurance before I actually show up for the appt.). I have never had ANY health issues (no high blood pressure, no diabetes, not even a sprained ankle). I'm never sick...and even explained to her at the 1st appt. that I don't have any issues with sleep or feeling tired. I have had an EKG, and a variety of other tests and passed w/ flying colors! I feel like this process could go on forever (and I can’t afford that b/c my insurance will start over on 1/1/10 and I’ll have to start over on my deductible).  I have now had 2 sleep studies, 2 office visits… and now have another 2 office visits scheduled (one for the machine and one for the follow up) and they billed me and my insurance close to $2,600 in studies and office visits. I have been dealing w/ this presumbly simple clearance since 7/22. Should I find another pulmonologist for clearance? Should I find another surgeon that doesn’t require pulmonary clearance? (I really like my surgeon!) Thanks for reading my lengthy rant!

 

Breathless with annoyance,

Me

Hmmm??? Sounds like the problem is with the sleep study place and not Dr. Rashid.  Have you discussed the situation with her and asked her to go ahead and submit to insurance?

The pulmonary clearance is not an insurance requirement, it is a Dr. Rashid requirement. So trechnically she can go ahead and send your stuff to insurance to get it approved,  then schedule your surgery when the pulmonary clearance comes in.

A lot of people have their insurance approval and the surgery date scheduled before they even do the pulmonary testing.

I didn't have a pulmonary clearance, so I can't offer any advice on who to switch to, but yes you could go to get a pulmonary clearance from someone else.

I think those sleep study places diagnose everybody with sleep apnea. I think some of them are quacks that are in cahoots with the durable equipment companies.

Now, what if you switch surgeons and they require a pulmonary clearance too? Won't you be n the same boat? Plus you'll have to go through the consult, seminar, etc again.

Keep us posted on what happens.

I am glad to see another shbp person finally getting their surgery. Our numbers sure have grown this year!

Two of my coworkers are also going through this process. One had surgery last Monday and one is in final stages of pre surgery prep (she's been approved already by the insurance company...UHC SHBP).  I'm trying to ride it out with the pulmonologist....They were able to move my appt. to 10/19 a few days after the original. Let's hope that's the last of it...or I'll be find a new pulmonologist for sure.

Did you ask Dr. Rashid if she will go ahead and send in your papers to UHC?

shbp UHC does not require pulmonary clearance for approval

What is the name of the pulmonologist that you went to? If you do have a problem and need another doctor then PM me I have a list of other pulmonologist that you can consider one that I've used and was pretty good about responding and doing what they needed but I didnt have one that gave me the run around as well and I just switched and went to a new one with no problems.