Sleep Study - where did you go?

Hello all!

I'm rounding the corner towards surgery and my last step (before my series 1 testing) is my sleep study. I have a list of potential sleep study centers given to my by my surgeon's office, but I've heard a lot of questionable things about some of them.

I of course want the best possible experience, considering the cir****tances. I live in Severna Park, MD (that's in Anne Arundel County), so I'd prefer to go to a clinic that's near my house. I'm thinking Annapolis might be best, but I want to hear your thoughts before I decide.

Here are my questions for you:

I've heard that the sleep center "near the Bay Bridge" is a good one, but I don't know the name of that center or why it's a good one - anyone know?

Where did you go for your sleep study?

Did you like it? Were you comfortable? How were the staff?

I have Empire BCBS insurance and they have stipulations for covering this type of study. I have to get the center to obtain preauthorization to bill based on diagnosis. Did any of you have this same process to go through? Do you have any suggestions?

I imagine this is EXPENSIVE without insurance coverage so I want to make sure I cover my bases. Thank you so much for your help everyone!

xoxo
Laura

I had two sleep studies - both performed at SleepMed in Forrest Hill (but I think they actually have a bunch around MD).  The staff was accomodating, and the room set up like a hotel room.  I was able to bring my pillow, blanket, etc - whatever I needed - and was given a tv, remote, a ton of magazines, etc.  There were no shower facilities available.

I hated the sleep study because #1) - it was uncomfortable.  Not the staff's fault - it is what it is, but I was pretty miserable with all those wires; #2)  I didn't mind that I was being watched, but I don't sleep on my back at home, and couldn't sleep well on my back there either.

When they told me I had to go back for a 2nd study with CPAP, I actually cried.

A couple of things I can recommend - take whatever you can for your comfort - pillow, blanket, etc.  I can also recommend scheduling your test so that you do not have to work the next day.  A few centers offer Friday night testing.

I have Empire BCBS.  I did not require pre-authorization, only a referral and doctor's order.  I did see the bill for the testing - it was approximately $1,200 for each testing - slightly more for the CPAP.  My BCBS does not pay for my CPAP - I pay a co-pay to rent it, and can not wait to give the danged thing back.

Good luck with your test.

Thank you SO MUCH Bernice. Thank you, thank you. Good info. I checked and they do have a sleep center right at Glen Burnie Medical Center. Perfect.

I'm actually going to PM you with a few other questions, if that's ok. It's really good to know someone with the same insurance as me. It's not the same as Carefirst BCBS, there are all these little nuances...annoying! Thank you so much for the info.

Laura

You're welcome.  Just know, I can't get to my PMs until this evening.  My work computer hates personal messages.  :-D

Mine is the same but I'm working from home today. :)

Well, the questions weren't private, so I can post them here. Thanks so much Bernice!

Couple of questions for you (sleep study related but also, insurance related):

Did you know (or did you have a pretty good idea) that you had sleep apnea before you went for the sleep study? I don't think I have it, but from what I'm seeing in WLS patients, it seems like we ALL have some form of it and just don't attribute feeling like crap, to that. I really don't want to go down this road, only to have to get a mask to wear at night and have to wear it for like 2 months and give it back. I've been sleeping without it and I've been overweight most of my life, I don't see why 2-3 months is going to help any...

Did you HAVE to get a CPAP? Could you have ignored the "suggestion" or was it necessary to follow through in order to get approval faxed to your surgeon?

Did you call Empire BCBS in advance to find out if you needed preauthorization? I did so today and the lady was so confusing but in the end she said "if you want your diagnosis to be covered and any resulting equipment or prescriptions, you have to get preauthorization." What a pain.

Did you have any run ins with Empire in getting approved for surgery?

Did you do a 6 month sueprvised weight loss program as part of the requirement? I'm having to do this now because I was told that Empire won't take Weigh****chers (online).

How long did it take for you to get approved for surgery once your surgeon submitted request to Empire?

Did you have any fees or surprise costs after the surgery that Empire didn't cover? They told me if you get approved and jump through the hoops, it's 100% covered.

Do you have any comorbidities (besides sleep apnea)?

