$4900 Sleep Study Claim Denied. Need Help!
I was dx’d with sleep apnea 7 years ago; my medical situation then changed. Last year, my cardiologist’s NP tried to get an authorization for a sleep study (SS) from my insurance. Let’s call this SS-1. Health insurance would not authorize SS-1, but they authorized SS-2.
During the study, the technician decided she could not do SS-2 per my medical readings she was evaluating. She performed the study as SS-1 and coded it SS-1.
The insurance company denied (again) SS-1 in part saying that I had already been dx’d with sleep apnea. ((Plot twist, this sleep study determined I did not have sleep apnea.)
Sleep study place says they ”had the right” to change the study from SS-2 (authorized), in the middle of it, to another kind of study, SS-1 (not authorized).
What should I do? I think this is BS and I think the insurance company’s claim denial for SS-1 is BS. They will probably say amount is between you and sleep study place.
Right now, I have appealed the insurance co.’s decision that I did not need SS-1 “because I had a dx years ago” and they claimed I said years back I was having problems with mask. (So what?)
Please help me come up with a plan to advocate for myself. I’m being crushed.
I have 30 days to file and self-pay for a state dept of insurance-sponsored arbitration hearing mediated by a lawyer between me and health insurance company. (Should I even do this?) The arbitration form asks if I’m representing myself or a lawyer. I don’t think a $500/hr lawyer will be affordable for me, so it’s me versus Goliath.
submitted by /u/rays0brite
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