Couple of questions for you (sleep study related but also, insurance related):

Did you know (or did you have a pretty good idea) that you had sleep apnea before you went for the sleep study? I don't think I have it, but from what I'm seeing in WLS patients, it seems like we ALL have some form of it and just don't attribute feeling like crap, to that. I really don't want to go down this road, only to have to get a mask to wear at night and have to wear it for like 2 months and give it back. I've been sleeping without it and I've been overweight most of my life, I don't see why 2-3 months is going to help any...

I did not know I had sleep apnea.  I'm a stomach sleeper, and never sleep on my back.  I don't wake up often at night (except to go to the bathroom - but that was diabetes related) and I always seem rested (except the past couple of days, but that's because I've gone back to work - boo).

Did you HAVE to get a CPAP? Could you have ignored the "suggestion" or was it necessary to follow through in order to get approval faxed to your surgeon?

Yes - I was requried to have the CPAP.  I had to take my mask to the hospital.  Because my diagnosis was reported back to my surgeon and my primary care, I couldn't get out of it.  I had to take my equipment with me to the hospital when I had my surgery - mask only, not the actual cpap machine.

Did you call Empire BCBS in advance to find out if you needed preauthorization? I did so today and the lady was so confusing but in the end she said "if you want your diagnosis to be covered and any resulting equipment or prescriptions, you have to get preauthorization." What a pain.

I did not - my surgeon's office made all related insurance calls for me, but I got referals for all my pre-op tests from my primary care to insure everything would be covered, as well as serving as "orders" for the tests.  If it comes from the primary care with a diagnosis of  "obesity" I had no problems with BCBS.

Did you have any run ins with Empire in getting approved for surgery?

None whatsoever.  I completed my pre-op testing on 10/20, submitted the paperwork to my surgeon the same day, they filed with BCBS on 10/21, and I got an approval on 10/23.  My surgeon's office is incredibly thorough.

Did you do a 6 month sueprvised weight loss program as part of the requirement? I'm having to do this now because I was told that Empire won't take Weigh****chers (online).

Yes - I could do six months of doctor supervised weightloss (don't miss a month and have your doctor put obesity treatment and weight management on all of your office visits).  I could also do two three month stints with Jenny Craig or Weigh****chers, but I had to go to meetings and couldn't do it online.  Since I saw my doctor monthly anyway, I went with him.  My surgeon's NUT gave me a plan to follow and my primary care approved it.  BCBS also required a letter of medical necessity from my primary care and a psych evaluation.  The psych evaluation is not covered.

How long did it take for you to get approved for surgery once your surgeon submitted request to Empire?

Once all my testing was done, 48 hours.

Did you have any fees or surprise costs after the surgery that Empire didn't cover? They told me if you get approved and jump through the hoops, it's 100% covered.
 

Make sure your surgeon is in Network.  Mine was not.  My surgery came to $6,000 (this doesn't include the hospital stay), of which BCBS paid $4,000.  I have to pay $2,000 out of pocket.  My surgeon's office also has a $1,000 program fee paid up front (before surgery) to cover all office visits (after the inital 90 days from surgery) for the next three years, including meetings with the NUT, behavioral therapist and exercise specialist, which are not covered by insurance.  I also paid $225 for my psych eval as BCBS does not cover that visit.  Plus my testing copays which were negligible.

Do you have any comorbidities (besides sleep apnea)?
Type II Insulin dependent diabetes (off insulin completely now),  heart disease (heart attack in 2003 at the age of 30), high blood pressure (down from 3 blood pressure meds to one), high cholesterol (off two cholesterol meds - soon to be off the last one), PCOS, and plantar facitis.

WOW! Thanks Bernice. You are the best - that is above and beyond answering all of my questions! Your surgeon's office DOES sound pretty amazing. Is that why you picked them even though they weren't in network?

Yes...unfortunately, I didn't know they weren't in networ****il after surgery...but what can you do?  I wanted the best surgeon for me, and Dr. McKenna is certainly the best in my eyes.  He's kind and caring, has only had 3 complications in over 2,000 surgeries, and his staff is amazing.  Love love love Dr. McKenna and Upper Chesapeake Bariatric Surgery.

I can't believe you didn't find out until after surgery - how could Empire have gone through the entire approval process and failed to mention that?! Do you have any advice on how I can investigate this further (in my case)? My surgeon said they are contracted with BCBS in Maryland and Empire BCBS said that's all they needed know, but perhaps I should make sure. But that surprises me to hear you had to learn that after the fact. Boo! Sorry Bernice. But glad you went with the surgeon you were happiest with!